Quality of Life Interventions in Breast Cancer Survivors: State of the Art in Targeted Rehabilitation Strategies

Abstract

: Breast cancer is the most common malignant tumor and the most prevalent cause of mortality in women. Advances in early diagnosis and more effective adjuvant therapies have improved the long-term survival of these patients. Pharmacotherapies and intrinsic tumor-related factors may lead to a wide spectrum of treatment-related disabling complications, such as breast cancer-related lymphedema, axillary web syndrome, persistent pain, bone loss, arthralgia, and fatigue. These conditions have a detrimental impact on the health-related quality of life of survivors. Here, we sought to provide a portrait of the role that rehabilitation plays in breast cancer survivors. Particular emphasis has been placed on recovering function, improving independence in activities of daily living, and reducing disability. This complex scenario requires a precision medicine approach to provide more effective decision-making and adequate treatment compliance.

Physical Therapies for Psychosomatic Symptoms and Quality of Life Induced by Aromatase Inhibitors in Breast Cancer Patients: A Systematic Review and Meta-Analysis

“…Furthermore, several RCTs evaluate different exercises, such as yoga, tai-chi, swimming, walking, and Pilates, which emphasized the benefits of supervised exercise on AIA, that is, pain, stiffness, grip strength, and QOL improvements (35,50). Previous studies had shown that exercise had positive impact and significantly improved a wide range of functional, psychological, and physiological markers in individuals regardless of the type of cancer and stages of treatment (51)(52)(53). Exercise might be associated with small decreases in pro-inflammatory markers (54).…”

Longitudinal Assessment of Physical Activity, Fitness, Body Composition, Immunological Biomarkers, and Psychological Parameters During the First Year After Diagnosis in Women With Non-Metastatic Breast Cancer: The BEGYN Study Protocol

“…Thus, therapeutic approaches must not be limited to surgery, antineoplastic medication, radiotherapy and psychological intervention alone, but should include the motivation for supportive activities such as exercise, which has great effect on the quality of life and prognosis ( 35 , 99 – 101 ). A better knowledge of biomarkers is a prerequisite to assess the effects of complementary therapies and to develop personalized strategies for rehabilitation, e.g., regarding the type and dose of exercise ( 9 ). Therefore, the BEGYN study unites multiple validated assessments, allowing cross-linking analyses between the level of physical activity, cardiopulmonary fitness, body composition, biochemical measurements, an in-depth immune status including quantification of circulating lymphocyte subpopulations, mRNA expression and cytokine profiles and an extensive evaluation of psychological factors.…”

“…Although modern breast cancer treatment such as improved diagnostic and staging procedures, advanced systemic therapy, surgery and radiotherapy increases long-term survival and clinical outcome of breast cancer patients, there is still a deficiency of supportive and psychosocial care ( 8 ). Breast cancer survivors are at risk of suffering potentially disabling physical and psychological sequelae, such as lymphedema, axillary web syndrome, chronic pain, osteoporosis and fractures, arthralgia, chronic fatigue syndrome and depression ( 9 ). During and after antineoplastic therapy, rehabilitation and complementary therapies are crucial to improve the quality of life and overall prognosis of breast cancer survivors ( 10 – 12 ).…”

“…Current data suggest that a complex interplay of the above-mentioned factors contributes to a positive correlation between the quantity of physical activities and event-free survival in cancer patients (69% reduced hazard of mortality among highly active patients) ( 25 ). In consequence, more prospective studies were recommended to characterize the influence of sporting activities on the immune system and on potential individualized rehabilitation approaches in cancer patients ( 9 , 26 , 27 ).…”

“…Studies that combine fitness tests, physical assessments, immunological markers, and psychological tests in breast cancer patients are still scarce, thus it is highly difficult to understand potential cross-links between these aspects. Filling this gap of knowledge could allow conclusions on individualized prevention and rehabilitation of the multiple sequelae that are potentially associated with breast cancer ( 9 ). Clinical studies in cancer patients must consider that according to current guidelines, all breast cancer patients are to be advised to exercise endurance and muscle strength ( 39 ).…”