Multimodal exercise improves quality of life of women being treated for breast cancer, but at what cost? Randomized trial with economic evaluation.

To evaluate the efficacy and economic efficiency of a multimedia, multimodal physical activity program for women undergoing adjuvant therapy following surgery for breast cancer. We conducted a randomized trial with concurrent incremental cost-effectiveness analysis and blinded baseline, 3, 6 and 12-month follow-up assessments amongst women undergoing adjuvant therapy following surgery for breast cancer (n = 89). The intervention was a multimedia, multimodal exercise program comprising strength, balance and endurance training elements. The control was sham flexibility and relaxation program delivered using similar materials. The primary outcome was health-related quality of life (EQ-5D & VAS, EORTC C30, BR23). Economic outcomes included direct health care costs and productivity gains and losses. Participants in the intervention group demonstrated greater improvement in health-related quality of life between baseline and the 3-month assessment [mean (sd) EQ-5D VAS (0-100) baseline: 72.6 (15.6), 3 month: 80.6 (11.6)] when compared to control group participants [baseline: 77.5 (13.5), 3 month: 74.1 (20.6), P = 0.006] and also improved more in terms of physical function [mean (sd) EORTC C30 physical function scale intervention (0-100) baseline: 84.9 (14.8), 3 month: 86.9 (10.7), control baseline: 91.3 (9.6), 3 month: 86.7 (14.9), P = 0.02]. These improvements were not sustained beyond this point. Upper limb volumes were also lower amongst intervention group participants. However, there was low probability that the intervention would be both less costly and more effective than the control condition (range probability = 0.05-50.02% depending on approach). Provision of multimodal exercise programs will improve the short-term health of women undergoing adjuvant therapy for breast cancer but are of questionable economic efficiency.

Early arm swelling after breast surgery: changes on both sides.

INTRODUCTION: Lymphedema is a common complication of treatment for breast cancer. However, little information is available describing changes in upper limb volumes in the early stages following surgery. STUDY DESIGN: Retrospective audit. PARTICIPANTS: Women who underwent unilateral mastectomy or axillary node removal for breast cancer at the Princess Alexandra Hospital, Brisbane, Australia. MEASUREMENTS: Circumferential measurements taken at 10 cm intervals from the ulnar styloid on each arm were converted to segmental volumes using the frustum approach. PROCEDURE: Pre-surgery baseline measures were taken by a physiotherapist at Preadmission Clinic at the Princess Alexandra Hospital. Follow-up measures were taken 6 weeks after surgery by Domiciliary Allied Health Acute Care and Rehabilitation Service physiotherapists in patients' homes. RESULTS: Limb segment volumes increased in the proximal upper limb segments at follow-up. The proportion of patients with a 10% or greater increase in volume in one or more segments of their upper limb were similar for ipsilateral (35%) and contralateral (32%) sides (to side of surgery), respectively. No significant interaction between time and arm (ipsilateral versus contralateral) was identified. DISCUSSION: These findings demonstrate that limb segment volume changes affect a greater proportion of patients during the first 6 weeks following surgery than previously recorded. They also indicate that flow of lymph from the side of surgery to the contralateral side may disperse lymph between sides during this early post-operative period. This has implications for how swelling is measured during this period and strategies to prevent onset of lymphedema.