Abstract:Background
The effect of preoperative physical activity on recovery and complications after primary breast cancer surgery is unknown. The objective of this trial was to evaluate whether a recommendation of non-supervised physical activity improved recovery after breast cancer surgery.
Methods
This parallel, unblinded, multicentre interventional trial randomized women in whom breast cancer surgery was planned. The intervention… Show more
“…Most studies (39 of 57) were RCT [ 19 – 57 ], five were controlled non randomized clinical trials [ 58 – 63 ], four were prospective cohort studies [ 61 , 64 – 66 ], one was a retrospective cohort study [ 67 ], two was a case–control study [ 68 , 69 ], four were quasi-experimental [ 70 – 73 ], one was a pilot study [ 74 ] and one was a feasibility study [ 75 ]. The studies originated from 22 countries distributed across 4 continents (i.e., Americas, Europe, Asia and Oceania), most of which were high income countries [ 19 – 26 , 29 , 31 , 33 – 36 , 39 – 41 , 44 – 47 , 50 , 52 – 54 , 56 , 57 , 59 , 61 – 69 , 71 , 73 – 75 ] or upper-middle income countries [ 27 , 28 , 30 , 32 , 37 , 38 , 42 , 43 , 48 , 49 , 58 , 60 , 72 ], with only three studies conducted in lower-middle income countries [ 51 , 55 , 70 ]. The body of literature on this topic turned out to be quite recent, with 71.9% (41 of 57) of studies published between 2010 and 2022 and 22.8% (13 out of 57) between 2000 and 2009.…”
Section: Resultsmentioning
confidence: 99%
“…Exercises targeting upper limb tissues and function were predominant. Fewer studies adopted a more global approach, providing aerobic exercises [ 21 , 23 , 52 , 66 , 71 ] or yoga [ 41 , 55 ], as well as strengthening or stretching of the lower extremity [ 19 – 21 ] or neck muscles [ 28 , 44 , 57 , 58 , 60 – 63 , 66 , 72 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Out of all included studies, 10 interventions [36,48,49,51,52,61,64,69,73,75] were initiated before surgery, including eight that were pursued from 4 weeks to 12 months post-surgery. Only patient education and active shoulder ROM or aerobic exercises were implemented in the preoperative period.…”
Background
Mastectomy is the first-line treatment approach for more than 90% of breast cancer patients. The numerous physical impairments associated with this surgical procedure negatively impact the patient’s quality of life. To date, rehabilitation resources available for breast cancer patients undergoing mastectomy within the institutions affiliated to the Centre intégré universitaire de soins de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS-MCQ) are lacking and do not always seem to reflect the particularities of breast cancer care pathways. The purpose of this review was to identify and describe the conservative interventions and the clinical outcome measures used in the perioperative physical rehabilitation of women with breast cancer who are awaiting or have undergone mastectomy. We also aimed to report on the barriers and facilitators to study participation and completion.
Methods
MEDLINE, CINAHL, and the Cochrane Library were searched from inception to January 2021, and we updated the search on July 11, 2022. We included peer-reviewed English and French literature with quantitative designs, describing conservative interventions and clinical outcome measures used within rehabilitation programs designed for women who were awaiting or had undergone mastectomy. Paired reviewers independently reviewed all citations and articles using a two-phase screening process and independently extracted the data.
Results
Of the 6080 articles identified, 57 met the inclusion criteria. Most interventions were multimodal, which combined exercise with patient education, manual therapy, and/or lymphatic drainage. The most frequently used objective measures of physical function were shoulder range of motion, muscle strength, and signs of lymphedema. In contrast, the primary patient-reported outcome measures were quality of life, shoulder function, and pain. Undergoing another breast surgery, death, and cancer recurrence were the most reported barriers to study completion.
Conclusion
This scoping review reports on the heterogeneity and wide range of conservative interventions and clinical outcome measures used in the physical rehabilitation of breast cancer patients who had undergone or were scheduled to undergo mastectomy. Tailoring interventions to breast cancer patients’ needs and promoting outpatient rehabilitation interventions appear to be better suited to the particularities of breast cancer care pathways. Further research is needed to better identify barriers and facilitators to study participation and completion.
“…Most studies (39 of 57) were RCT [ 19 – 57 ], five were controlled non randomized clinical trials [ 58 – 63 ], four were prospective cohort studies [ 61 , 64 – 66 ], one was a retrospective cohort study [ 67 ], two was a case–control study [ 68 , 69 ], four were quasi-experimental [ 70 – 73 ], one was a pilot study [ 74 ] and one was a feasibility study [ 75 ]. The studies originated from 22 countries distributed across 4 continents (i.e., Americas, Europe, Asia and Oceania), most of which were high income countries [ 19 – 26 , 29 , 31 , 33 – 36 , 39 – 41 , 44 – 47 , 50 , 52 – 54 , 56 , 57 , 59 , 61 – 69 , 71 , 73 – 75 ] or upper-middle income countries [ 27 , 28 , 30 , 32 , 37 , 38 , 42 , 43 , 48 , 49 , 58 , 60 , 72 ], with only three studies conducted in lower-middle income countries [ 51 , 55 , 70 ]. The body of literature on this topic turned out to be quite recent, with 71.9% (41 of 57) of studies published between 2010 and 2022 and 22.8% (13 out of 57) between 2000 and 2009.…”
Section: Resultsmentioning
confidence: 99%
“…Exercises targeting upper limb tissues and function were predominant. Fewer studies adopted a more global approach, providing aerobic exercises [ 21 , 23 , 52 , 66 , 71 ] or yoga [ 41 , 55 ], as well as strengthening or stretching of the lower extremity [ 19 – 21 ] or neck muscles [ 28 , 44 , 57 , 58 , 60 – 63 , 66 , 72 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Out of all included studies, 10 interventions [36,48,49,51,52,61,64,69,73,75] were initiated before surgery, including eight that were pursued from 4 weeks to 12 months post-surgery. Only patient education and active shoulder ROM or aerobic exercises were implemented in the preoperative period.…”
Background
Mastectomy is the first-line treatment approach for more than 90% of breast cancer patients. The numerous physical impairments associated with this surgical procedure negatively impact the patient’s quality of life. To date, rehabilitation resources available for breast cancer patients undergoing mastectomy within the institutions affiliated to the Centre intégré universitaire de soins de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS-MCQ) are lacking and do not always seem to reflect the particularities of breast cancer care pathways. The purpose of this review was to identify and describe the conservative interventions and the clinical outcome measures used in the perioperative physical rehabilitation of women with breast cancer who are awaiting or have undergone mastectomy. We also aimed to report on the barriers and facilitators to study participation and completion.
Methods
MEDLINE, CINAHL, and the Cochrane Library were searched from inception to January 2021, and we updated the search on July 11, 2022. We included peer-reviewed English and French literature with quantitative designs, describing conservative interventions and clinical outcome measures used within rehabilitation programs designed for women who were awaiting or had undergone mastectomy. Paired reviewers independently reviewed all citations and articles using a two-phase screening process and independently extracted the data.
Results
Of the 6080 articles identified, 57 met the inclusion criteria. Most interventions were multimodal, which combined exercise with patient education, manual therapy, and/or lymphatic drainage. The most frequently used objective measures of physical function were shoulder range of motion, muscle strength, and signs of lymphedema. In contrast, the primary patient-reported outcome measures were quality of life, shoulder function, and pain. Undergoing another breast surgery, death, and cancer recurrence were the most reported barriers to study completion.
Conclusion
This scoping review reports on the heterogeneity and wide range of conservative interventions and clinical outcome measures used in the physical rehabilitation of breast cancer patients who had undergone or were scheduled to undergo mastectomy. Tailoring interventions to breast cancer patients’ needs and promoting outpatient rehabilitation interventions appear to be better suited to the particularities of breast cancer care pathways. Further research is needed to better identify barriers and facilitators to study participation and completion.
“…We report 4 weeks and 12 months follow-up data from the PhysSURG-B randomised, controlled, prospective interventional trial evaluating an intervention of added aerobic physical activity before and after breast cancer surgery. The study protocol and primary outcome of self-reported physical recovery at 4 weeks after surgery have been published elsewhere [16]. Participants were recruited from three surgical departments in the Western Region of Sweden between Nov 2016 and Dec 2018.…”
Section: Study Design and Settingmentioning
confidence: 99%
“…The intervention in the PhysSURG-B trial has been described previously in detail [16]. In summary, patients in the intervention group received an individual consultation with a physiotherapist and were instructed to add 30 minutes of daily aerobic physical activity, 2 weeks ±1 week before and 4 weeks after breast cancer surgery.…”
PurposeWe conducted a randomised controlled trial (PhysSURG-B) to assess the short- and long-term effects of a non-supervised physical activity intervention at the time of breast cancer surgery. Here we report a secondary outcome, quality of life (QoL).MethodsFemale patients planned for surgery were randomly assigned to either an intervention of 30 minutes of self-administered physical aerobic activity daily 2 weeks before and 4 weeks after surgery, or control. QoL was assessed with questionnaires at baseline, 4 weeks and 12 months postop using the instruments FACT-B, RAND-36 and EQ-VAS.ResultsOut of 354 included participants at 12 months follow-up after surgery, 287 were available for QoL analysis. Comparing intervention to control, the results for the FACT- B score at 4 weeks showed an odds ratio (OR) of 0.975 (95% CI 0.636-1.495) and at 12 months an OR of 0.883 (95% CI 0.581-1.342). The subgroup of patients receiving adjuvant chemotherapy had significantly lower FACT-B at 12 months compared to no chemotherapy (OR 0.475, 95% CI 0.300-0.735). EQ-VAS showed OR 1.163 (95% CI 0.760-1.779) and 0.817 (95% CI 0.536-1.244) at 4 weeks and 12 months, respectively. RAND-36 domains “role limitations due to physical health” and “pain” showed a decrease at 4 weeks in both groups, returning towards baseline at 12 months follow-up.ConclusionAn intervention of non-supervised physical activity before and after surgery for breast cancer had no effect on QoL. Patients receiving adjuvant chemotherapy had significantly lower QoL, regardless of study group.Trial registrationClinicalTrials.gov registration number: NCT 02560662. Registered 25 September, 2015.
IntroductionUndertaking physical activity, pre‐ and post‐operatively, can benefit recovery time and improve post‐surgical outcomes. One cohort of patients that have reported these benefits are those undergoing surgery for breast cancer. Yet, what remains unclear is the level to which physical activity interventions are implemented into standard surgical care for patients with breast cancer.AimsThis systematic review aimed to examine existing qualitative evidence focusing on pre‐ and post‐operative physical activity interventions to better understand the benefits and shortcomings of physical activity within the surgical journey.MethodsA systematic literature search was undertaken in November 2022, across five databases: MEDLINE, PsycINFO, Embase, CINAHL, and Scopus. Qualitative studies involving people with breast cancer who had undertaken a physical activity intervention, either pre‐ and/or post‐operatively, were included for analysis. The review was registered on PROSPERO: CRD42022372466 and performed according to PRISMA guidelines. The Critical Appraisal Skills Programme qualitative study checklist was used to assess study quality.ResultsFourteen studies were included, comprising the perspectives of 418 people receiving surgery for breast cancer. One study implemented preoperative physical activity interventions; the remaining studies focused on post‐operative interventions. A narrative systematic review was undertaken due to heterogeneity in reported results. Four themes were developed by thematic analysis, centring on: (1) factors promoting engagement with physical activity interventions; (2) factors preventing engagement with physical activity interventions; (3) the impact of pre‐ and post‐operative interventions on physical and psychological health; and (4) participant recommendations for pre‐ and post‐operative interventions.ConclusionPre‐ and post‐operative physical activity interventions were well‐accepted. Patients recognised factors which promoted or prevented engagement with interventions, as well as pre‐ and post‐operative physical and psychological benefits that arose as a result. Evidence based co‐design studies may further inform successful implementation of prescribed physical activity into standard care for surgical breast cancer patients.
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