Abstract 4219: An exergaming intervention to reduce breast cancer risk in Black women

Obesity and low physical activity rates contribute to high rates of postmenopausal breast cancer in Black women. Use of new and exciting strategies to increase physical activity should be tested in health disparity populations at high risk of cancer. We tested the effect of a six-month exercise intervention using the active videogaming systems (exergaming) on anthropometric markers, body composition, and cardiovascular fitness (VO2max) in overweight and obese Black women. We conducted a six-month, two-arm randomized clinical trial comparing an exergaming intervention group to a control group in 100 cancer-free, overweight/obese, sedentary Black women who were 40-59 years of age. Participants were randomized to a supervised facility-based exergaming group (n=50) or a usual care control group (n=50). Participants in the exergaming group followed an exercise program using the Nintendo Wii Fit and/or the X-Box Kinect gaming systems under supervision of a clinical exercise physiologist. Control group participants were asked to maintain their normal daily activities. Endpoints were assessed at baseline, 3 months, and 6 months. Assessments included measurements of demographic variables, medical history, physical activity, VO2max, anthropometric variables (height, weight, waist and hip circumferences), and body composition. Distribution of baseline characteristics between exergaming and control groups was comparable except for education status and BMI. Data on 3 month and 6-month follow-up were available for 66 participants. Follow-up rates were similar for exergaming and control groups. Compared to control group participants whose waist circumference on average remained unchanged, exergaming group participants had lower waist circumference at 3-months and 6- months compared to baseline (mean change: -2.54 cm, P=0.05). Exergaming participants also had small changes in weight (-1.4 lbs) at 6 months compared to control group in whom average weight remained unchanged but this finding was not statistically significant. Fat mass and lean mass as measured by DXA did not show any changes at 3-months or 6-months in either the exergaming or the control group. This pilot study of a short-term exergaming in overweight/obese Black women was associated with small changes in waist circumference in the intervention group. Given the challenges associated with traditional physical activity interventions to reduce cancer risk, new and non-traditional interventions like exergaming should be tested in larger studies in health disparity populations.

Citation Format: Chiranjeev Dash, Jennifer Hicks, Vivian Watkins, Mary Mills, James Hagberg, Lucile L. Adams-Campbell. An exergaming intervention to reduce breast cancer risk in Black women [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4219. doi:10.1158/1538-7445.AM2017-4219

Abstract 3467: Moderate-intensity exercise to reduce radiation therapy-related fatigue in black breast cancer patients: A feasibility trial

Background: Fatigue is an important side-effect of radiation therapy (RT) for treatment of early stage breast cancer. Evidence on the efficacy of physical activity (PA) interventions in reducing fatigue among Black cancer patients undergoing RT is lacking. In a randomized controlled trial we tested the efficacy of a structured PA intervention, coinciding with the start of RT, in reducing cancer-related fatigue among Black patients undergoing RT for breast cancer.

Methods: We randomly assigned 30 Black, sedentary, RT-naïve, non-pregnant patients diagnosed with stage 0-IIIA breast cancer who had completed adjuvant or neo-adjuvant chemotherapy and were scheduled for RT to the PA intervention (n = 15) and control groups (n = 15). PA intervention was an 8-week structured, moderate-intensity aerobic exercise regimen (75 minutes/week) using PEDLARS (portable stationary cycle ergometers) concurrent with RT. Fatigue was measured by using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) survey, a 13-item scale whose score ranges from 0 to 52 with a higher score denoting lower fatigue. We used ANCOVA to compare fatigue levels between the groups at T8 weeks after adjusting for baseline (T0) fatigue levels. We also compared change in fatigue scores (T8 weeks - T0) using 2-sample t-tests. All tests were double-sided with alpha = 0.05.

Results: 27 women completed baseline and follow-up assessments. After adjusting for baseline fatigue scores, intervention group participants reported lower fatigue at T8 weeks than the control group (42.53 vs. 37.12; P = 0.17). Intervention group participants improved their fatigue scores at T8 weeks compared to T0 (mean change +1.3) but the control group did not (mean change -1.91; P = 0.42).

Conclusion: Although statistically not significant, moderate-intensity exercise regimen among Black breast cancer patients undergoing RT was associated with lower RT-associated fatigue. This trial demonstrated the feasibility and acceptability of conducting a randomized clinical trial of a moderate-intensity exercise program among women initiating RT for breast cancer.

Citation Format: Chiranjeev Dash, Mary Mills, Vivian Watkins, Pamela Randolph-Jackson, Claudine Isaacs, Kepher Makambi, Lucile L. Adams-Campbell. Moderate-intensity exercise to reduce radiation therapy-related fatigue in black breast cancer patients: A feasibility trial. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3467.

Abstract C06: Temporal changes in characteristics of women receiving screening mammograms at a community-based breast cancer screening center

The American Cancer Society recommends annual mammography screening for women over 40 years old, however, screening uptake is lower among African American, Hispanic, and Asian Americans than Whites. Socioeconomic factors such as income, lack of insurance, low education level, and immigrant status are also associated with lower mammography screening rates. Among uninsured/under-insured and medically underserved populations, community clinics are important providers for breast cancer screening services. The Capital Breast Care Center (CBCC) of the Georgetown-Lombardi Comprehensive Cancer Center was established in 2004 to deliver breast and cervical cancer screening to all women in the District of Columbia (D.C.) metropolitan region regardless of ability to pay. We examined the characteristics of women presenting to CBCC for screening mammograms from 2010-2012 and investigated temporal changes in selected demographic and socioeconomic characteristics during this period.

Data was abstracted from the electronic medical records at CBCC and analyzed. Patient characteristics were described in frequencies and the statistical significance was determined using chi-square tests. From 2010 to 2012, 4,604 women were screened at CBCC. Patient volume increased each year, with a greater number of returning patients than each previous year. In 2010, 1428 women were seen, 46% of whom were new. In 2011 and 2012, 1581 and 1594 patients were seen, with 43% and 38% as new patients, respectively. About 40% of the women screened at CBCC each year were below the age of 50. The age distribution of the women remained relatively constant over the 3 year study period. African-American and Hispanic women accounted for about 90% of those screened at CBCC over the 3 year period. However, between 2010 and 2012, the racial/ethnic composition of the screenees shifted with a 9% decrease in the number of African-Americans and an increase of 6% among Latinas (P<0.0001). A small increase in the number of Asian-American women was also noted (2%). Corresponding changes in the primary language spoken by the patients were also observed with the proportion of native English speakers decreasing and native Spanish speakers increasing by 6% from 2010 to 2012 (P < 0.01). More than half of the women seen at CBCC were uninsured. The proportion of uninsured women screened at CBCC increased by 13% from 2010 (46%) to 2012 (59%), with corresponding declines in the proportion of screenees with private insurance (-3.52%), Medicaid (-5.49%), and Medicare (-1.98%) (P<0.0001). 73% of the women screened between 2010 and 2012 had completed high school or higher education. Temporal changes in education levels of the participants were not evident in our data.

Reasons for the temporal changes in racial/ethnic composition and native language of the women seen at CBCC could be related to the demographic changes in the Washington D.C. metropolitan area and/or a demographic shift in the age distribution of Latinas thereby resulting in a greater percentage of them being eligible for mammograms. In addition, over the past three years, CBCC outreach efforts have increased in the Latino community with hiring of Spanish-speaking health educators and patient navigators. Results from our study underscore the importance of community-based clinics in increasing cancer screening uptake in un-/under-served communities.

Citation Format: Holly S. Greenwald, Chiranjeev Dash, Bridget Oppong, Tesha Coleman, Vivian Watkins, Lucile L. Adams-Campbell. Temporal changes in characteristics of women receiving screening mammograms at a community-based breast cancer screening center. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr C06.

Enzastaurin safety review: Data from phase I and phase II trials

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Background: Enzastaurin, an oral inhibitor of PKC and PI3K/AKT pathways, blocks tumor angiogenesis, tumor cell proliferation and induces tumor cell death. Enzastaurin has demonstrated promise in phase I and II trials in patients (pts) with various advanced cancers. We report preliminary analysis of safety data of enzastaurin, obtained in previous trials, with particular consideration to long-term therapy. Methods: Data available to date from 3 different non-randomized, single-arm trials in pts with advanced cancers, diffuse large B cell lymphoma and mantle cell lymphoma, were analyzed with regards to treatment emergent adverse events (TEAEs). Severities were defined by NCI guidelines and investigators assessed the relatedness of AEs to enzastaurin. Results: A total of 135 pts (58 F; 77 M), mean age 64 years (range: 24–87) received 20–700 mg oral enzastaurin daily (103 pts at 525 mg). 36 pts were dosed for 0–30 days, 45 for 31–60 days, 35 for 61–180 days and 19 for ≥ 180 days. No deaths were related to enzastaurin. Chromaturia was the most common drug-related event (14%). No drug-related bone marrow suppression, Gr 3 neutropenia, thrombocytopenia or anemia was reported. TEAEs in ≥ 15% pts, or drug-related events ≥ Gr 3 reported in > 1 pt, are listed in the table . Other Gr 3 AEs, including edema, migraine and peripheral motor neuropathy were observed in 1 pt, each. Pts on therapy for ≤ 30 D reported highest number of AEs, consistent with the severity of their disease. Pts with exposure ≥ 180 days did not experience any drug related AE ≥ Gr 3. Conclusions: Enzastaurin is well tolerated across all doses and for extended durations with minimal AEs. In the 19 patients who received oral enzastaurin for ≥ 180 days, there was no indication of increased severity of any event. Given the severity of the disease and the absence of controlled studies for comparison, no event other than chromaturia or fecal discoloration (due to reddish-orange color of the active ingredient) appears to be definitively attributable to enzastaurin by this analysis.

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