UK PROSPER trial backs early exercise after breast cancer surgery
medwireNews: Early, structured exercise reduces upper limb disability and improves physical quality of life (QoL) compared with usual care among women at risk for postoperative complications following breast cancer surgery, UK PROSPER study data show.
“The PROSPER exercise programme was clinically impactful and cost effective,” write Julie Bruce (University of Warwick, Coventry, UK) and co-authors in The BMJ.
They say: “This trial provides the best quality evidence to date in support of early exercise for women at high risk of shoulder problems after breast cancer treatment.”
Between 2016 and 2017, Bruce and team randomly assigned 382 women undergoing breast cancer surgery at 17 UK National Health Service cancer centers to receive usual care with or without a structured exercise program (n=191 per group).
The women were at high risk for postoperative upper limb morbidity due to planned axillary node clearance or radiotherapy to the axilla or supraclavicular fossa, obesity, existing shoulder problems, subsequent axillary surgery after sentinel lymph node biopsy, or planned axillary or supraclavicular radiotherapy within 6 weeks of primary surgery.
Participants in the usual care group were given information leaflets during preoperative clinics that recommended postoperative exercises and provided generic postoperative advice.
Those in the intervention group received the same leaflets but also took part in a structured, progressive exercise program that was led by physiotherapists and incorporated stretching, strengthening, physical activity, and behavioral change techniques to support exercise adherence. The first session took place 7 to 10 days postoperatively, with two further appointments at 1 and 3 months.
The researchers report that, at 12 months, upper limb function according to the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was significantly better among women in the exercise group relative to those in the usual care group, with mean scores of 16.3 versus 23.7. After adjustment for age, baseline DASH score, breast surgery, axillary surgery, radiotherapy, and chemotherapy, the mean difference in DASH between the two groups was a “clinically significant” 7.81 points.
Bruce et al also found that individuals in the exercise group had significantly lower postoperative pain intensity scores, fewer arm disability symptoms, and better physical health-related QoL at 12 months than those in the usual care group.
Conversely, there were no significant differences between the two groups in the rates of neuropathic pain, wound related complications, surgical site infection, lymphoedema, or mental health-related QoL over time.
The investigators note that the exercise program cost an average of £ 129 (US$ 172; € 152) per participant. However, when all healthcare and personal social services costs were taken into account the intervention was associated with an average cost saving of £ 387 ($ 516; € 457) per participant.
Bruce and co-authors conclude: “Our manualised exercise intervention is suitable for wider implementation in clinical practice.”
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