Multidisciplinary Rehabilitation Programme for Breast Cancer
Condition: Breast Cancer
MeSH terms: Breast Neoplasms
Study type: Interventional

Summary: 
      The study recruits breast cancer survivors who are already on chemotherapy or are going to
      start chemotherapy. Subjects will be asked for their preference to attend physiotherapy and
      educational class (for intervention group) or decline for it (for control group).

      For intervention group, subject will attend 24 sessions of physiotherapy (exercise class) and
      10 sessions of educational class over 12 weeks. The supervised 1-hour group exercise class
      will be conducted twice a week. Educational class will be once a week, with topics covering
      physical activity, management of fatigue, lymphoedema, neuropathy, brain fog, return to work,
      stress, nutrition, sexuality, psychosocial and caregiver issues.

      Subjects in control group will be asked to exercise on their own in the 12 weeks.

      12 weeks later, all subjects will attend a 2-hour survivorship transitional class, with
      topics covering cancer surveillance and follow up, addressing fear of recurrence: symptom and
      support, neuropathy/ fatigue/physical impairment/ brain fog, physical activity and diet,
      screening for colorectal and cervical cancers, return to work and community resources. During
      the class, a screening questionnaire will be administered to identify further physical,
      rehabilitation and psychosocial needs and to triage these patients to relevant hospital and
      community services.

      Outcome assessment will be done at pre-intervention, after intervention, 6 months and 1 year
      after the intervention.
    

Detailed description: 
      This study will be a mixed study of both quantitative and qualitative research to investigate
      the effect of the holistic program of combining patient education and intra chemotherapy on
      cancer survivorship.

      80 breast cancer survivors will be recruited from National University Cancer Institute,
      Singapore (NCIS). Breast cancer survivors who are already on chemotherapy or are going to
      start chemotherapy will be recruited.

      Subjects will be asked their preference to attend physiotherapy and educational class (for
      intervention group) or decline for it (for control group). The study is not randomized as
      challenges in subject recruitment are expected otherwise. Patients in intervention group will
      attend a program combining 24 sessions of physiotherapy and 10 sessions of educational class
      over 12 weeks. Subjects in control group will be asked to exercise on their own.

      The first visit for both groups will be an individual evaluation session by physiotherapist
      (PT), occupational therapist (OT), and study coordinator. Baseline assessments of outcome
      measures will be performed during the visit. PT and OT will also prescribe an individualized
      home exercise program for subjects in both groups.

      Subsequent visits for intervention group will be 24 sessions of physiotherapy (exercise
      class) and 10 sessions of educational class over 12 weeks. The supervised 1-hour group
      exercise class will be conducted twice a week, with a maximum of 8 patients in each class.
      Subjects will be given a home log for exercise recording. If subjects are unable to attend
      exercise class for any reason (eg., low counts or feeling unwell, etc.), they will be advised
      to continue exercises at home. On the day of one of the exercise classes each week, there
      will be an additional 1-hour group education/ discussion session which may be conducted by
      PT, OT, APN, dietician or medical social worker. Topics covered will include physical
      activity, management of fatigue, lymphoedema, neuropathy, brain fog, return to work, stress,
      nutrition, sexuality, psychosocial and caregiver issues. There will be 10 sessions of
      educational class in total for each subject.

      After completing all exercise classes and educational classes for subjects in intervention
      group, or after12 weeks' home exercise for subjects in control group, all subjects in both
      group will attend a 2-hour survivorship transitional class, which will be held in groups of
      up to 10 subjects. During the class, the trainer (usually APN) will educate and provide an
      overview of breast cancer survivorship issues, seek to empower with self-assessment skills
      and provide cancer survivors with information on available community resources. The class
      seeks to reintegrate cancer survivors back to the community and will also serve as a platform
      to screen for and identify those with further psychosocial and rehabilitation needs and
      triage them accordingly to the relevant hospital or community resources. The topics that will
      be covered in education will include cancer surveillance and follow up, addressing fear of
      recurrence: symptom and support, neuropathy/ fatigue/physical impairment/ brain fog, physical
      activity and diet, screening for colorectal and cervical cancers, return to work and
      community resources. During the class, a screening questionnaire will be administered to
      identify further physical, rehabilitation and psychosocial needs and to triage these patients
      to relevant hospital and community services.

      The subsequent 2 visits for both groups will be outcome assessment. One is after the
      survivorship transitional class, and the other one is at 1 year after the survivorship
      transitional class. Outcome measures will be administered by PT, OT, and study coordinator.
    

Intervention name(s): physiotherapy class
Intervention type(s): Other
Intervention description(s): The supervised 1-hour group exercise class will be conducted twice a week, with a maximum of 8 patients in each class. Subjects will be given a home log for exercise recording. If subjects are unable to attend exercise class for any reason (eg., low counts or feeling unwell, etc.), they will be advised to continue xercises at home. On the day of one of the exercise classes each week, there will be an additional 1-hour group education/ discussion session which may be conducted by PT, OT, APN, dietician or medical social worker. Topics covered will include physical activity, management of fatigue, lymphoedema, neuropathy, brain fog, return to work, stress, nutrition, sexuality, psychosocial and caregiver issues. There will be 10 sessions of educational class in total for each subject.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: Participants in the intervention group will attend a program combing 24 sessions of physiotherapy and 10 sessions of educational class over 12 weeks. Participants in the control group will be asked to exercise on their own.
Masking: None (Open Label)
Primary purpose: Supportive Care