Prehabilitation during neoadjuvant chemotherapy benefits patients with breast cancer
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Key takeaways:
- Women who received multimodal prehabilitation had better functional walking capacity and quality of life, and less fatigue, after neoadjuvant chemotherapy.
- Most reported full or partial adherence to exercise.
Prehabilitation during neoadjuvant chemotherapy appeared feasible and well received among a small cohort of women with breast cancer, according to results of a pilot study.
The findings, scheduled for presentation during this week’s American Society of Breast Surgeons Annual Meeting, suggest multimodal prehabilitation could improve clinically relevant outcomes among patients with breast cancer, including physical fitness, quality of life and fatigue, the researchers concluded.
Rationale and methods
During prehabilitation — the period between cancer diagnosis and surgery — patients undergo a physical and psychological assessment to establish their baseline function, identify impairments and provide targeted interventions, Frances Wright, MD, professor in the department of surgery at University of Toronto, said during a press briefing.
“The goal of prehabilitation before surgery is to reduce the incidence and severity of both current and future impairments,” Wright said. “No previous work has looked at prehabilitation for this group of patients, which makes this study quite unique.”
The multisite, randomized controlled trial included 72 women (mean age, 54.2 years) with nonmetastatic breast cancer. Researchers randomly assigned the women to either multimodal prehabilitation (n = 35) — an individualized exercise program for the duration of chemotherapy, dietetic support and stress management counseling — or usual care (n = 37) at Sunnybrook Health Sciences Centre and University Health Network in Toronto. Feasibility metrics included recruitment rates, attrition and intervention-associated adverse events.
Researchers conducted exploratory analyses of intervention efficacy on physical fitness, including aerobic capacity, grip strength and anthropometrics, and psychosocial outcomes, such as participant-reported quality of life, fatigue, physical activity levels, upper quadrant function, anxiety and depression. They gathered all data before neoadjuvant chemotherapy, after completion of chemotherapy and 6 months after surgery.
Women received an average of eight (range, 4-12) cycles of neoadjuvant chemotherapy.
Findings, implications
After chemotherapy, 33 women remained in the rehabilitation group and 32 in usual care.
Results showed that compared with women assigned to usual care, those in the prehabilitation group experienced better functional walking capacity after chemotherapy (between group difference, 49.43 meters ± 23 meters; 95% CI, 118.07 to 19.22) and 6 months after surgery (between group difference, 27.25 meters ± 23.9 meters; 95% CI, 96.8 to 42.18).
Women in the prehabilitation group appeared to meet physical activity guidelines based on self-reported physical activity at both timepoints, whereas women in the control group did not.
“We asked women in the prehabilitation group how adherent they were to the exercise and about 86% reported either fully or partially adherent, so they did more than 70% of the physical activity,” Wright said. “Women had similar 6-minute walk tests in the beginning. However, patients in the prehabilitation group maintained their 6-minute walk test, whereas women in the usual care group experienced quite a significant decrease in what they were able to do after chemotherapy. This wasn’t statistically different, but a minimally clinically important difference of 30 meters between the two groups. The prehabilitation group also maintained their activity and increased their activity 6 months later.”
In addition, women in the intervention group reported better quality of life and less fatigue than women in the usual care group at both timepoints after neoadjuvant chemotherapy.
Researchers observed no intervention-associated adverse events.
“Going forward, we need a bigger powered trial to assess this, but we have implemented the intervention in our center as a standard of care now,” Wright said.
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Brahmbhatt P, et al. A randomized control pilot of rehabilitation during neoadjuvant chemotherapy for women with breast cancer: A mixed methods study. Scheduled for presentation at: American Society of Breast Surgeons Annual Meeting; April 26-30, 2023; Boston.
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