A pilot study of a supervised group exercise programme as a rehabilitation treatment for women with breast cancer receiving adjuvant treatment. Efficacy of comprehensive group rehabilitation for women with early breast cancer in South Korea. Is the wish to participate in a cancer rehabilitation program an indicator of the need? Comparisons of participants and non-participants in a randomized study. Effects of a step-by-step inpatient rehabilitation programme on quality of life in breast cancer patients. A prospective randomised study. Randomized controlled trial of a structured training program in breast cancer patients with tumor-related chronic fatigue. A nursing rehabilitation program for women with breast cancer receiving adjuvant chemotherapy. Psychosocial rehabilitation of gynecologic oncology patients. Impact of a peer-delivered telephone intervention for women experiencing a breast cancer recurrence. A pilot study to assess the influence of tai chi chuan on functional capacity among breast cancer survivors.
This pilot study examined whether exercise as an adjunctive rehabilitation therapy could benefit women who have early stage breast cancer and are currently receiving chemotherapy/radiotherapy. The study was designed as a randomised controlled trial (RCT). Physical functioning, fatigue and Quality of Life (QoL) outcomes were evaluated pre and post a 12-week intervention. The results showed that after 12 weeks the women who participated in the exercise programme (n = 12) displayed significantly higher levels of physical functioning and reported higher QoL scores than the controls (n = 10). Changes in fatigue and satisfaction with life favoured the intervention group but did not reach significance. These results are encouraging and suggest that a structured group exercise programme during adjuvant treatment is a safe, well tolerated and effective way of providing physical and psychological health benefits to women during treatment for early stage breast cancer. Since this was a pilot study the numbers did not allow appropriately powered analyses of some variables of interest and favoured relatively young and socio-economically advantaged women. Future studies need to address these issues and determine if these short-term benefits can be sustained. The purpose of this study was to evaluate the effects of a comprehensive group rehabilitation program on the range of motion of the shoulder joint, psychosocial adjustment, and the quality of life for early breast cancer patients. Fifty-five women with early breast cancer were assigned to an intervention group or a control group. Intervention was provided three times per week for 10 weeks. The results showed an increased range of motion of the shoulder joint, and psychosocial adjustment and quality of life were shown to be significantly higher in the intervention group than in the control group. The rehabilitation program comprised psychology-based education, exercise, and peer support group activity to promote recovery of the affected shoulder joint range of motion, alleviate physical symptoms, and improve psychosocial adjustment and quality of life for early breast cancer patients in South Korea. In parallel with a randomized study of the 'starting again' rehabilitation program for cancer patients, a group of 73 non-participants were monitored (another 20 patients declined monitoring). In comparison with participants (intervention + control), gender, diagnosis, and 10 out of 18 dependent measures differed significantly at baseline. The non-participants group included more men, mostly with cancer of the prostate and irrespective of gender, they showed lower problem levels than participants throughout. Thus, the wish to participate seems to be an indicator of the need for assistance in the rehabilitation process. Social validation of effects was performed by comparing the non-participants with the intervention group. The rationale for this comparison is that non-participants presumably felt so well that they were in no need of rehabilitation. Effects on three variables were socially validated: patients' appraisal of having received sufficient information, physical strength and fighting spirit. No negative effects on outcome variables resulting from being randomized to the control condition (resentful demoralization) were detected when non-participants were compared with controls over one year. Further analysis showed that although a few patients in the control group may have experienced resentful demoralization, this did not significantly affect the outcome variables. The aim of this study was to compare a conventional oncological inpatient rehabilitation programme with an inpatient step-by-step rehabilitation programme with regard to quality of life in breast cancer patients.
                Women with the diagnosis of breast cancer were randomly assigned to either the step-by-step programme (group A: 3-week rehabilitation plus 4 and 8 months later a 1-week sojourn each time) or the conventional rehabilitation programme (group B: 4- week stay and no further interventions afterwards). Quality of life was assessed with the QLQ-C30 of the EORTC at t0 (beginning of the study), t1 (end of 3- or 4-week stay) and t2 (12 months after t0, end of study).
                Between t0 and t1, a tendency (0.1 > p = 0.05) could be shown in group B towards better improvement in global quality of life and emotional function. In the subgroup of patients that had impaired functions of quality of life at t0, superiority in group B reached significance (p < 0.05) for emotional and cognitive function at t1. Between t1 and t2, cognitive function improved further in group A, but diminished in group B. For the subgroup of patients with impaired cognitive function at t0, this difference between both groups became significant (p = 0.0098).
                Although not generally superior to conventional inpatient rehabilitation programmes, the analysed step-by- step rehabilitation provided marked benefits for patients with cognitive impairments. Cancer-related fatigue is the most disabling symptom experienced by breast cancer patients following the cancer treatment. The positive effects of physical activity in the rehabilitation of breast cancer patients are documented in several studies. In a randomized controlled study the effects of a structured physical training program on fatigue and health-related quality of life were evaluated.
                63 breast cancer patients with cancer-related chronic fatigue were randomized at the beginning of the inpatient rehabilitation. The control group received the standard complex rehabilitation program, the intervention group a structured physical training program and additional muscle strength and aerobic exercises. The effects of the treatment were evaluated by questionnaires at the start of rehabilitation (t1), end of rehabilitation (t2), and 3 months after t2 (t3). Isometric muscle strength and aerobic capacity were evaluated at t1 and t2.
                There was an improvement of muscle strength at the end of rehabilitation for both groups. The increase from t1 to t2 was significantly higher for the training group. The scores for global quality of life, physical well-being, and functionality increased from t1 to t2, but further improvement in the follow-up (t3) was only observed in the training group. The cancer-related fatigue was significantly reduced in the training group from t1 to t3, however, not in the control group.
                Structured physical training programs initiated during inpatient rehabilitation and continuously practiced in the time thereafter can improve symptoms of chronic fatigue and quality of life in breast cancer patients. To examine the effects of a comprehensive rehabilitation program on facilitating physical and psychosocial adaptation of women with breast cancer who are receiving adjuvant chemotherapy.
                Experimental.
                Breast evaluation clinics of two New England medical centers with comprehensive cancer treatment programs.
                14 women (mean age = 44 years) receiving adjuvant chemotherapy for breast cancer (86% stage II) following surgical treatment.
                Subjects were assigned randomly to the experimental group or the usual care group. Experimental group members began a structured exercise program of walking and attended support group meetings. All subjects were tested before beginning chemotherapy, during the course of chemotherapy, and one month following chemotherapy completion.
                Performance status, physical functioning, psychosocial adjustment, self-concept and body image, and 12 symptoms (e.g., fatigue, nausea, anxiety).
                Measures of physical performance, psychosocial adjustment, and symptom intensity revealed improved adaptation in subjects who completed the walking/support group program.
                Physical and psychosocial benefits from a modest walking exercise program and a support group are possible for patients receiving adjuvant chemotherapy.
                Although more detailed research is necessary to answer some of the questions raised by this study, implementing the walking program and forming a support group are achievable in an outpatient setting. This investigation studied the effectiveness of in-hospital, individual counseling on the psychosocial adjustment of patients with newly diagnosed gynecologic malignancies. Levels of psychologic distress, sexual functioning, and return to employment were assessed at 3, 6, and 12 months after counseling. The counseled patients were compared with a similar control group that was assessed but not counseled. In this study, levels of psychologic distress reported by cancer patients were similar to those reported in normal populations. However, at 3 months post-treatment, counseled cancer patients reported significantly less confusion and contradiction within areas of self-perception than did the noncounseled patients. Return to employment and sexual activities were both shown to be adversely affected by the diagnosis and treatment of genital cancer. Results suggested that counseling had a positive effect in enhancing return to normal vocational and sexual functions during the 1st year after treatment. A first breast cancer recurrence creates considerable distress, yet few psychosocial interventions directed at this population have been reported. The Southwest Oncology Group conducted a phase III randomized trial to evaluate the effectiveness of a brief telephone intervention.
                Three hundred five women experiencing a first recurrence of breast cancer were randomly assigned to standard care or intervention. The intervention consisted of four to eight telephone calls delivered over a 1-month period. The calls were conducted by trained peer counselors at a breast cancer advocacy organization, the Y-ME National Breast Cancer Organization, and followed a standard curriculum. Psychosocial distress (Cancer Rehabilitation Evaluation System-Short Form [CARES-SF]) and depressive symptoms (Center for Epidemiologic Studies Depression Scale [CES-D]) outcomes were assessed at baseline and 3 and 6 months. The 3-month assessment was the primary end point and is the focus of this article.
                Analysis revealed no differences in distress or depressive symptoms at 3 months between the intervention and control groups; at 3 months, 70% of control patients and 66% of intervention patients reported psychosocial distress, and 40% of control patients and 47% of intervention patients exhibited depressive symptoms.
                Telephone peer counseling did not lead to better psychosocial outcomes. The persistent distress in these women supports the urgent need for the development and testing of more intensive or different supportive interventions for this group of patients. Treatment of breast cancer can significantly diminish functional capacity in patients months and even years after the completion of treatments. Tai chi chuan (TCC) is a moderate form of exercise that may be an effective therapy for improving functional capacity among breast cancer survivors. We sought to provide pilot data comparing the efficacy of TCC and psychosocial therapy (PST; physical activity control) for improving functional capacity among breast cancer survivors post treatment. Twenty-one women who had completed treatment of breast cancer were randomized to receive TCC or PST 3 times/wk for 12 weeks. Functional capacity was assessed at baseline and at 12 weeks. The TCC group demonstrated significant improvement in functional capacity (specifically aerobic capacity, muscular strength, and flexibility) whereas the PST group showed significant improvement in flexibility only. These data suggest that TCC may be an efficacious intervention for enhancing functional capacity among breast cancer survivors and may support the need for larger randomized, controlled clinical trials to further elucidate these relationships.
There was 'low level' evidence that multidisciplinary rehabilitation can improve the outcomes of people with breast cancer in terms of functional ability, psychosocial adjustment and participation in social activities. There was no evidence available on functional gain at the level of activity. This review highlights the limitations of RCTs in rehabilitation settings and the need for high-quality trial-based research in this area. Regular evaluation and assessment of breast cancer survivors for rehabilitation is recommended.