Physical activity levels after treatment for breast cancer: Two-year follow-up

Highlights

• Two years after breast cancer surgery, physical activity levels are not yet recovered.

• Coaching breast cancer survivors may be needed to return to pre-operative activity levels.

• Long term monitoring of physical activity is warranted in breast cancer survivors.

Abstract

Objectives

Breast cancer treatment can have a considerable large and prolonged impact on activity levels of breast cancer survivors. Therefore, the aim of the present study was to investigate the change in total physical activity level and occupational, sport and household activity levels of breast cancer survivors from preoperatively up to 24 months after breast cancer surgery. Additionally, predictive factors for this change were investigated.

Methods

Patients with primary breast cancer (n = 267) filled in the Flemish Physical Activity Computerized Questionnaire (FPACQ) before surgery and 1, 3, 6, 12 and 24 months after surgery. Patient-, disease- and treatment-related factors were analyzed as predictive factors for change in physical activity.

Results

Two years after surgery, all activity levels (total, occupational, sport and household) were still significantly lower compared to preoperative values. After the first 12 months, no significant improvements were seen for none of the activity levels, except for the occupational activity.

Conclusions

Two years after breast cancer surgery, physical activity levels are still significantly lower compared to pre-operative values. Based on this limited recovery, it seems important to monitor physical activity levels in breast cancer patients and advice these patients to stay active after surgery and return to pre-operative activity levels in the long term as well. This study indicates the importance of long term monitoring and subsequently coaching of physical activity after breast cancer surgery.

Introduction

About 89% of women diagnosed with breast cancer survives five years after diagnosis [1]. This, among other things, is because of increasingly more and better options for cancer treatment [1]. However, several breast cancer treatment modalities such as breast and axillary surgery, radiotherapy, chemotherapy and hormone therapy can have a considerable large and prolonged negative impact on activity levels and quality of life [2,3]. Additionally, lower physical activity levels have also been shown to be associated with increased risk of breast cancer, worse disease outcome, more negative treatment related side effects, worse physical functioning and quality of life, higher risk of recurrence and eventually higher mortality [[4], [5], [6], [7], [8], [9], [10]]. Monitoring physical activity levels in breast cancer survivors is therefore of great importance, especially at long term.

Several studies, including one at our institution, indicated that one year after breast cancer surgery, pre-operative total physical activity level and occupational, sport and household activity levels are not yet recovered [6,[11], [12], [13], [14], [15], [16]]. However, few studies have examined recovery of activity levels beyond this first year after breast cancer surgery, providing conflicting results. First, the study of Alfano et al. showed that general physical activity levels reported at 24-months post-diagnosis were only slightly lower compared to (a retrospective report of) the pre-operative levels. Sixty-three percent of women reported maintaining or decreasing their sports and recreation activity during cancer treatment. Additionally, 65% of women reported to increase their household activity levels after the cancer diagnosis [17]. Mason et al. concluded that recreational activity levels stayed low and relatively constant up to 5 years follow-up with no clear predictors for this [18]. Another study reported a recovery of activity levels from shortly after surgery to 1 year post-surgery, followed by a reduction in physical activity 5 years post-surgery [13]. Second, in addition to the reduced general and recreational physical activity levels, most women interrupt work activities (temporarily) during treatment [19]. The study of Islam et al. concluded that 55% of breast cancer survivors returned to work after 12 months and 57% after 18 months [20]. The study of Roelen et al. showed that 37% of absences lasted longer than one year and 12% of absences lasted longer than two years particularly in women aged 25–34 years. The mean duration before return to work was nearly a year [21]. Balak et al. noticed as well that the mean duration before return to work was 11.4 ± 5.5 months and 35% of patients were absent longer than one year with 6% not returning to work within two years after diagnosis [22].

In conclusion, recovery of the different levels of physical activity (occupational, sport and household) in breast cancer survivors beyond the first year after surgery differ among studies. In addition, to our knowledge, no study used preoperative levels to examine the trajectory of change of these different types of activity from preoperatively up to two years after surgery in the same population together. Further, in retrospective reports recall bias may influence the results [17].

A wide range of predictive factors have been postulated for the change in activity levels at short term (i.e. up to one year after diagnosis). Patient-, disease- and treatment-related factors such as having a spouse, being employed, more invasive surgery, advanced age, active smoke behavior, higher pre-diagnosis activity level and higher Body Mass Index have been found to be associated with decreased physical activity levels one year after surgery [6,11,12]. To our knowledge, research into predictive factors for long term physical activity levels is very limited. One study reported a different recovery in general physical activity between women receiving chemotherapy versus women not receiving chemotherapy. Women receiving chemotherapy had an increase during the first 18 months after surgery and a decline afterwards. Women not receiving chemotherapy had a decline only after 3 years [13].

Therefore, the first aim of the present study is to investigate the evolution of total physical activity level and occupational, sport and household activity levels of breast cancer survivors from preoperatively up to 2 years after breast cancer surgery. The second aim is to explore predictive factors for the changes in activity levels between the pre-operative stage and 2 years post-surgery.