Breathing Exercise for Chronic Pain Management in Breast Cancer Survivors

An Evidence-based Breathing Exercise Intervention Protocol for Chronic Pain Management in Breast Cancer Survivors: A Preliminary Randomized Controlled Trial

The study will follow the MRC Framework to develop an evidence-based BE intervention protocol to help breast cancer survivors with better management of cancer-related chronic pain.

Study Overview

• Status: Completed
• Conditions: Breast Neoplasms; Chronic Pain; Cancer Survivors
• Intervention / Treatment: Other: Breathing exercise

Detailed Description

Cancer-related chronic pain remains as a big challenge for cancer survivors, which significantly affects the quality of life of cancer survivors. Evidence suggests that pain is well managed through combination of pharmacological and non-pharmacological interventions. Among all non-pharmacological interventions, breathing exercise (BE) might have potential effect for chronic pain management in cancer survivors, but the evidence is sparse in current literature. Therefore, this study will follow the Medical Research Council Framework for Developing and Evaluating Complex intervention (the MRC Framework) to develop an evidence-based BE protocol to help with cancer-related chronic pain management in breast cancer survivors. The first two phases of the MRC Framework will be included in this study. In the first phase, an evidence-based method will be utilized to develop the BE intervention protocol. In the second phase, a pilot randomised controlled trial (RCT) will be conducted to examine the feasibility of study and the acceptability of the BE intervention by the participants as well as to preliminarily assess the effect of the BE on chronic pain management in breast cancer survivors. Semi-structured interviews will be conducted after the RCT to explore participants' experiences of participating in the study and practicing the BE.

• Study Type: Interventional
• Enrollment (Actual): 72
• Phase: Not Applicable

Contacts and Locations

Study Locations

• China
  • Sichuan
    • Luzhou, Sichuan, China, 646000
      • The affiliated hospital of Southwest Medical University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. female breast cancer survivors ≥18 years age;
2. has a confirmed diagnosis of breast cancer at stage I, II or IIIa;
3. has been experiencing pain since cancer diagnosis constantly or intermittently for ≥3 months, with the average pain intensity in the last seven days on a numerical scale ≥4/10 ("0" indicates no pain and "10" indicates the worst pain);
4. has completed active anticancer treatment (such as chemotherapy, radiotherapy, surgery) for at least three months;
5. agrees to participate in the research and is willing to give informed consent;
6. can read and understand Mandarin Chinese.

Exclusion Criteria:

1. extremely weak and unable to perform the breathing exercises;
2. mentally incapable (i.e., unable to follow the study instructions);
3. has scheduled pain management interventions, such as having a procedure or operation;
4. receiving other pain relief treatments, such as acupuncture, yoga, qigong, exercise program, etc.;
5. has any pre-existing chronic pain conditions before cancer diagnosis, such as arthritis, rheumatoid arthritis, chronic low back pain, migraines, trigeminal neuralgia, fibromyalgia, joint dysfunction, Complex Regional Pain Syndrome, endometriosis, etc.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention group; Participants in the intervention group will receive breathing exercise training, pain information booklet, and usual care.	Other: Breathing exercise; Participants will receive breathing exercise training, and a 4-week self exercise
No Intervention: Control group; Participants in the control group will receive pain information booklet and usual care.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Feasibility: Time taken to recruit planned sample	The time that was taken to recruit the planned sample size of participants	Immediately after the allocation of the last subject
Feasibility: Referral rate	The number of referrals made by clinicians in different departments divided by all referrals	Immediately after the referral of the last subject
Feasibility: Recruitment rate	Proportion of subjects who participated in the study from all subjects eligible for participation	Immediately after the recruitment of the last subject
Feasibility: Retention rate	Proportion of participants who completed the whole study divided by all subjects who enrolled in the study	At the follow-up assessment 4 weeks after the intervention completion (T3)
Feasibility: Dropout rate	The number of subjects who dropped out after randomization divided by all subjects who enrolled in the study	At the follow-up assessment 4 weeks after the intervention completion (T3)
Reasons for dropping out	Feedback from the dropout subjects to identify their reasons for dropping out	Immediately once a dropout occurs
Feasibility of the questionnaires	The percentage of missing values for each item of the scales used, including the Brief Pain Inventory (BPI), Quality of life Cancer Survivors Version (QOL-CSV), Functional Assessment Cancer Therapy-Breast (FACT-B), and Hospital Anxiety and Depression Scale (HADS)	At baseline (T1), immediately after the completion of the 4-week intervention (T2), and the follow-up assessment at 4 weeks after the intervention completion (T3)
Feasibility: Adherence rates	the percentage of BE sessions performed by participants divided by the total number of BE sessions required	Immediately after completion of the 4-week intervention (T2)
Participants' feedback	Participants' feedback on and satisfaction with the intervention using a specifically designed feedback form	Immediately after completion of the 4-week intervention (T2)
Adverse events associated with the intervention	Data will be collected from the participants' BE logbooks and supplemented by information collected during weekly telephone contact	Immediately once an adverse event occurs

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Chronic pain	Chronic pain will be measured by using the Brief Pain Inventory which measures pain intensity and pain interference with the life. For pain severity, four items are used to measure the "worst", "least", "average" and "now" with a rating scale from 0 to 10, higher number indicating the higher score in each item. For pain interference, pain is measured from 7 aspects of general activity, mood, walking, work, relations with others, sleep and enjoyment of life with a scale of 0-10, and higher score indicates severe impact of pain.	At baseline (T1), immediately after the completion of the 4-week intervention (T2), and the follow-up assessment at 4 weeks after the intervention completion (T3)
Quality of life of breast cancer survivors ( using tool 1)	Quality of life will be measured by using the Quality of Life Cancer Survivors Version. This questionnaire contains 41 items measuring quality of life of cancer survivors from four aspects including physical well-being, psychological well-being, social well-being and spiritual well-being. The score of each item is based on a scale of 0 ( worse outcome) to 10 ( best outcome). Higher score indicates better quality of life.	At baseline (T1), immediately after the completion of the 4-week intervention (T2), and the follow-up assessment at 4 weeks after the intervention completion (T3)
Quality of Life of breast cancer survivors ( using tool 2)	Quality of life will also be measured by using the Functional Assessment of Cancer Therapy-Breast. This questionnaire has 37 items with a 5-point Likert scale ranging from 0 to 4, a higher score indicating better QoL.	At baseline (T1), immediately after the completion of the 4-week intervention (T2), and the follow-up assessment at 4 weeks after the intervention completion (T3)
Anxiety and Depression	Anxiety and depression will be measured by using the Hospital Anxiety and Depression Scale (HADS). This scale contains 14 items consisting of two subscales: the anxiety subscale and depression subscale with 7 items in each. The scale uses a 4-point Likert scale ranging from 0 to 3, and higher score indicates severe anxiety and depression.	At baseline (T1), immediately after the completion of the 4-week intervention (T2), and the follow-up assessment at 4 weeks after the intervention completion (T3)

Collaborators and Investigators

• Sponsor: Charles Darwin University
• Collaborators: The Affiliated Hospital Of Southwest Medical University
• Investigators: Principal Investigator: Professor Jing-Yu (Benjamin) Tan, PhD, Charles Darwin University

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2023
• Primary Completion (Actual): August 12, 2023
• Study Completion (Actual): August 12, 2023

Study Registration Dates

• First Submitted: February 3, 2022
• First Submitted That Met QC Criteria: February 22, 2022
• First Posted (Actual): February 25, 2022

Study Record Updates

• Last Update Posted (Actual): February 16, 2024
• Last Update Submitted That Met QC Criteria: February 14, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Keywords: Chronic Pain; Breast Neoplasms; Cancer survivors; Pain Management; Breathing Exercises
• Additional Relevant MeSH Terms: Skin Diseases; Neoplasms; Neoplasms by Site; Pain; Neurologic Manifestations; Breast Diseases; Breast Neoplasms; Chronic Pain
• Other Study ID Numbers: H21089

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: It needs to get the participants' consent if the data is shared with other researchers.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No