Rehabilitation Through Hippotherapy for the Management of Women After Primary Treatment of Breast Cancer

Breast cancer is the most common women's cancer and the third leading cause of death. Advances in prevention, detection and primary treatment have improved overall survival leading to its growing acceptance as a long-term disease. Following the announcement of breast cancer, but also after primary treatment, some symptoms appear directly compromising psychic and physical spheres. Hippotherapy is an emerging specialized rehabilitation approach performed through specially trained horses by accredited health professionals. The proposed hippotherapy program offers key elements for physical, psychic and social reinforcement, complementing conventional care. The aim is to provide patients with tools to consolidate their self-awareness and thus strengthen their ability to cope with the disease.

Following the announcement and evolution of breast cancer, but also in response to primary treatment, some symptoms appear to directly compromise the psychic and/or physical sphere of the individual. Current rehabilitation programs are not sufficiently oriented to solve most of these symptoms. Hippotherapy is an emerging specialized rehabilitation approach, performed on a specially trained horse by accredited health professionals (e.g. medical doctors, physical therapists, occupational therapists, psychomotricians, speech-language pathologists, clinical psychologists). The horse is an excellent collaborator in situations of physical and psychic disability, whether temporary or consolidated. It provides human support for impairments (anatomical or physiological), activity limitations, and participation restrictions as defined by WHO. Hippotherapy has a direct action on the sensorimotor capacities of the individual but also on his cognitive abilities, i.e. attention, memory, psychomotricity, emotion, perception, sequencing of complex movements, self-experience, psychic temporality. Overall, the strong solicitation of the sensory and motor spheres promotes and interacts with the mechanisms related to the execution of tasks in the cognitive domain through the interactions of several neural networks. A randomized simple-blinded controlled trial on hippotherapy versus conventional care will be carried out. After giving their informed consent, patients will be enrolled in the trial. The 6-months program includes 1-week daily sessions of hippotherapy by the end of the initial cancer treatment followed by three short 2-days sessions with an interval of 2 months between each. The study will focus on 86 patients. Recruitment will be done over a 48-months' period. A battery of self-administered questionnaires will allow to study both the functional and psychological outcome. The primary end point will be quality of life, whereas body image, fatigue, anxiety, depression and cognitive performances will be the secondary end points.

Eligibility Criteria:
Inclusion Criteria:

* Confirmed histological diagnosis of breast cancer staging \[T1-T3, N0-N2 and M0\]
* Patient already scheduled or ongoing treatment for surgery and/or chemotherapy and/or hormone therapy and/or radiotherapy
* Having consulted a physician of the Care and Support Unit of the MIS during its health care
* WHO performance index from 0 to 2
* Able to give her informed consent in writing
* Able to complete questionnaires
* Abduction of the hip necessary and sufficient (to allow horse riding)
* Affiliated to a social security scheme
* Certificate of no contraindication issued by the physician in charge

Exclusion Criteria:

* History of malignant tumors in the last 5 years with the exception of basocellular skin carcinoma or squamous cell carcinoma
* Breast cancer as a secondary diagnosis
* Medication intake or presence of conditions associated with fatigue (e.g. chronic fatigue syndrome)
* Concomitant and uncontrolled severe degenerative or chronic disease
* History of allergic reactions to dust and/or horsehair, or asthma
* Contraindications to physical activity
* History of horseback riding or hippotherapeutic treatment during the last 6 months
* Clinically significant cognitive impairment or dementia
* Pregnancy and breastfeeding
* Majors protected by law
* Patient participating in another biomedical research or in exclusion period