Effectiveness of a community-based multicomponent lifestyle intervention (the ADA programme) to improve the quality of life of French breast cancer survivors: protocol for a pragmatic cluster randomised trial and embedded qualitative study

INTRODUCTION

Breast cancer survivors (BCSs) are often faced with multiple mental and physical sequelae and are at increased risk of emotional distress, degraded health-related quality of life (HRQoL), chronic pain and fatigue.Physical activity is strongly associated with improved HRQoL and survival rates; however, adherence rates to recommendations for a healthy lifestyle are seldom satisfactory among BCSs. Also, few studies have examined the effectiveness of multicomponent and personalised interventions that integrate physical activity and motivational techniques to improve the HRQoL of BCS.

METHOD AND ANALYSIS

"Activité physique adaptée Doublée d'un Accompagnement d'après cancer" (ADA) is an integrated programme of physical activity enriched with a dietary and supportive care approach targeting BCS in the early post-treatment phase. The effectiveness of the ADA intervention will be evaluated using a cluster randomised controlled trial design with two arms (ADA programme vs usual care; 1:1 ratio).The ADA intervention aims to recruit 160 participants and will be implemented by Siel Bleu, a non-profit association specialised in health prevention via adapted physical activity. Measurements will be performed at baseline, 3, 6 and 12 months after the start of the intervention. The primary outcome will be participants' HRQoL, at 12 months measured by the Functional Assessment of Chronic Illness Therapy-Fatigue global score. Secondary outcome will include participants' physical, social, emotional and functional well-being. The effect of the intervention on physical activity level, motivation for physical activity, relation to food and self-efficacy will also be evaluated.

ETHICS AND DISSEMINATION

The study was approved by the 'CPP Paris XI' Institutional Review Board on 5 May 2022 (Ref no.: 21.04512.000048-22004). The study's findings will be shared through various channels, including academic publications, simplified reports for wider audiences and active engagement with medical and institutional organisations as well as patients' associations.

TRIAL REGISTRATION NUMBER

NCT05658341.

[Physical activity and chronic illness, a theoretical framework]

The positive effects of adapted physical activity (PA) in patients with chronic illness are scientifically recognized, and PA promotion is part and parcel of public policy. In this context, one task in public health research consists in improving knowledge of PA practice in persons with chronic illnesses. As a complement to studies evaluating the importance of various determinants of PA practice, qualitative research is called for. In this framework, the present article will propose a theoretical analytical framework for study of PA in chronic illness. It will be built around two key concepts, namely the "standards of life" drawn from the notion of health in the philosophy of Georges Canguilhem and the "illness trajectory" drawn from the interactionist sociology of Anselm Strauss. We will attempt to improve understanding of the important yet frangible "labor" of patients at work in transformation of their habits and life standards involving PA professionals.

Éducation du patient et « rapport à soi » après un cancer du sein

OBJECTIVE AND METHODS

Prevention programs recommend regular physical activity and a balanced diet after cancer treatment. Based on a qualitative research using a medical philosophy approach, this article aims to better understand people’s experience after an educational therapy program. At the end of treatment for localized breast cancer, interviews were conducted to analyze the experience of 23 women aged 30 to 84 years, half of whom had followed such a program.

RESULTS

Women’s narratives differed according to their participation in the program. Those who did not attend had no specific physical activity or diet. They made no link between lifestyle and cancer. Conversely, women who attented the program were aware of prevention recommendations. They acknowledged the link between lifestyle and cancer. Two groups stand out.The first group believes in this link. Among these women, a first sub-group was able to change their lifestyle easily. They developed a “performing” self-relationship. In the other subgroup, the practice is difficult and the relationship is marked by “self-responsability” and even guilt.The second group does not believe in the link. Practice may or may not follow the recommendations. It depends on people’s preferences. The self-relationship is “self-expression”.

CONCLUSION

Patient education after cancer can lead to both positive and negative experiences. We need to analyze this in relation to the programs’ characteristics.