Graded behavioral activity improves the physical and mental health of breast cancer patients

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According to research presented in the 13th European Congress of Breast Cancer 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 physical therapists help patients gradually increase the amount of physical activity they do and to continue to adhere to the program so that, ultimately, the increased activity will be integrate into your daily life. Activities are tailored to specific patients and graded over time, with specific goals.

Astrid Lahousse, from the Free University of Brussels and the Research Foundation of Flanders has pointed out at the congress: “For my doctorate in physiotherapy, I am focusing on the pain education and behavioral interventions related to persistent pain after breast cancer.

Thus, he has indicated that his objective is reduce the pain of patients and increase their quality of life through physical activity since the long-term use of pain medications is not appropriate and non-pharmacological 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 his colleagues carried out 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 acceptance commitment therapy) with outcomes for patients on the waiting list for treatment, usual care, psychological therapies only, or graded behavioral activity only.

In addition, they combined the effects of different studies and summarized them in a measure called “standardized mean difference” or MDS.

Still, the team found significant effects for people who received combination psychological therapy with graded behavioral activity compared to those on waiting lists who received none. Among them, improvements for anxiety, fatigue, depression, ability to handle 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 standard of care as usual, the researchers found significant average improvements for anxiety, depression, fatigue and physical activity. After one to three months, the mean effects on anxiety, depression, and fatigue were still significant.

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

The author of the study points out that the research was important to researchers, clinicians, and patients and survivors Of cancer. “It highlights, for researchers, the fact that they need innovative non-pharmacological interventions. Physicians need to know that there are other non-drug possibilities for care after cancer treatment, and that the medication should not be prescribed long-term. They should consider transferring patients’ 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 Research Foundation of Flanders.

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

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

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

For his part, the President of the European Breast Cancer Council, David Cameron, from the University of Edinburgh Cancer Research Centre, UK, representing the Council at EBCC13 has commented that “how breast cancer patients and survivors live their lives after completing their cancer treatment 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 could help, but more research is needed.”

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

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