Early integrated rehabilitation and risk of distant metastases in breast cancer patients: A prospective controlled study.

Abstract

e12701 Background: Integrated rehabilitation improves quality of life in breast cancer patients, but its impact on long-term outcome of disease is unclear. The aim of our study was to find out whether early initiation of integrated rehabilitation is associated with a lower incidence of distant metastases. Methods: The subjects of our prospective study were 553 female non-metastatic invasive breast cancer patients (26-65 (mean 52) years of age), who participated in the pilot study on the individualized integrated rehabilitation of breast cancer patients in 2019-2022. The patients completed three questionnaires (EORTC QLQ - C30, B23 and NCCN): before, six and twelve months after the beginning of cancer treatment. The control group included 278 patients and the intervention group 275 patients. The control group obtained the same rehabilitation as was offered to all breast cancer patients in our hospital before the start of our study. The multidisciplinary rehabilitation team reviewed the documentation of all the patients from the intervention group before, six and twelve months after the beginning of treatment and recommended appropriate interventions according to the patient's problems. The integrated rehabilitation coordinator referred patients for additional treatments in compliance with the institute’s new clinical pathway (psychologist, general practitioner, nutritional treatment, physical rehabilitation, kinesiologist-guided online exercises, gynaecologist, analgesia, vocational rehabilitation). Data on the patients’ demographics, disease extent, cancer treatment, distant dissemination and distant disease-free survival were collected. This data were analysed using the chi-square and ANOVA test. Distant disease-free survival and disease-specific survival were estimated using the Kaplan–Meier method, and between-group differences were assessed using the Cox proportional hazards model. Adjustment for tumor subtype and type of systemic therapy was not performed. Results: There were no differences between the control and the intervention group of patients in terms of age, education, disease extent, surgical procedures, systemic cancer treatment, radiotherapy, or disease-specific survival. The follow-up period ranged from 1 to 72 (median 57) months. Distant metastases occurred in 3% of the intervention group and 7% of the control group. Distant disease-free survival was 97% in the intervention group and 94% in the control group (HR = 0.43, 95% CI 0.19-0.98; p = 0.04). Conclusions: Early integrated rehabilitation is associated with longer distant disease-free survival compared to the control group. These findings suggests that early individualised integrated rehabilitation may contribute not only to improved quality of life but also to favourable long-term oncological outcomes.