THE PSYCHOLOGICAL AND PHYSICAL BENEFITS OF THE SUPERVISED INDIVIDUAL EXERCISE PROGRAM DURING RADIOTHERAPY IN BREAST CANCER PATIENTS: A RANDOMIZED STUDY

Öz

Objective Treatment side effects lead to a negative impact on the quality of life in breast cancer survivors. Exercise is reported to improve the physical and psychological status of these patients. We aimed to investigate the effect of exercise during radiotherapy on physical and psychological status in breast cancer patients. Material and Method A randomized controlled study was set in outpatient rehabilitation clinic. Histologically proven stage I-III breast cancer patients referred for adjuvant radiotherapy were randomly assigned to a supervised aerobic and strengthening exercise program or usual medical care without exercise training. The primary outcome parameters were Rosenberg Self Esteem Scale (RSES), Short Form-36 (SF_36) Quality of life, Coping Strategies Questionnaire (COPE Inventory), Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI). End points were assessed 1 week prior to and 1 week following 6 weeks of exercise training. Results In the repeated measured analysis, BAI and FSS scores decreased, general health (GH) and energy/ fatigue (E) scores of SF-36 increased in the exercise group (p=0.045, Cohen d=0.757 for BAI, p=0.02, Cohen d=0.863, p=0.010, Cohen d =1.02 for GH, p=0.032, Cohen d=0.801 for E), while the use of problem-based coping score decreased in the control group (p=0.049, Cohen d=0.641). No significant differences were found in scores for BDI and RSES (p>0.05). Conclusion In conclusion, supervised comined exercise training during adjuvant radiotherapy improved anxiety, fatigue, energy, general health perceptions and prevented decreasing in using effective coping strategies.

Anahtar Kelimeler

• Breast cancer radiotherapy
• Fatigue
• Coping
• Maximal oxygen uptake
• Supervised exercise
• Work rate

MEME KANSERİ HASTALARINDA RADYOTERAPİ SIRASINDA DENETİMLİ BİREYSEL EGZERSİZ PROGRAMININ PSİKOLOJİK VE FİZİKSEL FAYDALARI: RANDOMİZE BİR ÇALIŞMA

Öz

Amaç Meme kanserindenkurtulan hastalarda uzun dönem tedavi yan etkileri yaşam kalitesi üzerinde olumsuz etkilere yol açmaktadır. Egzersizin, bu hastaların fiziksel ve psikolojik durumları üzerindeki olumlu etkisi bilinmektedir. Bu çalışmada, meme kanseri tanısıyla radyoterapi alan hastalarda tedavi sırasında egzersizin fiziksel ve psikolojik duruma etkisini araştırmayı amaçladık. Gereç ve Yöntem Çalışma, randomize kontrollü olarak rehabilitasyon polikliniğinde yapıldı. Adjuvan radyoterapi için sevk edilen histolojik olarak kanıtlanmış evre I - III meme kanseri hastaları, denetimli bir aerobik ve güçlendirme egzersiz programı veya egzersiz eğitimi olmaksızın standart tıbbi bakım olmak üzere iki gruba randomize edildi. Birincil sonuç parametreleri Rosenberg Benlik Saygısı Ölçeği (RSES), Kısa Form-36 (SF_36) Yaşam Kalitesi, Başa Çıkma Stratejileri Anketi (COPE Envanteri), Yorgunluk Şiddeti Ölçeği (FSS), Beck Depresyon Envanteri (BDI), Beck Anksiyete Envanteri ( BAI) olarak belirlendi. Bu parametreler 6 haftalık egzersiz antrenmanından 1 hafta önce ve 1 hafta sonra değerlendirildi. Bulgular Tekrarlanan ölçüm analizinde egzersiz grubunda BAI ve FSS skorları azalmış, genel sağlık (GH) ve enerji/ yorgunluk (E) skorları egzersiz grubunda artmış (p=0.045, Cohen d=0.757 BAI için, p= 0.02, Cohen d=0.863, p=0.010, Cohen d =1.02 GH için, p=0.032, Cohen d=0.801 E için) olarak bulundu. Kontrol grubunda probleme dayalı başa çıkma puanının ise azaldığı saptandı (p=0.049, Cohen d=0.641). BDI ve RSES puanlarında anlamlı fark bulunmadı (p>0.05). Sonuç Sonuç olarak, adjuvan radyoterapi sırasında denetimli egzersiz eğitiminin anksiyete, yorgunluk, enerji, genel sağlık algılarını iyileştirdiği ve etkili baş etme stratejilerinin kullanılmasında azalmayı önlediği görüldü.

Anahtar Kelimeler

• Başa çıkma
• Çalışma hızı
• Denetimli egzersiz
• Maksimal oksijen uptake
• Meme radyoterapisi
• Yorgunluk
• Breast cancer radiotherapy
• Fatigue
• Coping
• Maximal oxygen uptake
• Supervised exercise
• Work rate

Kaynakça

1. 1. Wild CP, Weiderpass E, Stewart BW. World Cancer Report: Cancer Research for Cancer Prevention [Internet]. International Agency for Research on Cancer [cited 19 July 2021]. Available from: https://publications.iarc.fr/586
2. 2. Markes M, Brockow T, Resch KL. Exercise for women receiving adjuvant therapy for breast cancer. Cochrane Database Syst Rev. 2006;(4):CD005001. doi: 10.1002/14651858. CD005001.pub2.
3. 3. Partridge AH, Burstein HJ, Winer EP. Side effects of chemotherapy and combined chemohormonal therapy in women with early-stage breast cancer. J Natl Cancer Inst Monogr 2001;(30):135-42. doi: 10.1093/oxfordjournals.jncimonographs. a003451
4. 4. Kaptein, A. A., Schoones, J. W., Fischer, M. J., Thong, M. S., Kroep, J. R., & van der Hoeven, K. J. Illness perceptions in women with breast cancer—A Systematic Literature Review. Current Breast Cancer Reports, 2015;7(3), 117–126.
5. 5. Lee Y , Baek,JM, Jeon YW, Im EO. Illness perception and sense of well-being in breast cancer patients. Patient Prefer Adherence. 2019;13:1557-1567. doi: 10.2147/PPA.S225561.
6. 6. Juvet LK, Thune I, Elvsaas IKØ, Fors EA, Lundgren S, Bertheussen G et al. The effect of exercise on fatigue and physical functioning in breast cancer patients during and after treatment and at 6 months follow-up: A meta-analysis. Breast. 2017:166- 177. doi: 10.1016/j.breast.2017.04.003.
7. 7. Meneses-Echávez JF, González-Jiménez E, Ramírez-Vélez R. Effects of supervised exercise on cancer-related fatigue in breast cancer survivors: a systematic review and meta-analysis. BMC Cancer. 2015;15:77. doi: 10.1186/s12885-015-1069-4).
8. 8. Lipsett A, Barrett S, Haruna F, Mustian K, O'Donovan A. The impact of exercise during adjuvant radiotherapy for breast cancer on fatigue and quality of life: A systematic review and meta-analysis. Breast. 2017;32:144-155. doi: 10.1016/j.breast. 2017.02.002.

9. 9. World Health Organization. International Statistical Classification of Diseases and Related Health Problems. Geneva: WHO; 2004.
10. 10. Irwin ML, Crumley D, McTiernan A, Bernstein L, Baumgartner R, Gilliland FD, et al. Physical activity levels before and after a diagnosis of breast carcinoma: the Health, Eating, Activity, and Lifestyle (HEAL) study. Cancer 2003;97(7):1746-57. doi: 10.1002/cncr.11227
11. 11. Furmaniak AC, Menig M, Markes MH. Exercise for women receiving adjuvant therapy for breast cancer (Review). Cochrane Database of Systematic Reviews. 2016; Issue 9. Art. No.: CD005001.
12. 12. McNeely ML, Campbell KL, Rowe BH, Klassen TP, Mackey JR, Courneya KS. Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis. CMAJ. 2006;175:34-41.
13. 13. Mehnert A, Veers S, Howaldt D, Braumann KM, Koch U, Schulz KH. Effects of a physical exercise rehabilitation group program on anxiety, depression, body image, and health-related quality of life among breast cancer patients. Onkologie. 2011;34(5):248-253. doi:10.1159/000327813.
14. 14. Rosenberg M. Society and the adolescent self-image. New Jersey: Princeton University Press, 1965.
15. 15. Cuhadaroglu F. Self-esteem in the adolescent. Unpublished doctoral dissertation, Hacettepe University, Ankara, Turkey, 1986.
16. 16. Carver CS, Scheier MF, Weintraub JK. Assessing coping strategies: A theoretically based approach. J Pers Soc Psychol 1989; 56(2): 267-83.
17. 17. Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol. 1989;46(10):1121-3.
18. 18. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007 May;39(2):175-91. doi: 10.3758/bf03193146.
19. 19. Crosswell AD, Lockwood KB, Ganz PA, Bowera JE. Low heart rate variability and cancer-related fatigue in breast cancer survivors. Psychoneuroendocrinology 2014;45:58e66.
20. 20. Bower JE, Ganz PA, Desmond KA, Bernaards C, Rowland JH, Meyerowitz BE, et al. Fatigue in long-term breast carcinoma survivors: a longitudinal investigation. Cancer 2006;106:751e8.
21. 21. Manir KS, Bhadra K, Kumar G, Manna A, Patra NB, Sarkar SK. Fatigue in breast cancer patients on adjuvant treatment: course and prevalence. Indian J Palliat Care. 2012;18(2):109-16. doi: 10.4103/0973-1075.100826.
22. 22. Watson T, Mock V. Exercise as an intervention for cancer-related fatigue. Phys Ther. 2004;84(8):736-43.
23. 23. De Luca V, Minganti C, Borrione P, et al. Effects of concurrent aerobic and strength training on breast cancer survivors: a pilot study. Public Health. 2016;136:126-132. doi:10.1016/j. puhe.2016.03.028.
24. 24. Schmidt ME, Meynköhn A, Habermann N, Wiskemann J, Oelmann J, Hof H, Wessels S, Klassen O, Debus J, Potthoff K, Steindorf K, Ulrich CM.Resistance Exercise and Inflammation in Breast Cancer Patients Undergoing Adjuvant Radiation Therapy: Mediation Analysis From a Randomized, Controlled Intervention Trial. Int J Radiat Oncol Biol Phys. 2016;94(2):329-37. doi: 10.1016/j.ijrobp.2015.10.058.
25. 25. Mustian KM, Peppone L, Darling TV, Palesh O, Heckler CE, Morrow GR. A 4-week home-based aerobic and resistance exercise program during radiation therapy: a pilot randomized clinical trial. J Support Oncol. 2009;7(5):158-67.
26. 26. Hwang JH, Chang HJ, Shim YH, Park WH, Park W, Huh SJ, Yang JH.Effects of supervised exercise therapy in patients receiving radiotherapy for breast cancer. Yonsei Med J. 2008;49(3):443-50. doi: 10.3349/ymj.2008.49.3.443.
27. 27. Campbell A, Mutrie N, White F, McGuire F, Kearney N. A pilot study of a supervised group exercise programme as a rehabilitation treatment for women with breast cancer receiving adjuvant treatment. Eur J Oncol Nurs. 2005;9(1):56-63. doi: 10.1016/j.ejon.2004.03.007
28. 28. Mock V, Dow KH, Meares CJ, Grimm PM, Dienemann JA, Haisfield- Wolfe ME, et al. Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer. Oncol Nurs Forum. 1997;24(6):991-1000.
29. 29. Mutrie N, Campbell AM, Whyte F, McConnachie A, Emslie C, Lee L, et al. Benefits of supervised group exercise programme for women being treated for early stage breast cancer: pragmatic randomised controlled trial. BMJ. 2007;334(7592):517. doi: 10.1136/bmj.39094.648553.AE
30. 30. Aghili M, Farhan F, Rade M. A pilot study of the effects of programmed aerobic exercise on the severity of fatigue in cancer patients during external radiotherapy. Eur J Oncol Nurs. 2007;11(2):179-82. doi: 10.1016/j.ejon.2006.03.005
31. 31. Chandwani KD, Perkins G, Nagendra HR, Raghuram NV, Spelman A, Nagarathna R, et al. Randomized, controlled trial of yoga in women with breast cancer undergoing radiotherapy. J Clin Oncol. 2014;32(10):1058-65. doi: 10.1200/JCO.2012.48.2752.
32. 32. Massie MJ. Prevalence of depression in patients with cancer. J Natl Cancer Inst Monogr. 2004;(32):57-71. doi: 10.1093/jncimonographs/ lgh014.
33. 33. Patsou ED, Alexias GD, Anagnostopoulos FG, Karamouzis MV. Effects of physical activity on depressive symptoms during breast cancer survivorship: a meta-analysis of randomised control trials. ESMO Open. 2017;2(5):e000271. doi: 10.1136/esmoopen- 2017-000271.
34. 34. Sears SR, Stanton AL. Expectancy-value constructs and expectancy violation as predictors of exercise adherence in previously sedentary women. Health Psychol. 2001;20(5):326–33.
35. 35. Musanti R. A Study of Exercise Modality and Physical Self- esteem in Breast Cancer Survivors. Med Sci Sports Exerc. 2012. PMID: 21796050 Clinical Trial. doi: 10.1249/MSS. 0b013e31822cb5f2.
36. 36. Courneya KS, Segal RJ, Mackey JR, Gelmon K, Reid RD, Friedenreich CM, et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. J Clin Oncol. 2007;25(28):4396-404. doi: 10.1200/JCO.2006.08.2024
37. 37. Speck RM, Courneya KS, Mâsse LC, Duval S, Schmitz KH. An Update of Controlled Physical Activity Trials in Cancer Survivors: A Systematic Review and Meta-Analysis. J Cancer Surviv. 2010;4(2):87-100. doi: 10.1007/s11764-009-0110-5.
38. 38. Segar ML, Katch VL, Roth R S, Garcia AW, Portner TI, Glickman S G, et al. The effect of aerobic exercise on self-esteem and depressive and anxiety symptoms among breast cancer survivors. Oncol Nurs Forum. 1998;25(1): 107-13.
39. 39. Gjerset GM, Kiserud CE, Loge JH, Fosså SD, Wisløff T, Gudbergsson SB, Oldervoll LM, Thorsen L. Changes in fatigue, health- related quality of life and physical activity after a one-week educational program for cancer survivors. Acta Oncol. 2019 May;58(5):682-689. doi: 10.1080/0284186X.2018.1562210.
40. 40. Ahmed RL, Prizment A, Lazovich D, Schmitz KH, Folsom AR. Lymphedema and quality of life in breast cancer survivors: the Iowa Women's Health Study. J Clin Oncol. 2008 Dec 10;26(35):5689-96. doi: 10.1200/JCO.2008.16.4731.
41. 41. Courneya KS, Tamburrini AL, Woolcott CG, McNeely ML, Karvinen KH, Campbell KL, McTiernan A, Friedenreich CM. The Alberta Physical Activity and Breast Cancer Prevention Trial: quality of life outcomes. Prev Med. 2011 Jan;52(1):26-32. doi: 10.1016/j.ypmed.2010.10.014.
42. 42. Brunet J, Burke S, Grocott MP, West MA, Jack S.The effects of exercise on pain, fatigue, insomnia, and health perceptions in patients with operable advanced stage rectal cancer prior to surgery: a pilot trial. BMC Cancer. 2017;17(1):153. doi: 10.1186/s12885-017-3130-y.
43. 43. Lan M, Zhang L, Zhang Y, Yan J. The relationship among illness perception, coping and functional exercise adherence in Chinese breast cancer survivors. J Adv Nurs 2019;75(1):75-84. doi: 10.1111/jan.13832
44. 44. Coolidge FL, Segal DL, Hook JN, Stewart S. Personality disorders and coping among anxious older adults. Journal of Anxiety Disorders 2000; 14 (2):157–172. doi: 10.1016/s0887- 6185(99)00046-8.