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Background: The most commonly reported side effects experienced by breast cancer patients receiving chemotherapy are fatigue, anxiety and depression. Alongside psychosocial difficulties, evidence suggests chemotherapy treatment for breast cancer is associated with perceived cognitive impairment and that which is objectively detected in domains of memory, attention, concentration and executive function. As these concerns are becoming more prominent, research has shifted towards managing these side effects and helping to improve overall quality of life and well-being of breast cancer patients and survivors. To our knowledge, intervention studies have not yet considered physical activity as a potential for maintaining cognitive difficulties in breast cancer patients undergoing chemotherapy. Physical activity interventions are reported to be effective in alleviating emotional distress and fatigue in those with breast cancer. It has also been reported to improve cognitive functioning in the elderly, in those suffering with dementia and in children. It is proposed that physical activity could also help to manage cognitive impairment in female breast cancer patients and improve levels of psychosocial functioning. The aim of this PhD research was to implement a home-based, self-managed, physical activity intervention to alleviate cognitive and psychosocial difficulties experienced by female breast cancer patients undergoing chemotherapy. The intervention was designed using goal setting techniques enabling patients to self-manage their walking schedules and minimise input from NHS staff. Method: The randomised controlled trial compared a home-based, self-managed walking intervention to usual care alone among breast cancer patients receiving chemotherapy. Fifty participants were randomised to either the intervention group (n=25), receiving 12 weeks of moderate intensity walking, or the control group (n=25) mid-way through chemotherapy. Participants in the intervention group were provided with a pedometer and were asked to set goals and keep weekly diaries outlining the duration, intensity and exertion of their walking. Levels of psychosocial and cognitive functioning were assessed pre and post intervention in both groups. Primary outcome measures for this intervention were changes in cognitive functioning. Four domains of cognitive functioning were assessed using neuropsychological tests and subjective functioning was measured using The Cognitive Failures Questionnaire. Secondary outcome measures were on psychosocial functioning. Results: The self-managed intervention had positive effects on fatigue, self-esteem, mood, levels of physical activity and stage of motivational readiness but not anxiety and depression. Positive benefits of walking were also detected in perceived cognitive function but not in sustained attention, executive function, memory and visual spatial skills when assessed objectively. Qualitative data indicated that the self-managed intervention was feasible, adhered to and received positively during active chemotherapy. Conclusion: The home-based self-managed intervention was beneficial for improving psychosocial well-being and maintaining perceived cognitive functioning among breast cancer patients treated with chemotherapy. |
