Moving beyond cancer: longitudinal changes in 24-hour movement behaviors and their association with quality of life in breast cancer survivors.

Abstract

Background: Many breast cancer survivors experience persistent symptoms after treatment, impairing quality of life (QoL). At the same time, maintaining healthy levels of 24-hour movement behaviors (24h-MBs) i.e. engaging in 150 min of moderate-to-vigorous physical activity (PA) a week, several hours of light PA a day, limiting sedentary behavior during the day, and achieving restorative sleep, remains challenging. While these behaviors influence QoL individually, little is known about the combined impact of 24h-MBs in breast cancer survivorship. Therefore, this study aimed to 1) examine longitudinal changes in 24h-MBs across 1 week, 4 months, and 12 months post-surgery, 2) compare 24h-MBs of breast cancer survivors at 12-month post-surgery with healthy controls and 3) investigate associations between 24h-MBs and QoL in breast cancer survivors.

Methods: The 24h-MBs were measured by a hip-worn Actigraph GT3X-BT + , and QoL by the McGill QoL questionnaire at 1 week, 4 months, and 12 months post-surgery. Compositional data analysis was used to account for the time-use interdependence of 24h-MBs. Multivariate linear mixed models assessed longitudinal changes in 24h-MBs, a MANOVA explored the group differences and regressions models examined associations between 24h-MBs and QoL at each timepoint.

Results: Results from 184 breast cancer survivors (54 ± 15 y/o) showed that sedentary behavior decreased while light and moderate-to-vigorous PA increased over 12 months (p < 0.001). Compared to 135 healthy women (44 ± 10 y/o), breast cancer survivors at 12 months post-surgery showed 24h-MBs with more sleep (> 9h/night) and less low and moderate-to-vigorous PA (p < 0.001). At 4 months post-surgery, light PA (relatively against the other behaviors) was associated with a better overall QoL, whereas longer sleep duration (relatively against the other behaviors) was associated with a worse overall QoL and less perceived support. No significant associations were found at 1 week and 12 months post-surgery. However, at all three timepoints, the most commonly self-reported impairing symptoms related to their QoL were fatigue, insomnia and pain.

Conclusion: Breast cancer survivors gradually improved their 24h-MBs in the first year after surgery, but their 24h-MB profiles remained less favorable than those of healthy controls. More optimal post-surgery 24h-MBs were associated with a better QoL, emphasizing their relevance for recovery.