Impact of Rehabilitation on Breast Cancer Related Fatigue: A Pilot Study.

Marco Invernizzi,Carlo Cisari,Alessandra Gennari,Lorenzo Lippi,Konstantinos Venetis,Francesca Gimigliano,Nicola Fusco,Elham Sajjadi,Alessandro De Sire,Carmen Criscitiello

doi:10.3389/fonc.2020.556718

Abstract

Breast cancer fatigue (BCF) is a complex and multidimensional condition characterized by a persistent sense of physical and/or mental stiffness, resulting in a substantial impairment of health-related quality of life in breast cancer survivors. Aim of this prospective cohort study was to evaluate the feasibility and the effectiveness of a 4-week rehabilitation protocol on BCF, muscle mass, strength, physical performance, and quality of life in breast cancer (BC) survivors. We recruited adult BC women with a diagnosis of BCF, according to the International Classification of Diseases 10 criteria, referred to the Outpatient Service for Oncological Rehabilitation of a University Hospital. All participants performed a specific physical exercise rehabilitative protocol consisting of 60-min sessions repeated 2 times/week for 4 weeks. All outcomes were evaluated at the baseline (T0), at the end of the 4-week rehabilitation treatment (T1), and at 2 months follow up (T2). The primary outcome measure was the Brief Fatigue Inventory (BFI); secondary outcomes included: Fat-Free Mass and Fat Mass, assessed by Bioelectrical Impedance Analysis (BIA); Hand Grip Strength Test (HGS); Short Physical Performance Battery (SPPB); 10-meter walking test (10 MWT); 6-min walking test (6 MWT); European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ–C30). Thirty-six women (mean age: 55.17 ± 7.76 years) were enrolled in the study. Significant reduction of BCF was observed both after the 4-week rehabilitation treatment (T1) (BFI: 5.4 ± 1.6 vs. 4.2 ± 1.7; p = 0.004) and at the follow-up visit (T2) (BFI: 5.4 ± 1.6 vs. 4.4 ± 1.6; p = 0.004). Moreover, significant differences (p < 0.001) HGS, SPPB, 10 MWT, 6 MWT, and EORTC QLQ-C30 were found at T1, while at T2 all the outcome measures were significantly different (p < 0.05) from the baseline. The rehabilitation protocol seemed to be feasible, safe, and effective in reducing BCF, improving muscle mass and function, and improving HRQoL in a cohort of BC survivors. The results of this study could improve awareness of this underestimated disease, suggesting the definition of a specific therapeutic exercise protocol to reduce BCF.

Highlights

Breast cancer is the most common cancer in women and one of the leading causes of cancer-related death worldwide [1]
We found significant differences at T1 in terms of Hand Grip Strength Test (HGS) (20.1 ± 5.8 vs. 22.5 ± 5.2: p < 0.001), Short Physical Performance Battery (SPPB) (9.3 ± 2.0 vs. 11.3 ± 1.2; p < 0.001), 10-meter walking test (10 MWT) (1.5 ± 0.3 vs. 1.8 ± 0.3; p < 0.001), 6-min walking test (6 MWT) (464.5 ± 62.9 vs. 554.1 ± 71.6; p < 0.001), EORTC QLQ-C30 Functional score (69.2 ± 14.9 vs. 76.9 ± 15.7; p < 0.001), EORTC QLQ-C30 Symptoms score (29.2 ± 14.9 vs. 21.2 ± 16.0: p < 0.001), and EORTC QLQ-C30 Global Health score (40.7 ± 12.5 vs. 67.6 ± 14.8; p < 0.001)
We subjected an exploratory cohort of breast cancer survivors suffering from breast cancer fatigue (BCF) to a physical exercise rehabilitative protocol consisting of 10 min of warm-up, 40 min of aerobic exercise and strength training, and 10 min of cool-down, twice a week for 4 weeks

Summary

Introduction

Breast cancer is the most common cancer in women and one of the leading causes of cancer-related death worldwide [1]. Owing to the advances in the clinical management of this tumor, the number of long-term survivors has progressively increased during the past four decades [1] In this scenario, health-related quality of life has become more and more important in the overall patients’ outcome evaluation [2,3,4,5,6]. Cancer-related fatigue, known as cancer fatigue, is a highly prevalent long-term side effect among breast cancer survivors [7, 8] This complex and multidimensional condition is clinically characterized by a persistent sense of physical, emotional, and/or cognitive stiffness, resulting in a substantial impairment of health-related quality of life [7, 9]. The great heterogeneity in these diagnostic methods, coupled with the lack of widely adopted guidelines, represents a major limitation in the clinical management of BCF [13, 14]

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