Cancer patients and survivors have better mental and physical health and quality of life when they participate in a physical activity program called “behavioral activity” combined with psychological therapies, according to a new study presented at the 13th European Breast Cancer Conference in Barcelona . Spain.
Behavioral Graded Activity involves physical therapists who help clients gradually increase the amount of physical activity they engage in and continue to stick to the program so that the increased activity is ultimately incorporated into their daily lives. Activities are tailored to specific patients and graded over time with specific goals.
Ms. Astrid Lahousse from the Vrije Universiteit Brussel and Research Foundation, Flanders, Brussels, Belgium told the conference: “For my PhD in physical therapyI focus on pain education and behavioral interventions related to persistent post-pain breast cancer. My goal is to relieve patients’ pain and improve patients’ quality of life through physical activity. Long-term use of painkillers is not appropriate and non-pharmacological treatments are required.
“We already know that exercise can be beneficial, but some patients do not stay active once their exercise program is complete. Until now there weren’t any systematic review of the effects of behavioral graded practice on different outcomes cancer patients.”
Ms. Lahousse and colleagues performed a systematic review and meta-analysis of 33 studies involving 4,330 cancer patients and survivors and compared the effectiveness of behavioral graded activity and psychological therapies (such as cognitive behavioral therapy and acceptance-commitment therapy) with outcomes for patients who are on waiting lists for treatment, or who receive usual care, or who receive only psychological therapies, or who receive only behavioral activities.
They combined the effects of different studies and combined them into a measurement called the standardized mean difference, or SMD.
They found significant effects for people who received psychological therapy combined with behavioral activity compared to those on waitlists who received neither. These included large to moderate improvements in anxiety, fatigue, depression, ability to perform daily tasks, mental stress, physical activity, quality of life, and social impairment. After a period of one to three months, only the effects on psychological distress remained statistically significant.
When comparing people who received psychological therapies combined with behavioral activity to those who received the usual standard of care, the researchers found significant mean improvements in anxiety, depression, fatigue and physical activity. After one to three months, the mean effects on anxiety, depression, and fatigue remained significant.
No statistically significant effects were found when comparing psychological therapies combined with behavioral activity versus behavioral-only activity psychological therapies only.
Ms Lahousse said: “When comparing behavioral activity to usual care such as booklets, education and standard recommendations, fatigue, anxiety and depression were reduced and physical activity increased due to the behavioral intervention. When comparing behavior-based activity without intervention, only psychological problems were sustainably reduced.”
She said the research is important for researchers, doctors, cancer patients and survivors. “It underscores researchers that new, non-pharmacological interventions are needed. Physicians need to be aware of other non-drug options for post-cancer care and that drugs should not be prescribed long-term. They should consider transferring care from patients to other appropriate healthcare providers, such as physical therapists and psychologists. The study also provides patients with guidance on how they could improve their daily functioning and quality of life during and after cancer treatment.
“It is important for cancer survivors to improve non-pharmacological treatments after cancer treatment. Currently, oncologists provide the best care during cancer treatment. However, after cancer, patients often feel lost and ill-informed about the side effects of treatment. For this reason, more research is needed, not only on what should be provided, but how, as each patient requires individualized care. Therefore, a general post-cancer program may not be best for everyone. Interventions may be more appropriate and should be further explored.”
The strength of the research is that it is the first to analyze behavioral interventions in cancer patients and survivors, which is a step toward more personalized treatment that allows patients to set their own goals. A limitation is the large variation between the different studies included in the systematic review, which can make it difficult to draw strong conclusions without further research.
The President of the European Breast Cancer Council, Professor David Cameron from the University of Edinburgh Cancer Research Centre, UK, represents the Council at the EBCC13 and was not involved in the research. He commented: “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 support from the healthcare system is necessary to help them achieve a good quality of life.
“This study identifies interventions that might help, but more research is needed. Such interventions must also be fully funded so that each patient has access to therapies that could help them live full and pain-free lives. This remains a challenge in some countries.”
Abstract #23, “The Effect of Behavioral Graded Activity on Physical Activity Levels, Health-Related Quality of Life, and Symptom Management in Cancer Patients and Survivors: Systematic Review and Meta-Analysis,” by Astrid Lahousse, Wednesday November 16, Poster in the Spotlight Session, 13.00-13.50 CET, Exhibition Hall.
Provided by the European Organization for Research and Treatment of Cancer
Citation: Gradual Increase in Daily Activity, Psychological Therapy May Improve Mental Health of Cancer Patients and Survivors (2022 November 16) Retrieved November 16, 2022 from https://medicalxpress.com/news/2022-11-gradual-daily -psychologological-therapy-mental.html
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