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Related Experiment Video

Updated: Oct 2, 2025

Ultrasonographic Evaluation of Breast Cancer-related Lymphedema
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Exercise to prevent shoulder problems after breast cancer surgery: the PROSPER RCT.

Julie Bruce1, Bruno Mazuquin1, Pankaj Mistry1

  • 1Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK.

Health Technology Assessment (Winchester, England)
|February 28, 2022
PubMed
Summary

A structured exercise program significantly improved upper limb function and quality of life for breast cancer survivors, while also reducing healthcare costs. This intervention offers a cost-effective approach to managing post-treatment complications.

Keywords:
BREAST CANCERECONOMIC EVALUATIONPHYSIOTHERAPYRANDOMISED CONTROLLED TRIAL

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Area of Science:

  • Oncology
  • Rehabilitation Medicine
  • Health Economics

Background:

  • Upper limb problems are a common and significant concern for breast cancer survivors post-treatment.
  • Existing care pathways may not adequately address the functional and quality-of-life deficits experienced by these patients.
  • Risk stratification is crucial for identifying patients who would benefit most from targeted interventions.

Purpose of the Study:

  • To evaluate the clinical effectiveness of a structured exercise program versus usual care for improving upper limb function in breast cancer patients.
  • To assess the cost-effectiveness of the structured exercise program from a healthcare system perspective.
  • To investigate the impact of the exercise program on broader health-related outcomes and patient-reported costs.

Main Methods:

  • A pragmatic, two-arm, randomized controlled trial (RCT) involving 392 women diagnosed with breast cancer at high risk for shoulder problems.
  • Intervention group received early, structured physiotherapy (3-6 sessions) including strengthening and behavioral strategies; control group received usual care.
  • Primary outcome: upper limb function (Disabilities of Arm, Hand and Shoulder questionnaire) at 12 months. Secondary outcomes included pain, quality of life, and costs.

Main Results:

  • The exercise group demonstrated significantly greater improvement in upper limb function (mean DASH score difference -7.81, p=0.001) compared to the usual care group at 12 months.
  • Participants in the exercise group reported lower pain scores and higher health-related quality of life (SF-12) (mean difference 4.39, p=0.001).
  • The exercise program was associated with lower healthcare costs and higher quality-adjusted life years, indicating cost-effectiveness. No significant differences in adverse events or lymphoedema were observed.

Conclusions:

  • Early, supported exercise referral significantly enhances shoulder function and quality of life for breast cancer survivors at risk of shoulder problems.
  • The structured exercise program is a clinically effective and cost-effective intervention compared to usual care.
  • Implementation of such exercise programs into routine clinical practice for high-risk patients is recommended.