Barcelona, Spain: According to a new study presented at the 13e European Breast Cancer Conference in Barcelona, Spain.
Graded behavioral activity involves physiotherapists helping patients to gradually increase the amount of physical activity they do and to continue to adhere to the program so that, eventually, the increased activity is incorporated into their daily lives. . The activities are adapted to specific patients and graduated over time, with precise objectives.
Ms Astrid Lahousse, from the Vrije Universiteit Brussel and the Research Foundation, Flanders, Brussels, Belgium, told the conference: “For my doctorate in physiotherapy, I am focusing on pain education and behavioral interventions related to persistent pain after breast cancer. My goal is to decrease patients’ pain and increase patients’ quality of life by being physically active. Long-term use of analgesics is not appropriate and non-pharmacological treatments are necessary. We already know that exercise can be beneficial, but some patients do not stay active after completing their exercise program. Until now, there has been no systematic review of the effects of graded behavioral exercise on different outcomes in cancer patients.
Ms. Lahousse and her colleagues conducted a systematic review and meta-analysis of 33 studies involving 4,330 cancer patients and survivors, comparing the effectiveness of graded behavioral activity and psychological therapies (such as cognitive therapy Behavioral and Acceptance Commitment Therapy) with outcomes for patients on the waiting list for treatment, or receiving usual care, or receiving only psychological therapies, or graded behavioral activity only.
They combined the effects of different studies and summarized them in a measure called the “standardized mean difference,” or SMD.
They found significant effects for people who had psychological therapy combined with graded behavioral activity compared to those on waitlists who received neither. These included large to moderate improvements in anxiety, fatigue, depression, ability to manage daily tasks, psychological distress, physical activity, quality of life and social disturbances. After a period of between one and three months, only the effects on psychological distress remained statistically significant.
Comparing people who received psychological therapies combined with graded behavioral activity with people who received the usual standard of care, the researchers found significant mean improvements for anxiety, depression, fatigue and physical activity. After one to three months, the mean effects on anxiety, depression and fatigue remained significant.
No statistically significant effects were observed when comparing psychological therapies plus behavioral graded activity with behavioral graded activity only, or psychological therapies only.
Ms Lahousse said: “Comparing graded behavioral activity with usual care such as leaflets, education and standard recommendations, fatigue, anxiety and depression were reduced and physical activity increased in reason for the behavioral intervention. When behavioral activity is compared to no intervention, only psychological problems were reduced in the long term.
She said the research was important to researchers, doctors, and cancer patients and survivors. “This highlights to researchers that new non-pharmacological interventions are needed. Physicians should be aware of other non-drug care options after cancer treatment, and that drugs should not be prescribed long term. They should consider transferring patient care to other appropriate health care providers, such as physical therapists and psychologists. The study also shows patients how they could improve their daily functioning and quality of life during and after cancer treatment.
“For cancer survivors, it is important to improve non-pharmacological treatments after cancer care. Currently, oncologists provide the best care during cancer treatment. However, after cancer patients often feel lost and uninformed about the side effects of treatment. For this reason, more research is needed not only on what should be provided, but also how, as each patient requires personalized care. Thus, a general post-cancer program may not be suitable for everyone. For this reason, behavioral interventions might be more appropriate and should be investigated further.
The strength of the research is that it is the first to analyze behavioral interventions in cancer patients and survivors, which is a step towards more personalized treatment, with patients able to set their own goals. One limitation is the wide variation between the different studies included in the systematic review, which can make it difficult to draw strong conclusions without additional research.
The Chair of the European Breast Cancer Council, Professor David Cameron, of the University of Edinburgh Cancer Research Centre, UK, is representing the Council at EBCC13 and did not attend the research. He commented, “How breast cancer patients and survivors live their lives after their cancer treatment ends is an important but often overlooked area of investigation. Survivors can live for years or even decades. Support from the healthcare community is therefore needed to help them achieve a good quality of life. This study identifies interventions that might help, but more research is needed. Any such intervention must also be fully funded so that every patient can have access to therapies that could help them lead fulfilling, pain-free lives. This remains a challenge in some countries.
Summary no: 23, “The effect of graded behavioral activity on physical activity level, health-related quality of life, and symptom management in cancer patients and survivors: a systematic review and meta-analysis” , by Astrid Lahousse, Wednesday, November 16, Displayed in Spotlight Session, 1:00-1:50 p.m. CET, Exhibit Hall.
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The effect of graded behavioral activity on physical activity level, health-related quality of life, and symptom management in cancer patients and survivors: systematic review and meta-analysis
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