Early Detection of Brain Metastases in a Supervised Exercise Program for Patients with Advanced Breast Cancer: A Case Report

Medicine & Science in Sports & Exercise, vol. 55, pp. 1745–1749

Abstract

INTRODUCTION: Around 25% of metastatic breast cancer (mBC) patients develop brain metastases, which vastly affects their overall survival and quality of life. According to the current clinical guidelines, regular magnetic resonance imaging screening is not recommended unless patients have recognized central nervous system-related symptoms. PATIENT PRESENTATION: The patient participated in the EFFECT study, a randomized controlled trial aimed to assess the effects of a 9-month structured, individualized and supervised exercise intervention on quality of life, fatigue and other cancer and treatment-related side effects in patients with mBC. She attended the training sessions regularly and was supervised by the same trainer throughout the exercise program. In month 7 of participation, her exercise trainer detected subtle symptoms (e.g., changes in movement pattern, eye movement or balance), which had not been noticed or reported by the patient herself or her family, and which were unlikely to have been detected by the oncologist or other health care providers at that point since symptoms were exercise related. When suspicion of brain metastases was brought to the attention of the oncologist by the exercise trainer, the response was immediate, and led to early detection and treatment of brain metastases. CONCLUSION AND CLINICAL IMPLICATIONS: The brain metastases of this patient were detected earlier due to the recognition of subtle symptoms detected by her exercise trainer and the trust and rapid action by the clinician. The implementation of physical exercise programs for cancer patients requires well-trained professionals who know how to recognize possible alterations in patients and also, good communication between trainers and the medical team to enable the necessary actions to be taken.

Authors 11

1. Mireia Peláez

   Onkologikoa

   Affiliation as printed

   R&D Department, Fundación Onkologikoa, Donostia-San Sebastian, SPAIN

2. Martijn Matthias Stuiver

   The Netherlands Cancer Institute · Amsterdam University of Applied Sciences

   Affiliation as printed

   Center for Quality of Life and Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, THE NETHERLANDS

   Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, THE NETHERLANDS

3. Marike L. D. Broekman Aachen Department of Neurosurgery, Haaglanden Medical Center Department of Neurosurgery, Leiden University Medical Center

   Leiden University Medical Center · Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum

   Affiliation as printed

   Department of Neurosurgery, Haaglanden Medical Center, The Hague, the Netherlands and Department of Neurosurgery, Leiden University Medical Center, Leiden, THE NETHERLANDS

4. Kathryn H. Schmitz

   University of Pittsburgh

   Affiliation as printed

   Department of Medicine, University of Pittsburgh, Pittsburgh, PA

5. Eva Maria Zopf

   Cabrini Hospital · Australian Catholic University

   Affiliation as printed

   Cabrini Cancer Institute, Department of Medical Oncology, Cabrini Health, Malvern, Victoria, AUSTRALIA

   Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, AUSTRALIA

6. Dorothea Clauss

   German Sport University Cologne

   Affiliation as printed

   Department of Molecular and Cellular Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, GERMANY

7. Yvonne Wengström

   Karolinska University Hospital

   Affiliation as printed

   Theme Cancer, Karolinska University Hospital, Stockholm, SWEDEN

8. Friederike Rosenberger

   Heidelberg University · University Hospital Heidelberg · National Center for Tumor Diseases

   Affiliation as printed

   Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, GERMANY

9. Karen Steindorf

   German Cancer Research Center · National Center for Tumor Diseases

   Affiliation as printed

   Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, GERMANY

10. Ander Urruticoechea

    Onkologikoa

    Affiliation as printed

    R&D Department, Fundación Onkologikoa, Donostia-San Sebastian, SPAIN

11. Anne Maria May corresponding

    Utrecht University · The Netherlands Cancer Institute · University Medical Center Utrecht

    Affiliation as printed

    Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, THE NETHERLANDS

    Anne M. May, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands

    Center for Quality of Life and Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, THE NETHERLANDS