Alberta Moving Beyond Breast Cancer (AMBER)
CIHR Team in Physical Activity and Breast Cancer Survivorship: The Alberta Moving Beyond Breast Cancer (AMBER) Cohort Study
The objective of our research team is to study physical activity (PA) and health-related fitness (HRF) to improve breast cancer survivorship from the time of diagnosis and for the balance of life. We propose to achieve this objective by establishing a large cohort of breast cancer survivors with a comprehensive assessment of subjective and objective measures of physical activity and health-related fitness (e.g., physical fitness, physical functioning, body composition). This cohort will allow us to address important questions related to physical activity and health-related fitness including: (a) examining associations with important outcomes such as disease outcomes, symptoms, late effects, psychosocial outcomes, and quality of life, (b) examining determinants such as medical, social cognitive, and environmental, and (c) examining mechanisms and moderators of observed associations. These data will help inform strategies to promote physical activity and health-related fitness to improve breast cancer survivorship.
Our study will include:
- a comprehensive self-report measure of PA developed by our team that measures the type, frequency, intensity, and duration of PA at work, at home, and for recreation and transportation
- a self-report assessment of sedentary behavior (e.g., television viewing, sitting time) that has emerged as an important independent predictor of disease outcomes in other populations including the risk of developing ovarian cancer
- state-of-the-science objective measures of PA and sedentary behavior (i.e., accelerometers)
- a comprehensive assessment of HRF including standardized and validated measures of cardiorespiratory fitness, musculoskeletal fitness, and body composition
- a full assessment of biomarkers purported to mediate possible associations between PA, HRF, and breast cancer outcomes
- a comprehensive assessment of PROs including quality of life, fatigue, and cognitive function using standardized and validated measures
- a complete assessment of potential determinants of PA and HRF based on a social ecological model that includes social cognitive and environmental correlates.
The cohort study will provide the most comprehensive inquiry into the role of PA and HRF in breast cancer survivorship to date. The data generated will allow us to answer key questions related to PA and HRF in breast cancer survivors including:
- the independent and interactive associations of PA and HRF with important health outcomes in breast cancer survivors including disease outcomes (e.g., recurrence, breast cancer-specific mortality, overall survival), treatment completion rates, symptoms and side effects (e.g., pain, lymphedema, fatigue, cognitive dysfunction), and PROS (e.g., QoL, anxiety, depression, self-esteem, happiness)
- the determinants of PA and HRF including demographic, medical, social cognitive, and environmental variables
- the mediators of any observed associations between PA, HRF, and health outcomes including biological, functional, and psychosocial outcomes
- the moderators of any observed associations including demographic, medical, and biological factors.
The AMBER cohort will serve as the basis for five initial research projects proposed within our CIHR Team Grant. The overall aim is to establish a cohort of breast cancer survivors in whom the role of PA, HRF in breast cancer outcomes can be examined. Specific objectives have been established for the five initial projects that will use this cohort. This large cohort will be built in Alberta over approximately a 4 year period with assessments at multiple time points using subjective and objective measures of PA, HRF, and health.
Overview of Study Design and Methods
A prospective cohort study is proposed that will recruit 1500 survivors of incident, histologically-confirmed, primary breast cancer from Edmonton (i.e., Cross Cancer Institute) and Calgary (i.e., Tom Baker Cancer Centre) who will be followed for a minimum of five years postbaseline assessment. A rapid case ascertainment method using the Alberta Cancer Registry (ACR) will be used to identify cases prior to surgery and to enrol them into this study. Assessments will be made at baseline (within 2 months of surgery and generally prior to the initiation of adjuvant therapy), and at 1 and 3 years follow-up of their PA, HRF, PROs, determinants of PA, and lymphedema through a combination of objective and self-reported measurements. PA, PROs and determinants of PA will be followed up at 5 years. Blood samples will also be taken at baseline, 1 and 3 years follow-up. The cohort members will be followed up by regular vital status linkages and through chart abstractions to identify progressions, recurrences, and new primaries that occur in this cohort. Five projects are initially proposed that will use this cohort to examine separate scientific questions regarding the associations between PA, HRF and breast cancer outcomes.