Khan, F., Amatya, B., Pallant, J.F., Rajapaksa, I., & Brand, C. (2012). Multidisciplinary rehabilitation in women following breast cancer treatment: A randomized controlled trial. Journal of Rehabilitation Medicine, 44, 788–794.

To assess effectiveness of an ambulatory rehabilitation program for women with breast cancer

A sample of patients referred to a rehabilitation center was selected based on criteria of diagnosis of breast cancer, considered to be disease free. Patients were then randomly assigned to an intervention group or a control group that continued with usual activity in the community. The rehabilitation program was conducted three to five days per week for up to eight weeks and was aimed at improving activity and participation in activities. Interventions included physiotherapy, lymphedema care, occupational therapy, and clinical psychology for counseling and support. Study assessments were done at baseline and at four months after program completion.

• The study reported on a sample of 79 female patients with breast cancer.
• Median patient age was 57 years (range = 33–80).
• About half of the patients had undergone mastectomy, while 66% in the intervention group and 55% in the control group had undergone lumpectomy. More patients in the intervention group had received chemotherapy, and slightly more than 70% in both groups had received radiotherapy.
• More than half (62%) of patients were married or partnered; 63% in the intervention group versus 38% in the control group had tertiary level education.
• At baseline, depression scores were higher in the intervention group.
• Duration of disease was 2.3 years in the intervention group and 4.0 years among controls, ranging from < 1 to 24 years.

• Single site
• Outpatient setting
• Australia

Patients were undergoing multiple phases of care.

A randomized, single-blind, controlled trial design was used.

• Depression Anxiety Distress Scale
• Perceived Impact of Problems Profile
• Cancer Rehabilitation Evaluation System Short Form
• Functional Independent Measure (FIM)

Out of 42 patients, 31 completed the rehabilitation program. Over the study period, more patients in the treatment group showed a decrease in depression scores compared with the control group (p = 0.02). Intervention group patients also showed significant differences in impact profile scores (p = 0.05). There were no differences between groups in anxiety or FIM scores.

Findings suggest that comprehensive multidisciplinary rehabilitation may improve depression among women with breast cancer.

• The study had a small sample size, with less than 100 participants.
• The study had baseline sample/group differences of import that could have influenced results.
• Risk of bias existed due to no blinding, no appropriate attentional control condition, and sample characteristics.
• Subject withdrawals were ≥ 10%.
• Of the intervention group patients, 26% did not complete the rehabilitation program, leading to the question of practicality and acceptability of this approach for patients.
• Intervention group patients were more depressed at baseline; other studies have shown that interventions for depression tend to work better for individuals who actually have clinically relevant depression. It is not known if there could have been a floor effect in measurement used.
• Intervention group patients were more educated. 
• More control group patients had symptoms such as phantom breast sensations and phantom breast pain, which might have influenced findings.
• Given differences in the prevalence of some demographic factors, it is surprising that differences were not significant. 
• There was a very broad range of time since diagnosis, suggesting very broad differences in the sample that were not taken into account.

Some patients may benefit from a multidisciplinary rehabilitation program after breast cancer treatment. This study provides some evidence in support of this approach, but has several limitations. Further research is needed to determine the benefit versus cost of such programs.