A Look at Tailored Exercise & Wellness Programs for Breast Cancer

Breast cancer, wellness: Breast cancer, wellnessTailored exercise and wellness programs administered before and after breast cancer treatment can provide physical health benefits, as well as quality of life benefits, and reduce health care costs. Those were the findings from two studies presented at the 2023 American Society of Breast Surgeons Annual Meeting. One study was a randomized, controlled pilot study of a personalized prehabilitation program for women with breast cancer to undergo during neoadjuvant chemotherapy and before surgery (Abstract 1387186). “Prehab, to our knowledge, has not been done in breast cancer or during chemotherapy. We show similar benefits to other patients, but these patients were going straight to the OR, and they were having gastrointestinal surgery,” the study's author Frances C. Wright, MD, Med, Professor of Surgery at the University of Toronto, told Oncology Times. The other study was an open-label, randomized, prospective, comparative clinical trial of patients with early-stage breast cancer (Stage 1-2) who were randomly assigned to either a control group or an exercise training group who received 12 weeks of post-surgical, prescribed, individualized exercise that aligned with the American College of Sports Medicine exercise guidelines for cancer survivors (Abstract 1385675). “With the momentum in the field now, especially in breast cancer and this becoming standard of care, we really wanted to show the health care utilization and costs that were associated with exercise for breast cancer patients,” noted Karen Wonders, PhD, Professor and Program Director at Wright State University and Founder and CEO of Maple Tree Cancer Alliance. Value of Prehabilitation For the prehab study, Wright and team analyzed data from 72 women who participated in the trial. Of the group, 35 underwent the prehab intervention and 37 were part of the control group. Mean age was 54. The patients received an average of 8 cycles of neoadjuvant chemotherapy. The intervention group received an individualized exercise program for the duration of their neoadjuvant chemotherapy, dietetic support, and stress management counseling. They exercised 3-4 times per week for most patients, which was generally walking. They received dietetic and stress counseling at least once, and then on an as-needed basis. To evaluate the program's feasibility effects, the researchers measured recruitment rates, attrition, and intervention-related adverse events. They also conducted exploratory analyses of intervention efficacy on physical fitness (as measured by 6-minute walk test, grip strength, and anthropometric tests) and psychosocial outcomes (as measured by patient-reported quality of life, fatigue, physical activity levels, upper quadrant function, and anxiety and depression). They collected data before the patients started chemotherapy, at the completion of chemotherapy, and 6 months after surgery. The data showed the following: Recruitment rate for participants was 53 percent (137 women were approached; 72 participated). Attrition rate was 13 percent over the study period. There were no intervention-related adverse events. Participants in the prehab group were meeting physical activity guidelines based on self-reported physical activity at both post-chemotherapy time points, whereas control participants were not. Participants in the prehab group had better functional walking capacity at the post-chemo time point (by 49.43 meters) and at the post-surgery time point (by 27.25 meters) compared with the control group. Participants in the prehab group reported better quality of life and less fatigue compared with the participants in the control group at both post-chemotherapy time points. The data showed no difference for the other physical fitness tests (grip strength and anthropometrics) between the groups. The researchers noted in their conclusion that the data show the intervention is feasible and well-received—and also that an adequately powered trial to determine efficacy is warranted. Wright noted that the small size of the trial was the key limitation. But she believes these types of programs will change clinical practice, given the benefits associated with them. “We are working with a charity called Wellspring that is running a virtual prehab program twice a week for patients across Canada,” she noted. Individualized Exercise Programs The second study that looked at the individualized exercise program for early-stage breast cancer patients included 243 participants (120 in the control group and 123 in the exercise intervention group). The patients in the exercise intervention group completed 12 weeks of prescribed, individualized exercise that aligned with the American College of Sports Medicine exercise guidelines for cancer survivors. Patients in the intervention group underwent an initial physical fitness evaluation and were then prescribed an exercise program tailored to their fitness level and personal abilities. Each patient was assigned a trainer who administered the program over the course of the study period. The control group received the current standard of care, which includes a resource guide with various options available to survivors. The researchers measured quality-of-life factors before and after the intervention, as well as health care utilization and costs, such as emergency room visits, hospital outpatient visits, and private office visits. The data showed the following results. All dimensions of health-related quality-of-life items studied were positively impacted by exercise (including physical functioning, pain, general and mental health, emotional health, social functioning, and fatigue). Among those in the exercise intervention group, emergency room visits decreased by 33.2 percent. Among those in the exercise intervention group, hospital outpatient visits decreased by 21.5 percent. Among those in the exercise intervention group, private office-based visits decreased by 41.8 percent. The results show that the intervention improved all dimensions of health-related quality of life measured and decreased health care costs, Wonders told Oncology Times. More specifically, she added, “The greater the quality of life for the individual, the lower their health care utilization was [when it came to unplanned expenditures].” She noted that unplanned hospitalizations, for example, are very expensive for everyone involved. Quality of life includes physical, as well as psychosocial and emotional health components, she said. And all of that seems to help with functioning and outcomes, including side effects and subsequent unplanned hospital visits. Wonders believes that an individualized exercise program or prescription is ideal for patients with cancer because it's tailored to that patient and their needs. But group classes or other exercise programs can be beneficial, too. “Whatever you enjoy, that's what you should do—because that's what you'll stick with,” she concluded. Sarah DiGiulio is a contributing writer.

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