Adapted Fencing for Patients With Invasive Breast Cancer: The RIPOSTE Pilot Randomized Controlled Trial

Abstract

IntroductionEven if indications for mastectomy have been progressively reduced in loco-regional breast cancer (BC) treatment, the harmful effects of surgery are still numerous and can impact physical and psychological wellbeing of women. The RIPOSTE (Reconstruction, self-Image, Posture, Oncology, “Santé”-Health, Therapy, “Escrime”-Fencing) program aimed to propose adapted fencing to patients with BC. This study aims to investigate the effect and conditions of effectiveness of the RIPOSTE program.Methods and analysisThis is a prospective randomized controlled trial including 24 patients with invasive BC who have just undergone surgery. The study will be proposed to the patient and if interested, the patient will be referred to a sports physician for a medico-sportive evaluation. At the end the evaluation, if the patient meets the inclusion criteria, she will be randomly assigned to one of the 2 groups based on a 1:1 principle: Early RIPOSTE group (receive one fencing session per week for 3 months immediately after their inclusion), Delayed RIPOSTE group (receive one fencing session per week for 3 months but within the 3 months following their inclusion). Patients will be included for 6 months with 3 follow-up times (0, 3, and 6 months) by a sport physician. The primary outcome is the evolution of quality of life score. Secondary outcomes are disability score, fatigue, anxiety-depression, cost-effectiveness and process evaluation.Ethics and disseminationThe study protocol has been approved by a French ethics committee (CPP Sud Méditerranée IV, N°ID-RCB: 2020-A01916-33). Results will be submitted for publication, at scientific conferences and through press releases.Trial RegistrationNCT04627714.

Evaluating the feasibility and acceptability of an adapted fencing intervention in breast cancer surgery post-operative care: the RIPOSTE pilot randomized trial

“…To overcome the obstacle of distance, we could consider having the fencing master travel to extend the program to the whole of the target area, or cover the participants’ transport costs. Regarding the size of the group, it seemed preferable to all that it be small ( 10 – 12 ) and stable, with an even number of participants. Finally, the interviews also highlighted the importance of considering participants’ particularities (e.g., vision or hearing problems) to ensure that the equipment is adapted.…”

“…This framework extends beyond standard measures of efficacy, considering individual and organizational factors that can either facilitate or impede the successful implementation and dissemination of a program ( 29 , 30 ). A full description of the design and methodological protocol of the program have been reported previously ( 10 ). This research complies with the Helsinki declaration and received ethical authorization by the French committee for individual protection (CPP Sud Méditerranée IV, N°ID-RCB: 2020-A01916-33).…”

“…From November 10 th to January 19 th 2021, patients diagnosed with invasive BC were screened from 3 centers in Northeastern France (University Hospital of Nancy CHRU, France), Institut de Cancérologie de Lorraine, Nancy, France and Hôpital d’Instruction des Armées Legouest, Metz, France). Among the 309 patients screened, 24 met the inclusion criteria ( 10 ) and were selected from those who had recently undergone breast surgery for invasive BC. The surgeon, anesthesiologist or oncologist referred them to a sports physician within 2 to 4 weeks after surgery for an inclusion visit.…”

“…Based on these evidence-based benefits, a fencing program under the French acronym RIPOSTE (Reconstruction, Image de soi, Posture, Oncologie, Santé, Thérapie, Escrime) literally in English (Reconstruction, Self-Image, Posture, Oncology, Health, Therapy, Fencing) was created for BC surgery patients in 2014 ( 10 ). This adapted physical activity (APA) program has been considered by public health and medical stakeholders as an innovative intervention through fencing ( 10 , 11 ). APA is defined as “a cross-disciplinary body of practical and theoretical knowledge directed toward impairments, activity limitations, and participation restrictions in physical activity” ( 12 ).…”

“…APA is defined as “a cross-disciplinary body of practical and theoretical knowledge directed toward impairments, activity limitations, and participation restrictions in physical activity” ( 12 ). The relevance of fencing as an APA program in the context of BC was suggested quite naturally, as it is well adapted to combating fatigue, pain and reduced arm mobility, as well as improving patients’ physical and psychological well-being ( 10 , 13 , 14 ). More specifically, the use of the saber (and not the foil or epee) allows maximum mobilization and opening of the shoulder, due to the particularity of this weapon.…”