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Does a pragmatic physiotherapist-led physical activity intervention work to improve the physical activity behaviour of breast cancer survivors?
S16
ABSTRACTS
Introduction: Cancer Related Fatigue (CRF) is an increasingly recognised and distressing phenomenon common to most patients during cancer treatment. Chronic fatigue is experienced by over a third of cancer survivors’ years following treatment, and has been linked to shorter survival in breast cancer. The aetiology of CRF remains poorly defined, however abnormalities of immunological cell number and function remain the focus of research as potential causative factors. Methods: The lymphocyte phenotype of patients undergoing treatment for breast cancer both pre- and post-chemotherapy were compared to identify changes related to the development of fatigue. These results were compared with a cohort of patients newly diagnosed with Chronic Fatigue Syndrome (CFS) to identify similarities in lymphocyte phenotype. Fatigue and physical functional limitations were assessed by validated questionnaires: Chalder Fatigue scores and SF-36 respectively, and detailed lymphocyte phenotype was assessed using peripheral blood stained for lymphocyte cell surface antibodies and analysed with multi-colour flow cytometry (FACS Canto-II). Results: Pre-treatment data are available for 43 breast cancer, 21 CFS patients, and 7 controls. Initial matched post-treatment data are available for 16 breast cancer patients. Lymphocyte numbers and subpopulations did not significantly differ between CFS and pre-chemotherapy breast cancer patients. However, we noted reduced transitional B-cell (CD19+ CD24hi CD38hi) populations correlated with the severity of diminished physical function in CFS patients (r¼0.82, p¼0.006) and in post-chemotherapy breast cancer patients, (r¼0.73, p¼0.006). IL-10 production by transitional B-cells correlated inversely with severity of fatigue in postchemotherapy patients (r¼0.65; p¼0.03). Discussion: The preliminary findings suggest transitional B cells may correlate with the severity of physical limitation in CRF and CFS, and require further study to assess their potential role in the aetiology of fatigue. http://dx.doi.org/10.1016/j.ejso.2016.02.069
P017. Does a pragmatic physiotherapist-led physical activity intervention work to improve the physical activity behaviour of breast cancer survivors? Sarah Williams1, Ian Lahart2, Amtul R. Carmichael3 1 DGNHSFT, Dudley, UK 2 University of Wolverhampton, Wolverhampton, UK 3 London Breast Institute, London, UK Introduction: The role of physical activity in the management of breast cancer has consolidated over the last decade. We designed a pragmatic physiotherapist-led physical activity intervention to enhance the physical activity behaviour of breast cancer survivors. Patients and methods: All patients, who attended breast cancer follow up clinic more than one year after the diagnosis, were invited to take part in this intervention. 74 patients completed baseline assessments and 55
patients completed post 6-month intervention (retention: 74%). The intervention is shown in Table 1. Results: There was improvement in overall physical activity and number meeting PA guidelines and the participants spent less time engaged in sedentary behaviour (i.e. time sitting). Mean improvement in 6-min walk distance was by 40m. There were significant improvements in mean HRQoL (FACT) outcomes; these improvements satisfy the minimal important difference criterion (BCS¼2e3 points, FACT-G¼5e6 points, FACTB¼7e8 points, and TOI¼5e6 points) (Eton et al., 2005) Conclusion: Patients in our pragmatic physiotherapist-led intervention improved on average overall PA, quality of life and cardiorespiratory fitness. http://dx.doi.org/10.1016/j.ejso.2016.02.070
P018. Prevalence of cardiovascular disease risk factors in breast cancer survivors Ian Lahart1, George Metsios1, George Kitas2, Alan Nevill1, Amtul R. Carmichael3 1 University of Wolverhampton, Wolverhampton, UK 2 DGNHSFT, Dudley, UK 3 London Breast Institute, London, UK Introduction: Cardiorespiratory Fitness (CRF) is associated with both increased breast cancer and CVD mortality risk, independent of adiposity. Women diagnosed with breast cancer experience an excess of CVD mortality. Therefore, the purpose of the current study was to examine the CRF levels and prevalence of CVD risk factors in a sample of breast cancer patients within one year of completing post-adjuvant therapy. Methods: With local NHS ethics committee approval, 32 breast cancer patients (age¼5210 years; height¼1625.4 cm; mass¼70.610.3 kg; BMI¼27.24.4 kg∙m2; chemotherapy received¼16/32, 50%) underwent an incremental exercise tolerance test to symptom limitation to assess CRF (peak oxygen uptake, VO2peak). Pre-test patient’s height and mass measurements were taken and physical activity (PA) was assessed via International PA Questionnaire (IPAQ). We stratified CVD risk based on Wilkins et al., (2012) model (model 1), and an additional model (2) with insufficient PA and overweight/obesity included. Results: Eight breast cancer survivors had pre-existing co-morbidities. According, to risk stratification model 1, only one (4%) participant had all optimal levels of included risk factors, however, 12 (48%) and 18 (72%) participants had at least one major risk factor based on model 1 and 2, respectively. Conclusions: A relatively large number of our sample were exposed to an increased risk of CVD and breast cancer-related mortality and would benefit from CVD and breast cancer mortality risk lowering interventions. http://dx.doi.org/10.1016/j.ejso.2016.02.071
Table 1. Method
Objective
Duration (min)
Adjunct
Instigator
Baseline assessment
Goal setting
30
Information booklet
Trained member of the research team
Face to face consultation
Uptake of PA Safety information
Support telephone call
Motivation Positive reinforcement Prevention of relapse
15
Standardised script
Trained member of the research team
Mailed physical activity prompt
Continued encouragement
N/A
N/A
Member of the research team
Return Assessment
Months of Intervention 0
1
2
3
O
O
O
4
5
O
O
6
O
DVD (developed by Breast Cancer Care)
O
ABSTRACTS
Introduction: Cancer Related Fatigue (CRF) is an increasingly recognised and distressing phenomenon common to most patients during cancer treatment. Chronic fatigue is experienced by over a third of cancer survivors’ years following treatment, and has been linked to shorter survival in breast cancer. The aetiology of CRF remains poorly defined, however abnormalities of immunological cell number and function remain the focus of research as potential causative factors. Methods: The lymphocyte phenotype of patients undergoing treatment for breast cancer both pre- and post-chemotherapy were compared to identify changes related to the development of fatigue. These results were compared with a cohort of patients newly diagnosed with Chronic Fatigue Syndrome (CFS) to identify similarities in lymphocyte phenotype. Fatigue and physical functional limitations were assessed by validated questionnaires: Chalder Fatigue scores and SF-36 respectively, and detailed lymphocyte phenotype was assessed using peripheral blood stained for lymphocyte cell surface antibodies and analysed with multi-colour flow cytometry (FACS Canto-II). Results: Pre-treatment data are available for 43 breast cancer, 21 CFS patients, and 7 controls. Initial matched post-treatment data are available for 16 breast cancer patients. Lymphocyte numbers and subpopulations did not significantly differ between CFS and pre-chemotherapy breast cancer patients. However, we noted reduced transitional B-cell (CD19+ CD24hi CD38hi) populations correlated with the severity of diminished physical function in CFS patients (r¼0.82, p¼0.006) and in post-chemotherapy breast cancer patients, (r¼0.73, p¼0.006). IL-10 production by transitional B-cells correlated inversely with severity of fatigue in postchemotherapy patients (r¼0.65; p¼0.03). Discussion: The preliminary findings suggest transitional B cells may correlate with the severity of physical limitation in CRF and CFS, and require further study to assess their potential role in the aetiology of fatigue. http://dx.doi.org/10.1016/j.ejso.2016.02.069
P017. Does a pragmatic physiotherapist-led physical activity intervention work to improve the physical activity behaviour of breast cancer survivors? Sarah Williams1, Ian Lahart2, Amtul R. Carmichael3 1 DGNHSFT, Dudley, UK 2 University of Wolverhampton, Wolverhampton, UK 3 London Breast Institute, London, UK Introduction: The role of physical activity in the management of breast cancer has consolidated over the last decade. We designed a pragmatic physiotherapist-led physical activity intervention to enhance the physical activity behaviour of breast cancer survivors. Patients and methods: All patients, who attended breast cancer follow up clinic more than one year after the diagnosis, were invited to take part in this intervention. 74 patients completed baseline assessments and 55
patients completed post 6-month intervention (retention: 74%). The intervention is shown in Table 1. Results: There was improvement in overall physical activity and number meeting PA guidelines and the participants spent less time engaged in sedentary behaviour (i.e. time sitting). Mean improvement in 6-min walk distance was by 40m. There were significant improvements in mean HRQoL (FACT) outcomes; these improvements satisfy the minimal important difference criterion (BCS¼2e3 points, FACT-G¼5e6 points, FACTB¼7e8 points, and TOI¼5e6 points) (Eton et al., 2005) Conclusion: Patients in our pragmatic physiotherapist-led intervention improved on average overall PA, quality of life and cardiorespiratory fitness. http://dx.doi.org/10.1016/j.ejso.2016.02.070
P018. Prevalence of cardiovascular disease risk factors in breast cancer survivors Ian Lahart1, George Metsios1, George Kitas2, Alan Nevill1, Amtul R. Carmichael3 1 University of Wolverhampton, Wolverhampton, UK 2 DGNHSFT, Dudley, UK 3 London Breast Institute, London, UK Introduction: Cardiorespiratory Fitness (CRF) is associated with both increased breast cancer and CVD mortality risk, independent of adiposity. Women diagnosed with breast cancer experience an excess of CVD mortality. Therefore, the purpose of the current study was to examine the CRF levels and prevalence of CVD risk factors in a sample of breast cancer patients within one year of completing post-adjuvant therapy. Methods: With local NHS ethics committee approval, 32 breast cancer patients (age¼5210 years; height¼1625.4 cm; mass¼70.610.3 kg; BMI¼27.24.4 kg∙m2; chemotherapy received¼16/32, 50%) underwent an incremental exercise tolerance test to symptom limitation to assess CRF (peak oxygen uptake, VO2peak). Pre-test patient’s height and mass measurements were taken and physical activity (PA) was assessed via International PA Questionnaire (IPAQ). We stratified CVD risk based on Wilkins et al., (2012) model (model 1), and an additional model (2) with insufficient PA and overweight/obesity included. Results: Eight breast cancer survivors had pre-existing co-morbidities. According, to risk stratification model 1, only one (4%) participant had all optimal levels of included risk factors, however, 12 (48%) and 18 (72%) participants had at least one major risk factor based on model 1 and 2, respectively. Conclusions: A relatively large number of our sample were exposed to an increased risk of CVD and breast cancer-related mortality and would benefit from CVD and breast cancer mortality risk lowering interventions. http://dx.doi.org/10.1016/j.ejso.2016.02.071
Table 1. Method
Objective
Duration (min)
Adjunct
Instigator
Baseline assessment
Goal setting
30
Information booklet
Trained member of the research team
Face to face consultation
Uptake of PA Safety information
Support telephone call
Motivation Positive reinforcement Prevention of relapse
15
Standardised script
Trained member of the research team
Mailed physical activity prompt
Continued encouragement
N/A
N/A
Member of the research team
Return Assessment
Months of Intervention 0
1
2
3
O
O
O
4
5
O
O
6
O
DVD (developed by Breast Cancer Care)
O