Exercise and Wellness Programs Enhance Breast Cancer Patients’ Well-Being and Can Lower Healthcare Costs
Specialized exercise and wellness programs significantly elevated breast cancer patients’ physical well-being and quality-of-life while reducing healthcare costs in new research presented in April at the American Society of Breast Surgeons Annual Meeting in Boston.
Karen Wonders, PhD, FACSM, lead study author and Professor of Exercise Physiology, Program Director of Exercise Science at Wright State University, and her team examined the impact of a 12-week post-surgical program of individualized exercise aligned with the American College of Sports Medicine Guidelines for Cancer Survivors. They found program participants improved on all health-related quality-of-life measurements, while the control group declined or remained the same. Also examining for the first time the relationship between exercise intervention and utilization of healthcare resources, researchers found that patient emergency department (ED), hospital and office-based visits significantly declined, lowering healthcare costs.
Canadian researchers, led by Frances Wright, MD, MEd, FRCSC, lead study author and Professor of Surgery at Sunnybrook Health Sciences Center, Toronto, ON, presented data on the impact of individualized prehabilitation programs combining exercise with dietary and stress management counseling on breast cancer patients prior to surgery as they underwent neoadjuvant (pre-surgical) chemotherapy (NACT). Immediately after chemotherapy and six months post-cancer surgery, program participants demonstrated better functional walking capacity and self-reported general quality-of-life and fatigue measurements as well as other improvements compared to the control group.
Dr. Wonders’ prospective clinical trial involved 243 patients randomized to the exercise and control groups. Interventions consisted of 150 minutes of cardiovascular exercise weekly, primarily walking or recumbent bicycling at a low to moderate intensity. Each week, the group also engaged in two to three 60-minute sessions of full body workouts weekly using free weights or exercise stretch bands.
Both groups were assessed pre- and post-intervention using the Functional Assessment of Cancer Therapy-Breast (FACT-B), the Short Form-36 Health Survey (SF-36) and the Brief Fatigue Inventory (BFI).
“These well-recognized measurement tools focus on physical, social, emotional and functional well-being, rating performance on a scale of one to 28. Controlling for demographic factors and comorbidities, differences between the two groups were significant,” comments Dr. Wonders. “There was a linear relationship between exercise and decrease in health care utilization.” ED visits decreased by 33.2%, hospital outpatient visits by 21.5% and office-based visits by 41.8%.
“With a growing recognition of the importance of exercise, currently it is written into the standards or guidelines of several major national U.S. breast cancer organizations,” she comments. “Our study adds to the body of literature supporting it, not only by demonstrating benefits but also by showing that exercise can help cut healthcare costs.”
Dr. Wright’s research breaks new ground in examining prehabilitation (a program focused on optimizing health during the pre-operative time period) for breast cancer patients as they embark on a stringent course of varied of cancer therapies for up to 12 months. While the main aim of the study was to assess the feasibility of such a program, the study also yielded significant data on its benefits. With almost half of the women approached agreeing to participate and 87% completing the program, authors conclude that prehabilitation is feasible and well-received by patients.
In the study, 72 participants were randomized into the intervention and control groups. The attrition rate over the course of the study was 13%. Prehabilitation consisted of an individual counseling session with a nutritionist and psychiatrist. After evaluation by a physiotherapist, participants were assigned a customized exercise program centering on several 30-minute cardiovascular exercise sessions each week complemented by upper body strength training.
They were administered physical fitness tests and a variety of well-recognized self-rating health-related questionnaires for baseline, post-NACT and post-surgical data. In addition to these quantitative measures, qualitative interview data suggested that the program had a substantial positive impact on the treatment experience overall.
“The impact of our prehabilitation was quite positive with no intervention-related adverse events reported,” comments Dr. Wright. “While a more extensive trial is warranted to determine efficacy, our program will be operationalized shortly though a non-profit that will offer it on a virtual platform nationally throughout Canada for women who wish to participate. We are very excited about the prospects.”
Both researchers agree that exercise and wellness programs for breast cancer patients are a win-win.