Graded behavioral activity improves physical and mental health in breast cancer patients

Graded behavioral activity improves physical and mental health in breast cancer patients

According to research presented in the 13th European Breast Cancer Congress in Barcelonaa, cancer patients and survivors have better physical and mental health and a better quality of life if participate in a physical activity program called “graded behavioral activity” in combination with psychological therapies.

Graded behavioral activity implies that physiotherapists help patients gradually increase the amount of physical activity they do and to continue to adhere to the program so that ultimately the increase in activity is integrate into your daily life. The activities are adapted to specific patients and graduated over time, with specific objectives.

Astrid Lahousse, from the Free University of Brussels and the Flanders Research Foundation underlined this during the congress: “For my doctorate in physiotherapy, I focus on the pain education and behavioral interventions related to persistent pain after breast cancer.

Thus, he indicated that his objective is reduce patients’ pain and increase their quality of life through physical activity since the 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 are not active at the end of their exercise program. Until now, there has been no systematic review of the effects of behavioral graded exercise on different outcomes in cancer patients. »

Lahousse and his colleagues conducted a systematic review and meta-analysis of 33 studies involving 4,330 cancer patients and survivors, compare the effectiveness of graded behavioral activity and psychological therapies (such as cognitive behavioral therapy and acceptance commitment therapy) with outcomes for patients on the waitlist for treatment, usual care, psychological therapies only, or graded behavioral activity only.

Moreover, they combined the effects of different studies and summarized them in a measure called “standardized mean difference” CMS.

However, the team found significant effects for those who received combined psychotherapy with graded behavioral activity compared to those on the waitlists who received none. Between them, improvements in 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.

By comparing people who received psychological therapies combined with graded behavioral activity to people who received the usual standard of care, the researchers found significant average improvements for anxiety, depression, fatigue and physical activity. After one to three months, the average effects on anxiety, depression and fatigue were still significant.

On another side, no statistically significant effect was observed when psychological therapies combined with graded behavioral activity were compared with either graded behavioral activity alone or psychological therapies alone.

Lahousse said, “When comparing graded behavioral activity with usual care, such as standard pamphlets, education, and recommendations, fatigue, anxiety and depression were reduced and physical activity increased due to behavioral intervention. Comparing graded behavioral activity to no intervention, only long-term psychological problems were reduced.”

The author of the study points out that the the research was important to researchers, clinicians, patients and survivors From cancer. “This highlights for researchers that they need innovative non-pharmacological interventions. Physicians should know that there are other options for non-drug care after cancer treatment, and that the drug 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 can improve their daily functioning and quality of life during and after cancer treatment”

Astrid Lahousse, from the Free University of Brussels and the Flanders Research Foundation.

Astrid Lahousse indicated that currently oncologists better care during cancer treatment. However, after cancer patients often feel missed and misinformed about side effects of treatment. For this reason, he stressed that more research is needed not just on what should be provided, but also how, as each patient needs personalized attention.

“Therefore, it is possible that a the overall post-cancer program may not be the best for everyone. For this reason, behavioral interventions might be more appropriate and should be investigated further. »

The strength of the research is that is the first to analyze behavioral interventions in cancer patients and survivors, which is a step towards more personalized treatment with patients who can set their own goals. A limitation, however, is the wide variation between the different studies included in the systematic reviewwhich can make it difficult to draw firm conclusions without resorting to additional research.

For his part, the President of the European Breast Cancer Council, David Cameron of the University of Edinburgh Cancer Research Centre, The UK, representing the Council at EBCC13, said “how breast cancer patients and survivors live their lives after completing cancer treatment is an important but often overlooked area of ​​research” .

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 may help, but more research is needed.”

David Cameron, from the University of Edinburgh Cancer Research Centre.

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