Strauss-Blasche, G., Gnad, E., Ekmekcioglu, C., Hladschik, B., & Marktl, W. (2005). Combined inpatient rehabilitation and spa therapy for breast cancer patients: effects on quality of life and CA 15-3. Cancer Nursing, 28, 390–398.

The three-week inpatient rehabilitation included exercise, manual lymph drainage, and massage; some patients also received group counseling, progressive muscle relaxation, and balneotherapy (carbon dioxide bath and mud therapy). The aim of carbon dioxide baths is to increase peripheral blood flow while mud packs increase tissue temperature. Measures were obtained two weeks preadmission, at the end of treatment, and six months later.

• The sample was comprised of 149 women with breast cancer who were 3 to 72 months postsurgery.
• Mean age was 57 years (standard deviation = 10.5 years; range 32–82 years).
• Of the patients, 70% had lymphedema.

Rehabilitation center and spa in Austria

The study used a pre-/posttest design.

• European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) 
• Hospital Anxiety and Depression Scale (HADS)
• CA15-3 tumor markers
• German Illness-Coping Questionnaire

Patients received a median of 61 treatments. Of the patients, 22% dropped out at follow-up. There was a significant decrease in fatigue (p < 0.001) from pre- to posttest (effect size [ES] = .38) and pretest to six-month follow-up (ES = .38).

Fatigue improvement was greater for those with greater lymphedema.

• The study lacked a control group.
• The measure of fatigue was limited.
• The study was very heterogeneous in terms of type of treatment and time since treatment.
• No data were provided regarding cost or whether service was free.