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Breast Cancer: Tailored Rehabilitation Strategies to Address the Challenge of...
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Breast Cancer: Tailored Rehabilitation Strategies to Address the Challenge of Survivorship Issues

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 3 July 2025 | Viewed by 18714

Special Issue Editors

Dr. Marco Invernizzi

E-Mail Website
Guest Editor
Physical and Rehabilitation Medicine, Department of Health Sciences, University of Eastern Piedmont, 10121 Novara, Italy
Interests: rehabilitation; osteoporosis; sarcopenia; osteoarthritis; pain management; breast cancer related lymphedema; stroke; physical exercise
Special Issues, Collections and Topics in MDPI journals
Dr. Lorenzo Lippi

E-Mail Website
Co-Guest Editor
Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy
Interests: cancer rehabilitation; osteoporosis; sarcopenia; aging; physical exercise; pain management; sports medicine
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Breast cancer (BC) is the most common malignant tumor in women and one of the top causes of cancer-related death worldwide. In the past few years, the advances in early tumor diagnosis coupled with more effective treatment strategies have led to an increase in overall survival. On the other hand, as a result of the higher prevalence of breast cancer survivors, growing attention is being given to disabling consequences related to breast cancer and its treatment. These complications may lead to physical impairment, functional limitations, and strong psychological distress, with detrimental consequences for health-related quality of life (HR-QoL). Nevertheless, although several therapeutic approaches have been proposed in the management of functional and psychosocial symptoms experienced by breast cancer survivors, different limitations are reported in the current literature, and the optimal therapeutic strategies are far from being fully characterized. In this scenario, a precision medicine approach has been proposed, focused on the specific stratification of clinical risk factors and anatomopathological biomarkers, aiming at promoting a deeply tailored rehabilitation plan and focusing efforts on preventive strategies improving not only the personal and social wellbeing of women with breast cancer but also reducing the health care burden related to the long-term management of chronic disabling complications. Therefore, the aim of this Special Issue is to provide a broad overview of the evidence supporting rehabilitation approaches in breast cancer survivors in order to guide future research in creating precise and specific approaches and provide clinically relevant data to guide physicians in the effective prescription of tailored rehabilitation treatments.

Dr. Marco Invernizzi
Dr. Lorenzo Lippi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • breast cancer
  • rehabilitation
  • biomarkers
  • survivorship
  • precision medicine

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Published Papers (5 papers)

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Research

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16 pages, 497 KiB  
Article
Randomized Trial Evaluating a Self-Guided Lifestyle Intervention Delivered via Evidence-Based Materials versus a Waitlist Group on Changes in Body Weight, Diet Quality, Physical Activity, and Quality of Life among Breast Cancer Survivors
by Leah S. Puklin, Maura Harrigan, Brenda Cartmel, Tara Sanft, Linda Gottlieb, Bin Zhou, Leah M. Ferrucci, Fang-Yong Li, Donna Spiegelman, Mona Sharifi and Melinda L. Irwin
Cancers 2023, 15(19), 4719; https://doi.org/10.3390/cancers15194719 - 25 Sep 2023
Cited by 5 | Viewed by 2058
Abstract
Background: Lifestyle interventions for breast cancer survivors have proved effective at stimulating positive behavior change and promoting healthy weight loss, although integrating these programs into clinical practice is challenging. We evaluated the effect of a 6-month, unsupervised, self-guided, lifestyle intervention using printed materials [...] Read more.
Background: Lifestyle interventions for breast cancer survivors have proved effective at stimulating positive behavior change and promoting healthy weight loss, although integrating these programs into clinical practice is challenging. We evaluated the effect of a 6-month, unsupervised, self-guided, lifestyle intervention using printed materials and online videos vs. waitlist group on body weight for breast cancer survivors. Methods: The Lifestyle, Exercise and Nutrition (LEAN) Self-Guided trial randomized breast cancer survivors with a body mass index ≥25 kg/m2 to a 6-month lifestyle intervention (N = 102) or waitlist group (N = 103). Effects of the intervention on self-reported body weight, physical activity (PA), diet quality (via Health Eating Index—2010 (HEI-2010)), and quality of life were assessed using mixed model repeated measures analysis. Results: At 6 months, the intervention arm had significantly greater weight loss compared with the waitlist group (mean difference = −1.3 kg, 95% confidence interval [CI] = −2.5, −0.13). We observed suggestive improvements in PA (mean difference = 18.7 min/week, 95% CI = −24.2, 61.6), diet quality (mean difference in HEI = 3.2 points, 95% CI = −0.20, 6.5), and fatigue (mean difference in Functional Assessment of Chronic Illness Therapy—Fatigue scale = 1.4 points, 95% CI = −1.1, 3.9). Conclusions: The LEAN Self-Guided intervention led to favorable weight changes over 6 months. Low-resource-intensive programs have the potential to be delivered in diverse healthcare settings and may support breast cancer survivors in achieving a healthy body weight. Full article
(This article belongs to the Special Issue Breast Cancer: Tailored Rehabilitation Strategies to Address the Challenge of Survivorship Issues)
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21 pages, 1202 KiB  
Article
Algorithm-Based Risk Identification in Patients with Breast Cancer-Related Lymphedema: A Cross-Sectional Study
by Mauro Nascimben, Lorenzo Lippi, Alessandro de Sire, Marco Invernizzi and Lia Rimondini
Cancers 2023, 15(2), 336; https://doi.org/10.3390/cancers15020336 - 4 Jan 2023
Cited by 5 | Viewed by 2446
Abstract
Background: Breast cancer-related lymphedema (BCRL) could be one consequence of breast cancer (BC). Although several risk factors have been identified, a predictive algorithm still needs to be made available to determine the patient’s risk from an ensemble of clinical variables. Therefore, this study [...] Read more.
Background: Breast cancer-related lymphedema (BCRL) could be one consequence of breast cancer (BC). Although several risk factors have been identified, a predictive algorithm still needs to be made available to determine the patient’s risk from an ensemble of clinical variables. Therefore, this study aimed to characterize the risk of BCRL by investigating the characteristics of autogenerated clusters of patients. Methods: The dataset under analysis was a multi-centric data collection of twenty-three clinical features from patients undergoing axillary dissection for BC and presenting BCRL or not. The patients’ variables were initially analyzed separately in two low-dimensional embeddings. Afterward, the two models were merged in a bi-dimensional prognostic map, with patients categorized into three clusters using a Gaussian mixture model. Results: The prognostic map represented the medical records of 294 women (mean age: 59.823±12.879 years) grouped into three clusters with a different proportion of subjects affected by BCRL (probability that a patient with BCRL belonged to Cluster A: 5.71%; Cluster B: 71.42%; Cluster C: 22.86%). The investigation evaluated intra- and inter-cluster factors and identified a subset of clinical variables meaningful in determining cluster membership and significantly associated with BCRL biological hazard. Conclusions: The results of this study provide potential insight for precise risk assessment of patients affected by BCRL, with implications in prevention strategies, for instance, focusing the resources on identifying patients at higher risk. Full article
(This article belongs to the Special Issue Breast Cancer: Tailored Rehabilitation Strategies to Address the Challenge of Survivorship Issues)
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Review

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13 pages, 715 KiB  
Review
Empowering beyond Pain: Pain Neuroscience Education Interventions in Breast Cancer Survivorship Care
by Marco Balordi, Paola Tiberio, Matteo Castaldo, Alessandro Viganò, Flavia Jacobs, Alberto Zambelli, Armando Santoro and Rita De Sanctis
Cancers 2024, 16(16), 2806; https://doi.org/10.3390/cancers16162806 - 9 Aug 2024
Viewed by 1241
Abstract
Chronic pain is a common consequence of breast cancer (BC) and its treatments. Pain neuroscience education (PNE) is a non-pharmacological intervention that adopts a biopsychosocial approach and has already been proven to be effective for different chronic pain syndromes. The present review aims [...] Read more.
Chronic pain is a common consequence of breast cancer (BC) and its treatments. Pain neuroscience education (PNE) is a non-pharmacological intervention that adopts a biopsychosocial approach and has already been proven to be effective for different chronic pain syndromes. The present review aims to critically assess clinical trials comparing the efficacy of PNE to traditional biomedical education (BME) in reducing BC-related pain and improving quality of life. We conducted a literature search in scientific databases, including all studies regarding PNE use specifically for BC-related pain. Ongoing randomized controlled and observational studies were identified from ClinicalTrials.gov and congress proceedings. A total of eight clinical trials met the review criteria. The participants were all administered physical therapy and assigned to receive either BME or PNE interventions. Among the completed clinical studies, one reported no statistically relevant differences between the two groups, whereas the other showed lower levels of pain-related indexes in the PNE population compared to the BME one. While the current literature is inconclusive regarding the effectiveness of PNE for managing BC pain, we strongly support the need for further trials, as PNE could empower BC patients in both prevention of and coping with pain, offering the advantage of having no side effects. Full article
(This article belongs to the Special Issue Breast Cancer: Tailored Rehabilitation Strategies to Address the Challenge of Survivorship Issues)
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17 pages, 1362 KiB  
Review
Obesity and Cancer Rehabilitation for Functional Recovery and Quality of Life in Breast Cancer Survivors: A Comprehensive Review
by Lorenzo Lippi, Alessandro de Sire, Arianna Folli, Alessio Turco, Stefano Moalli, Marco Marcasciano, Antonio Ammendolia and Marco Invernizzi
Cancers 2024, 16(3), 521; https://doi.org/10.3390/cancers16030521 - 25 Jan 2024
Cited by 3 | Viewed by 2163
Abstract
Obesity is a global health challenge with increasing prevalence, and its intricate relationship with cancer has become a critical concern in cancer care. As a result, understanding the multifactorial connections between obesity and breast cancer is imperative for risk stratification, tailored screening, and [...] Read more.
Obesity is a global health challenge with increasing prevalence, and its intricate relationship with cancer has become a critical concern in cancer care. As a result, understanding the multifactorial connections between obesity and breast cancer is imperative for risk stratification, tailored screening, and rehabilitation treatment planning to address long-term survivorship issues. The review follows the SANRA quality criteria and includes an extensive literature search conducted in PubMed/Medline, Web of Science, and Scopus. The biological basis linking obesity and cancer involves complex interactions in adipose tissue and the tumor microenvironment. Various mechanisms, such as hormonal alterations, chronic inflammation, immune system modulation, and mitochondrial dysfunction, contribute to cancer development. The review underlines the importance of comprehensive oncologic rehabilitation, including physical, psychological, and nutritional aspects. Cancer rehabilitation plays a crucial role in managing obesity-related symptoms, offering interventions for physical impairments, pain management, and lymphatic disorders, and improving both physical and psychological well-being. Personalized and technology-driven approaches hold promise for optimizing rehabilitation effectiveness and improving long-term outcomes for obese cancer patients. The comprehensive insights provided in this review contribute to the evolving landscape of cancer care, emphasizing the importance of tailored rehabilitation in optimizing the well-being of obese cancer patients. Full article
(This article belongs to the Special Issue Breast Cancer: Tailored Rehabilitation Strategies to Address the Challenge of Survivorship Issues)
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25 pages, 3043 KiB  
Review
Physical Exercise and the Hallmarks of Breast Cancer: A Narrative Review
by Celia García-Chico, Susana López-Ortiz, Saúl Peñín-Grandes, José Pinto-Fraga, Pedro L. Valenzuela, Enzo Emanuele, Claudia Ceci, Grazia Graziani, Carmen Fiuza-Luces, Simone Lista, Alejandro Lucia and Alejandro Santos-Lozano
Cancers 2023, 15(1), 324; https://doi.org/10.3390/cancers15010324 - 3 Jan 2023
Cited by 18 | Viewed by 9521
Abstract
Growing evidence suggests that, among the different molecular/cellular pathophysiological mechanisms associated with cancer, there are 14 hallmarks that play a major role, including: (i) sustaining proliferative signaling, (ii) evading growth suppressors, (iii) activating invasion and metastasis, (iv) enabling replicative immortality, (v) inducing angiogenesis, [...] Read more.
Growing evidence suggests that, among the different molecular/cellular pathophysiological mechanisms associated with cancer, there are 14 hallmarks that play a major role, including: (i) sustaining proliferative signaling, (ii) evading growth suppressors, (iii) activating invasion and metastasis, (iv) enabling replicative immortality, (v) inducing angiogenesis, (vi) resisting cell death, (vii) reprogramming energy metabolism, (viii) evading immune destruction, (ix) genome instability and mutations, (x) tumor-promoting inflammation, (xi) unlocking phenotypic plasticity, (xii) nonmutational epigenetic reprogramming, (xiii) polymorphic microbiomes, and (xiv) senescent cells. These hallmarks are also associated with the development of breast cancer, which represents the most prevalent tumor type in the world. The present narrative review aims to describe, for the first time, the effects of physical activity/exercise on these hallmarks. In summary, an active lifestyle, and particularly regular physical exercise, provides beneficial effects on all major hallmarks associated with breast cancer, and might therefore help to counteract the progression of the disease or its associated burden. Full article
(This article belongs to the Special Issue Breast Cancer: Tailored Rehabilitation Strategies to Address the Challenge of Survivorship Issues)
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