Yale School of Public Health Associate Dean of Research and Susan Dwight Bliss Professor of Epidemiology Melinda Irwin, Ph.D., M.P.H., has been awarded a five-year, $7 million grant from the National Cancer Institute to explore how nutrition and exercise interventions can improve chemotherapy outcomes and reduce toxicity for women with ovarian cancer.
Ovarian cancer is particularly lethal because it is difficult to detect. Most cases are identified at an advanced stage such that 90% of women diagnosed with ovarian cancer receive chemotherapy. Completing treatment in a timely manner increases chances of survival. Toxicities from chemotherapy treatment are common, however, and occur in about two-thirds of patients.
Irwin and her research team at the Yale Cancer Center have already made substantial findings on the benefits of nutrition and exercise when it comes to cancer treatment. In a previous study, she found that regular brisk walking after chemotherapy treatment improved cognitive function, depression scores, quality of life, cancer-related fatigue and biomarkers related to ovarian cancer.
More research is needed, however, to support the use of such interventions as part of the standard of care, she said. “To date, few exercise and nutrition interventions have been delivered during chemotherapy for ovarian cancer,” Irwin said.
Most studies in this area focus on a single intervention. Trials testing the effects of both nutrition and exercise on chemotherapy completion rates for women with ovarian cancer have not been done, Irwin said.
The National Cancer Institute award will allow Irwin to conduct an 18-week randomized trial of medical nutrition therapy and exercise intervention in a racially and ethnically diverse sample of 200 women newly diagnosed with ovarian cancer. While the 5-year survival rate for ovarian cancer has increased from 33% to 48% in non-Hispanic white women, it has decreased from 44% to 41% in Black women. Recent estimates also show poorer ovarian cancer survival for Hispanic women compared to non-Hispanic white women. Irwin explained that these disparities are due to later-stage diagnosis, chemotherapy dose delays and reductions, and higher obesity rates and related comorbidities.
Irwin’s team will assess the effect of the intervention on treatment delays, patient-reported chemotoxicities and relevant biomarkers. The team will follow up with patients three months after the intervention and 12 months after diagnosis to evaluate physical activity, diet, patient-reported chemotoxicities and health care utilization. The team hopes that women with improved nutrition and exercise during their chemotherapy will report fewer chemotoxicities and be able to maintain a healthy lifestyle long-term.
“Positive results would accelerate a paradigm shift,” Irwin said. “Ovarian cancer patients could receive nutrition and exercise programming as part of the standard of care in tandem with chemotherapy treatment to minimize chemotoxicity and optimize treatment dose delivery for a curative outcome.”
Irwin and her team at Yale will collaborate on the study with Associate Professor Tracy Crane, Ph.D., co-leader of the Cancer Control Research Program at the Sylvester Comprehensive Cancer Center at the University of Miami. In addition to her other responsibilities, Irwin serves as associate Cancer Center director for Population Sciences; co-leader of Cancer Prevention and Control at the Yale Cancer Center and deputy director (Public Health) of the Yale Center for Clinical Investigation.
In a separate study currently underway, Irwin and her team are investigating the impact of nutrition and exercise on chemotherapy completion rates among women newly diagnosed with breast cancer.