Biopsychosocial approach in the rehabilitation of patients with operable breast cancer

The relevance: more than 60% of cases are due to early breast cancer (EBC). Priority is the treatment of patients with early breast cancer, provided that the maximum quality of life (QL) is maintained. During or after complex treatment, more than half of patients with EBC report the occurrence of functional disorders that reduce the QL.
Aim: to evaluate the event-free survival rate (EFS) of EBC patients undergoing rehabilitation within the framework of a biopsychosocial approach in the course of complex antitumor treatment.
Materials and methods: the study involved 228 patients with EBC who received complex treatment from 2015 to 2019. In the prospective part of the study, 114 patients were subjected to rehabilitation measures in the framework of a biopsychosocial approach that considers both biological features of functional restriction and psychosocial disorders, a multidisciplinary team of specialists worked with all patients. In the control group, 114 patients were selected retrospectively and underwent physical and psychological rehabilitation as prescribed by a doctor. Patients of both groups are divided into subgroups depending on the availability of preoperative chemotherapy. Event-free survival was assessed over a 2-year follow-up period. Events were accepted as censored events: relapse, metastases, the occurrence of another cancer, a new concomitant disease, an exacerbation of concomitant pathology, and death.
Results: Rehabilitation measures within the framework of the biopsychosocial model improve the indicators of EFS in patients with EBC. The use of a biopsychosocial approach in rehabilitation increased EFS by 3.8 months. The results of multivariate analysis, reducing the risk of occurrence of the event EBC patients undergoing rehabilitation within the framework of the biopsychosocial approach in the presence of neoadjuvant chemotherapy was 28%, in patients of younger age group (25–44 years) was 29%, in patients in menopause – 25%.

1. Kaprin A.D., Starinskiy V.V., Petrova G.V. (eds.). Malignant neoplasms in Russia in 2017 (morbidity and mortality). Moscow: P.A. Hertsen Moscow Oncology Research Center – branch of FSBI NMRRC of the Ministry of Health of Russia; 2019. (In Russ.) Available at: http://www.oncology.ru/service/statistics/malignant_tumors/2018.pdf.

2. Siegel R.L., Miller K.D., Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7–30. doi: 10.3322/caac.21590.

3. Ness K.K., Wall M.M., Oakes J.M., Robison L.L., Gurney J.G. Physical performance limitations and participation restrictions among cancer survivors: A population-based study. Annals of Epidemiology. 2006;16(3):197–205. doi: 10.1016/j.annepidem.2005.01.009.

4. Cormier J.N., Askew R.L., Mungovan K.S., Xing Y., Ross M.I., Armer J.M. Lymphedema Beyond Breast Cancer: A Systematic Review and MetaAnalysis of Cancer-Related Secondary Lymphedema. Cancer. 2010;116(22):5138–5149. doi: 10.1002/cncr.25458.

5. Alfano C.M., Smith A.W., Irwin M.L., Bowen D.J., Sorensen B., Reeve B.B. et al. Physical activity, longterm symptoms, and physical health-related quality of life among breast cancer survivors: A prospective analysis. J Cancer Surviv. 2007;1(2):116–128. doi: 10.1007/s11764-007-0014-1.

6. De Jong N., Candel M.J.J.M., Schouten H.C., Abu-Saad H.H., Courtens M. A course of mental fatigue and motivation in breast cancer patients receiving adjuvant chemotherapy. Ann Oncol. 2005;16(3):372–382. doi: 10.1093/annonc/mdi095.

7. Irwin M.L., Crumley D., McTiernan A., Bernstein L., Baumgartner R., Gilliland F.D. 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):1746–1757. doi: 10.1002/cncr.11227.

8. Semiglazov V.F. (ed.). International Guidelines for the Treatment of Early Breast Cancer. Moscow: Spetsialnoe Izdatelstvo Meditsinskikh Knig (SIMK); 2020. 232 p. (In Russ.)

9. Perry S., Kowalski T., Chang C. Quality of life assessment in women with breast cancer: benefits, acceptability and utilization. Health Qual. Life Outcomes. 2007;5:24. doi: 10.1186/1477-7525-5-24.

10. Dawes D.J., Meterissian S., Golberg M., Mayo N.E. Impact of lymphoedema on arm function and healthrelated quality of life in women following breast cancer surgery. J Rehabil Med. 2008;40(8):651–658. doi: 10.2340/16501977-0232.

11. Ryan J.L., Carroll J.K., Ryan E.P., Mustian K.M., Fiscella K., Morrow G.R. Mechanisms of cancer‐related fatigue. Oncologist. 2007; 12(1):22–34. doi: 10.1634/theoncologist.12-S1-22.

12. Hartvig P., Aulin J., Hugerth M., Wallenberg S., Wagenius G. Fatigue in cancer patients treated with cytotoxic drugs. J Oncol Pharm Pract. 2006;12(3):155–164. doi: 10.1177/1078155206070774.

13. McNeely M.L., Campbell K.L., Rowe B.H., Klassen T.P., Mackey J.R., Courneya K.S. Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis. CMAJ. 2006;175(1):34–41. doi: 10.1503/cmaj.051073.

14. Glaessel A., Kirchberger I., Stucki G., Cieza A. Does the comprehensive international classification of functioning, disability and health (ICF) core set for breast cancer capture the problems in functioning treated by physiotherapists in women with breast cancer? Physiotherapy. 2011;97(1):33–46. doi: 10.1016/j.physio.2010.08.010.

15. Fava G.A., Sonino N. The biopsychosocial model thirty years later. Psychother Psychosom. 2008;77(1):1–2. doi: 10.1159/000110052.

16. Goedendorp M.M., Gielissen M.F., Verhagen C.A., Bleijenberg G. Psychosocial interventions for reducing fatigue during cancer treatment in adults. Cochrane Database Syst Rev. 2009;21(1):CD006953. doi: 10.1002/14651858.CD006953.pub2.

17. Kholmogorova A.B., Rychkova O.V. 40 years of Bio-Psycho-Social model: what’s new? Sotsialnaya psikhologiya i obshchestvo = Social Psychology and Society. 2017;8(4):8–31. (In Russ.) doi: 10.17759/sps.2017080402.

18. Schmidt M.E., Chang‐Claude J., Vrieling A., Heinz J., Flesch-Janys D., Steindorf K. Fatigue and quality of life in breast cancer survivors: temporal courses and long‐term pattern. J Cancer Surviv. 2012;6(1):11–19. doi: 10.1007/s11764-011-0197-3.

19. Charavel M., Bremond A., Courtial I. Psychosocial profile of women seeking breast reconstruction. Eur J Obstet Gynecol. 1997;74(1):31–35. doi: 10.1016/s0301-2115(96)02675-9.

20. Semiglazova T.Y., Kluge V.A., Kasparov B.S., Kondratieva K.O., Krutov A.A., Zernova M.A. et al. The international model of rehabilitation of cancer patients. Meditsinskiy sovet = Medical Countil. 2018;(10):108–116. (In Russ.) doi: 10.21518/2079-701X-2018-10-108-116.

21. Brach M., Cieza A., Stucki G., Füssl M., Cole A., Ellerin B. et al. ICF Core Sets for breast cancer. Journal of Rehabilitation Medicine. 2004;(44):121–127. doi: 10.1080/16501960410016811.

22. Semiglazova T.Yu., Kariczkij A.P., Chulkova V.A., Pestereva E.V. Reabilitaciya onkologicheskogo bol`nogo kak osnova povy`sheniya kachestva ego zhizni. Voprosy onkologii = Problems in oncology. 2015;61(2):180–184. (In Russ.) Available at: https://elibrary.ru/item.asp?id=23388180.

23. Brown J.C., Huedo‐Medina T.B., Pescatello L.S., Pescatello M.S., Ferrer R.A., Johnson B.T. Efficacy of exercise interventions in modulating cancer‐related fatigue among adult cancer survivors: a meta‐analysis. Cancer Epidemiol Biomarkers Prev. 2011;20(1):123–133. doi: 10.1158/1055-9965.EPI-10-0988.

24. Fors E.A., Bertheussen G.F., Thune I., Juvet L.K., Elvsaas I.-K., Oldervoll L. et al. Psychosocial interventions as part of breast cancer rehabilitation programs? Results from a systematic review. Psychooncology. 2011;20(9):909– 918. doi: 10.1002/pon.1844.

25. Travier N., Velthuis M.J., Steins Bisschop C.N., van den Buijs B., Monninkhof E.M., Backx F. et al. Effects of an 18-week exercise programme started early during breast cancer treatment: a randomised controlled trial. BMC Med. 2015;13:121. doi: 10.1186/s12916-015-0362-z.

26. van Waart H., Stuiver M.M., van Harten W.H., Geleijn E., Kieffer J.M., Buffart L.M. et al. Effect of low-intensity physical activity and moderateto high-intensity physical exercise during adjuvant chemotherapy on physical fitness, fatigue, and chemotherapy completion rates: results of the paces randomized clinical trial. J Clin Oncol. 2015;33(17):1918–1927. doi: 10.1200/JCO.2014.59.1081.

27. Newell S.A., Sanson-Fisher R.W., Savolainen N.J. Systematic review of psychological therapies for cancer patients: overview and recommendations for future research. J Natl Cancer Inst. 2002;94(8):558–584. doi: 10.1093/jnci/94.8.558.

28. Kasparov B.S., Semiglazova T.Y., Kovlen D.V., Ponomarenko G.N., Klyuge V.A. et al. Scientometric analysis of evidence-based studies of physical factors in the rehabilitation of breast cancer patients. Zlokachestvennye opukholi = Malignant tumors. 2018;8(4):5–12. (In Russ.) doi: 10.18027/2224-5057-2018-8-4-5-12.

29. Cannioto R.A., Hutson A., Dighe S., McCann W., McCann S.E., Zirpoli G.R. et al. Physical activity before, during and after chemotherapy for high-risk breast cancer: relationships with survival. JNCI: Journal of the National Cancer Institute. 2020. doi: 10.1093/jnci/djaa0.