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Physical Activity and Survival in Women With Advanced Breast Cancer

Palesh, Oxana, PhD, MPH*; Kamen, Charles, PhD, MPH*; Sharp, Susan, PsyD; Golden, Ashleigh, PsyD; Neri, Eric, PhD; Spiegel, David, MD**; Koopman, Cheryl, PhD**

doi: 10.1097/NCC.0000000000000525

Background: Several empirical investigations have attempted to characterize the effect of physical activity on cancer mortality, but these investigations have rarely focused on patients with advanced breast cancer.

Objective: The current study examined the hypothesis that greater physical activity is associated with longer survival among women with advanced breast cancer.

Methods: We conducted a secondary data analysis of a prospective study of 103 patients with stage IV (n = 100) or locally recurrent (n = 3) breast cancer involved in a group psychotherapy trial. Physical activity was assessed at baseline using the Seven-Day Physical Activity Recall questionnaire, and patients were followed until April 1, 2016, at which time 93 of 103 had died.

Results: Greater physical activity level at baseline was significantly associated with longer subsequent survival time in a Cox proportional hazards model (hazard ratio [HR], 0.90; 95% confidence interval [CI], 0.84–0.97; P < .01). Engaging in 1 additional hour per day of moderate activity reduced the hazard of subsequent mortality by 23% (HR, 0.77; 95% CI, 0.65–0.92; P < .01). These results remained significant even after controlling for demographic, medical, cancer, depression, and cortisol variables (HR, 0.91; 95% CI, 0.84–0.99; P < .05).

Conclusions: Women with advanced breast cancer who engaged in physical activity for 1 or more hours per day at baseline had an increased likelihood of survival compared with those who exercised less than 1 hour per day.

Implications for Practice: Nurses should consider recommending moderate physical activity for women with advanced breast cancer. Randomized trials of physical activity interventions for this population are needed.

Author Affiliations: Department of Psychiatry and Behavioral Sciences, Stanford University, California (Drs Palesh, Neri, Spiegel, and Koopman); Wilmot Cancer Center, University of Rochester, New York (Dr Kamen); and PGSP-Stanford Psy.D. Consortium, Palo Alto University, California (Drs Sharp and Golden).

*Joint first authors. **Joint senior authors.

This study was supported by National Institute of Mental Health grant 5R01MH047226, with additional funding from National Cancer Institute (NCI) grants K07 CA190529, UG1 CA189961, and R01CA118567 and National Institute on Aging/NCI grant P01AG018784.

The authors have no conflicts of interest to disclose.

Correspondence: Charles Kamen, PhD, MPH, Wilmot Cancer Center, University of Rochester Medical Center, 265 Crittenden Blvd, Box 420658, Rochester, NY 14642 (

Accepted for publication May 13, 2017.

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