Barcelona, Spain: Cancer patients and survivors have better physical and mental health and a better quality of life if they participate in a physical activity program called ‘graduated behavioral activity’ in combination with psychological therapies, according to new research presented in the 13the European Congress of Breast Cancer in Barcelona, Spain.
Graduated behavioral activity involves physical therapists helping patients gradually increase the amount of physical activity they do and continue to adhere to the program so that the increased activity is ultimately integrated into their daily lives. Activities are tailored to specific patients and graded over time, with specific goals.
Ms Astrid Lahousse, from the Vrije Universiteit Brussel and Research Foundation, Flanders, Brussels, Belgium, told the conference: “For my PhD in physiotherapy, I am focusing on pain education and behavioral interventions related to pain. persistent pain after breast cancer. My goal is to decrease the pain of patients and increase the quality of life of patients through physical activity. Long-term use of pain medications is not appropriate and non-drug treatments are needed. We already know that exercise can be beneficial, but some patients are not active when their exercise program ends. Until now, there has not been a systematic review of the effects of behavioral graded exercise on different outcomes among cancer patients.”
Lahousse and colleagues conducted a systematic review and meta-analysis of 33 studies involving 4,330 cancer patients and survivors, comparing the efficacy of graded behavioral activity and psychological therapies (such as cognitive behavioral therapy and commitment therapy). of acceptance) with the results of the waiting patients. ready to receive treatment, or receive usual care, or receive psychological therapies only, or graduated behavioral activity only.
They combined the effects from different studies and summarized them into a measure called the “standardized mean difference” or SMD.
They found significant effects for people who received psychological therapy combined with graded behavioral activity compared with those on waiting lists who received none. These included large to medium improvements for anxiety, fatigue, depression, ability to manage daily tasks, psychological distress, physical activity, quality of life, and social impairment. After a period of between one and three months, only the effects on psychological distress remained statistically significant.
When comparing people who received psychological therapies combined with graded behavioral activity to people who received standard of care as usual, 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 were still significant.
No statistically significant effects were observed when psychological therapies combined with graded behavioral activity were compared with graded behavioral activity alone or psychological therapies alone.
Lahousse said: “When comparing graded behavioral activity to usual care, such as pamphlets, education, and standard recommendations, fatigue, anxiety, and depression were reduced, and physical activity was increased due to the behavioral intervention. When comparing graded behavioral activity to no intervention, only long-term psychological problems were reduced.”
She said the research was important to researchers, doctors, and cancer patients and survivors. “It highlights to researchers that new non-pharmacological interventions are needed. Physicians should be aware of other non-drug possibilities for care after cancer treatment, and that long-term drugs should not be prescribed. They should consider transferring care of patients to other appropriate health care providers, such as physical therapists and psychologists. The study also shows patients how they can improve their daily functioning and quality of life during and after cancer treatment.
“For cancer survivors, it is important to improve non-drug treatments after cancer care. Today, oncologists provide the best care during cancer treatment. However, after cancer, patients often feel lost and misinformed about the side effects of treatment. For this reason, more research is needed not only on what should be provided, but also on how, because each patient needs individualized care. Therefore, a general post-cancer program may not be best for everyone. For this reason, behavioral interventions might be more appropriate and should be further investigated.”
The strength of the research is that it is the first to test behavioral interventions among cancer patients and survivors, which is a step toward more personalized treatment with patients who can set their own goals. One limitation is the large variation between the different studies included in the systematic review, which may make it difficult to draw strong conclusions without further investigation.
The President of the European Breast Cancer Council, Professor David Cameron, from the University of Edinburgh Cancer Research Centre, UK, represents the Council at EBCC13 and was not involved in the research. He commented: “How breast cancer patients and survivors live their lives after their cancer treatment ends is an important but often neglected area of research. Survivors can live for years, if not decades, so the support of the health care community is necessary 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 each patient can have access to therapies that could help them enjoy a fulfilling and pain-free life. This remains a challenge in some countries.”
