Health Economic Evaluation of an Adapted Physical Activity Program for Women With Breast Cancer

Scientific rationale: The incidence of breast cancer in women is on the rise again over the period 2010-2018. The overall cost of cancer treatment is 16.8 billion euros, including 3.6 billion for drugs alone. The treatments are more and more prolonged, the proportion of anticancer drugs continues to increase with 10% of the amount reimbursed for drugs delivered in pharmacies in 2017.

Adapted physical activity (APA) was recognized as a non-drug therapy by the HAS in 2011. It reduces certain side effects of treatments, as well as certain symptoms linked to the catabolic activity of the disease such as: fat gain, loss of muscle mass, physical deconditioning, fatigue or pain. For breast cancer, a meta-analysis showed that APA following adjuvant therapy may have a beneficial effect on quality of life. The APA shows in particular for breast cancer, a reduction in all-cause mortality as well as specific mortality and a reduction in recurrence.The prescription of APA has been allowed since the 2016 health law but there is no coverage by the French national health insurance fund (CNAM) despite the benefits shown. APA is only accessible in a few centers in France that have chosen to offer it to patients, thus creating social inequalities in health.

Very few studies have examined the efficiency of APA programs during the active phase of treatment. They related to cohorts of 60 to 165 patients and uses different methods. The investigators decided to set up a study that can measure the efficiency of the standardized APA programs offered to patients diagnosed with breast cancer, assuming that non-drug therapy such as APA would improve the quality of life while reducing health costs.

Description of the procedures: The intervention consists of an initial consultation appointment with a medical check-up and physical tests, then inclusion in the standardized APA program for 6 months. The control group will be offered the same initial consultation appointment with medical check-up and physical tests and will receive recommendations for physical practice as well as a calendar of activities to be practiced independently for 6 months. Inclusion in the APA program will be offered one year after inclusion.

Follow-up: The data will be collected at T0, T + 3 months, T + 6 months, T + 9 months and T + 12 months in both arms. There will be 1 year of data analysis.

Inclusion criteria

• women with breast cancer
• any type of breast cancer, all grades, all stages
• during treatment: surgery +/- chemotherapy +/- radiotherapy +/- hormone therapy

Exclusion criteria

• World Health Organization (WHO) 4
• Unstable angina
• Uncontrolled Atrial fibrillation
• Uncontrolled high blood pressure
• Recent myocardial infarction or myocarditis or pericarditis or thromboembolic disease (less than 3 weeks)
• Aortic stenosis or valve disease to operate
• Cardiac or respiratory failure, with dyspnea at rest
• Symptomatic anemia, thrombocytopenia
• Lytic or painful bone metastases, Severe osteoporosis
• Severe infectious syndrome,
• Surgery in the last 3 weeks
• Extreme fatigue, sharp pain, dizziness, disturbance of consciousness, severe undernutrition
• Contraindication to the practice of an adapted physical activity programme
• Currently involved or exclusion period of a interventional study or adapted Physical Activity program
• Patient with protective measures (guardianship, curators, and deprivation of liberty).
• Pregnancy or breastfeeding
• Patient with severe functional limitations