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POSTER IN THE SPOTLIGHT 16 November 2022 13.30–14.20: Poster in the spotlight| Volume 175, SUPPLEMENT 1, S9, November 01, 2022

The effect of behavioral graded activity on physical activity level, health-related quality of life, and symptom management in cancer patients and survivors: systematic review and meta-analysis

  • A. Lahousse
    Affiliations
    Vrije Universiteit Brussel, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Brussels, Belgium;

    Research Foundation, Flanders FWO, Brussels, Belgium;
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  • I. Reynebeau
    Affiliations
    Vrije Universiteit Brussel, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Brussels, Belgium;
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  • J. Nijs
    Affiliations
    Vrije Universiteit Brussel, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Brussels, Belgium;

    University of Gothenburg, Institute of Neuroscience and Physiology, Gothenburg, Sweden;
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  • D. Beckwée
    Affiliations
    Vrije Universiteit Brussel, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Brussels, Belgium;

    University of Antwerp, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Wilrijk, Belgium;
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  • C.P. Van Wilgen
    Affiliations
    Vrije Universiteit Brussel, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Brussels, Belgium;

    Transcare, Transdisciplinary Pain Management Centre, Groningen, Netherlands;
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  • C. Férnandez-de-las-Penas
    Affiliations
    Universidad Rey Juan Carlos, Department of Physical Therapy Occupational Therapy, Physical Medicine and Rehabilitation, Madrid, Spain
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  • E. Roose
    Affiliations
    Vrije Universiteit Brussel, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Brussels, Belgium;
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  • L. Leysen
    Affiliations
    Vrije Universiteit Brussel, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Brussels, Belgium;
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      Background: In past years, behavioral graded activity (BGA) has demonstrated positive effects on debilitating symptoms, physical functioning, and pain in chronic pain populations, and appears foremost in cognitive behavioral therapy or other psychological informed practices (PIP). Up to now, no systematic review has been published about the effect of BGA on different biopsychosocial outcomes within cancer populations. Therefore, this systematic review and meta-analysis determined the effectiveness of PIP with BGA compared to (1) waitlists (WL), (2) usual care (UC), (3) PIP alone, or (4) BGA alone in cancer patients and survivors (CPaS).
      Material and methods: PubMed, Web of Science, and Embase were systematically screened for randomized controlled trials encompassing BGA (e.g., graded activity, graded exercise, operant conditioning) and PIP (e.g., acceptance commitment therapy, behavior strategies, cognition therapy, cognitive behavioral therapy) in CPaS. Effect sizes were inventoried for outcomes regarding physical activity, quality of life (QoL), and debilitating symptoms. The quality of the evidence was classified by the GRADE approach. Subgroup analyses were undertaken based on the methodological quality and quality of the given BGA to reduce heterogeneity (I2 > 50%).
      Results: Thirty-three studies were found eligible (n = 4,330). Significant effects of PIP+BGA comparing to WL were found for anxiety (SMD:−1.29 [−1.71;−0.86], I2 = 0%), fatigue (SMD:−0.86[−1.18;−0.54], I2 = 61%), depression (SMD:−0.79[−1.10;−0.48], I2 = 0%), functional impairment (SMD:−0.72[−0.95;−0.50], I2 = 0%), psychological distress (SMD:−0.58 [−0.82;−0.34], I2 = 51%), physical activity (self-reported SMD:−0.58[−0.84; −0.32], I2 = 47% and objectively measured SMD:−0.51[−0.90;−0.13], I2 = 0%), QoL (SMD:−0.38[−0.68;−0.09], I2 = 51%), social impairment (SMD: −0.33[−0.58;−0.08], I2 = 0%) and only the psychological distress (SMD: −0.89[−1.76;−0.02], I2 = 82%) remained significantly after 1 to 3 months. When comparing PIP+BGA to UC, significant effects were found for anxiety (SMD:−0.47[−0.88;−0.06], I2 = 83%), depression (SMD:−0.46[−0.84; −0.09], I2 = 82%), fatigue (SMD:−0.35[−0.51;−0.20], I2 = 48%), and physical activity (SMD:−0.26[−0.41;−0.11], I2 = 44%). After 1 to 3 months, anxiety (SMD:−1.54[−2.88;−0.21], I2 = 87%), depression (SMD:−1.43[−2.46; −0.39], I2 = 89%)and fatigue (SMD:−0.34[−0.58;−0.10], I2 = 47%)remained significantly. These significant effects were not observed in the meta-analyses of studies comparing PIP+BGA to BGA or PIP alone.
      Conclusions: PIP with BGA had a favorable effect on debilitating symptoms, physical activity, and QoL in CPaS when compared to no interventions and usual care. However, further research is needed on ‘how’ and ‘when’ BGA should be provided in cancer rehabilitation.
      No conflict of interest.