The Effect of Cardiac Rehabilitation on Quality of Life and 6-Minute Walk Test in Breast Cancer Patients after Treatment with Anthracyclines
Authors: Salah Sameh Saad , Abdel Aziz Khaled , Kadry Ahmed , El Missiri Ahmed 
Published: August 2023

Abstract

Breast cancer is the most frequently diagnosed cancer and the leading cause of cancerrelated death among women worldwide. About 1.15 million patients are diagnosed with invasive breast cancer annually, and approximately 40 million women die annually due to breast cancer [1,2] Chemotherapy for the treatment of breast cancer often leads to increased symptoms of fatigue and depression, effects that negatively affect quality of life and often last long beyond the completion of therapy [3]. Physical activity levels are reduced significantly for many women after a diagnosis of breast cancer and remain low after treatment is completed. [4] The implementation of a tailored Cardiac Rehabilitation program may provide effective strategy to reduce decline in physical activity and improve Quality of life in Breast Cancer Patients during treatment with Anthracycline- containing regimens

Objective
To investigate the effect of tailored Cardiac Rehabilitation Program on quality of life (using FACT-B questionnaire) and 6-minute walk test in breast cancer patients after treatment with Anthracyclines.

Patients and Methods
In this 2-arm parallel prospective, randomized, controlled clinical trial, sixty breast cancer patients diagnosed with Breast Cancer and scheduled for Anthracyclines cycles were recruited at Ain Shams University hospitals and divided into two groups Study group (n = 30); participated in modified CR program (Home based CR + Hospital based CR) and Control group (n = 30) did not participate in CR program but still received the usual cancer care. Cardiac rehabilitation program consisted of education, diet control, drug adherence, 9 exercise sessions in between chemotherapy cycles (Hospital based CR) and walking for 30 mins at home (Home based CR), Behavior and psychosocial management, sexual activity, education, smoking cessation. Functional capacity was assessed after study period by sixminute walk test (6MWT). All patients were personally interviewed for assessment of quality of life after study period using (FACT-B) questionnaire.

Results
Sixty female breast cancer survivors were enrolled. There were no significant differences between the two groups regarding age, baseline BMI, medical history, chemotherapy protocol, and. When comparing two groups, the study group showed significant increase in 6 MWD (p = 0.037), percentage of expected of 6MWT (p = 0.01) QOL score (p = 0.005), along with significant decrease in Borg Fatigue post 6 MWT (p = 0.003), Borg Dyspnea post 6 MWT (p = 0.001). Among the Study Group, There was significant increase in METS (p &lt; 0.001), ET (p &lt; 0.001), Maximal HR (p &lt; 0.001), HRR (p &lt; 0.001) along with significant decrease in Basal HR (p &lt; 0.001)

Conclusion
The results of this study demonstrated that Modified Cardiac Rehabilitation program implemented during treatment with Anthracyclines improves functional capacity and Quality of life in Breast Cancer patients

Recommendations
We recommend that multicomponent supervised cardiac rehabilitation program should be incorporated within the usual care of breast cancer patients once diagnosed with Breast Cancer and scheduled for treatment with Anthracyclines-containing regimens

Abbreviations
6MWD: 6-minute walk distance; 6MWT: 6-minute walk test; BBs: Beta blockers; BC: Breast cancer; BCS: Breast-cancer subscale; BMI: Body-mass index; COPD: Chronic obstructive pulmonary disease; CR: Cardiac rehabilitation; CVD: Cardiovascular disease; DBP: Diastolic blood pressure; DM: Diabetes mellitus; ECG: Electrocardiography; ET: Exercise time; EWB: Emotional well being; FPG: Fasting plasma glucose; FWB: Functional well being; Hb: Hemoglobin; HBA1C: Hemoglobin A1C; HR: Heart rate; HRmax: Maximum heart rate; HRR: Heart rate reserve; HTN: Hypertension; METs: Metabolic equivalents; NYHA: New York heart association; PWB: Physical well being; QoL: Quality of life; SBP: Systolic blood pressure; CRF: Cardiorespiratory fitness; HRrest: Resting Heart rate