Two new studies revealed that specialized exercise and wellness programs may significantly increase physical well-being and quality of life as well as reduce health-care costs in patients with breast cancer, according to findings presented by Wonders et al and Brahmbhatt et al at the 24th American Society of Breast Surgeons (ASBrS) Annual Meeting.
Benefits of Individualized Exercise Oncology Programs
In the first study, the researchers examined the impact of a 12-week postsurgical individualized exercise program—aligned with the American College of Sports Medicine Guidelines for Cancer Survivors—in 243 patients randomly assigned to undergo or not undergo the exercise interventions. The researchers found that the patients who participated in the exercise program experienced improvements in all health-related quality-of-life measurements, whereas the control group experienced declines or no changes in these measurements. Additionally, the new study was one of the first to explore the relationship between exercise interventions and use of health-care resources, and it uncovered that patient emergency department, hospital, and office-based visits as well as health-care costs consequently declined with these interventions.
The researchers explained that the exercise interventions consisted of 150 minutes of cardiovascular exercise weekly—primarily walking or recumbent bicycling at a low to moderate intensity. Each week, the patients also engaged in two to three 60-minute sessions of weekly full-body workouts using free weights or exercise stretch bands.
Both groups were assessed pre- and post-intervention using the Functional Assessment of Cancer Therapy–Breast, the Short Form-36 Health Survey, and the Brief Fatigue Inventory.
“These well-recognized measurement tools focus on physical, social, emotional, and functional well-being, rating performance on a scale of 1 to 28. Controlling for demographic factors and comorbidities, differences between the two groups were significant,” highlighted lead study author Karen Wonders, PhD, FACSM, Professor of Exercise Physiology and Program Director of Exercise Science at Wright State University. “There was a linear relationship between exercise and decrease in health-care utilization,” she added.
The researchers also found decreases in emergency department visits of 33.2%, hospital outpatient visits of 21.5%, and office-based visits of 41.8%.
Prehabilitation Programs During Neoadjuvant Chemotherapy
In the second study, researchers randomly assigned 72 patients with cancer to undergo or not undergo a prehabilitation program—a program focused on optimizing health prior to treatment—as they began a stringent course of varied cancer therapies for 12 months. The attrition rate over the course of the study was 13%.
The researchers analyzed the impacts of individualized prehabilitation programs combining exercise with dietary and stress management counseling prior to surgery and during neoadjuvant (presurgical) chemotherapy. Immediately after chemotherapy and 6 months postsurgery, the patients who participated in the program demonstrated higher functional walking capacity, self-reported general quality-of-life and fatigue measurements, and other improvements compared with the control group.
The researchers explained that prehabilitation consisted of an individual counseling session with a nutritionist and psychiatrist. After evaluation by a physiotherapist, the study participants were assigned a customized exercise program centering around several weekly 30-minute cardiovascular exercise sessions complemented by upper body strength training.
The patients were then asked to partake in physical fitness tests and a variety of self-rating health-related questionnaires at baseline, posttreatment with neoadjuvant chemotherapy, and postsurgery. In addition to these quantitative measures, qualitative interview data suggested the program had a substantial positive impact on the treatment experience overall.
Although the main objective of the study was to assess the feasibility of the prehabilitation program, the study also yielded significant data on its benefits. With almost half of the patients agreeing to participate and 87% of them completing the program, the researchers deduced that prehabilitation may be feasible and well received.
Conclusions
“With a growing recognition of the importance of exercise, currently it is written into the standards or guidelines of several major national U.S. breast cancer organizations,” Dr. Wonders underscored. “Our study adds to the body of literature supporting it, not only by demonstrating benefits but also by showing that exercise can help cut health-care costs,” she stressed.
“The impact of our prehabilitation [program] was quite positive with no intervention-related adverse events reported,” emphasized senior study author Frances Wright, MD, MEd, FRCSC, Professor of Surgery and General Surgery as well as Health Policy, Management, and Evaluation at the University of Toronto. “While a more extensive trial is warranted to determine efficacy, our program will be operationalized shortly through a nonprofit that will offer it on a virtual platform nationally throughout Canada for [patients] who wish to participate. We are very excited about the prospects,” he concluded.
The researchers from both studies agreed that exercise and wellness programs for those with breast cancer had significant potential to boost patients’ quality of life.
Disclosure: For full disclosures of the study authors, visit breastsurgeons.org.
