Research An De Groef

Abstract

A diminished function of the upper limb, meaning difficulties in performing activities of daily living with the arm on the operated side, is highly prevalent, occurring in 50% of cases one year after breast cancer surgery. Post-treatment upper limb issues in breast cancer are complex and multifactorial, involving a variety of underlying mechanisms. In this longitudinal study, we aim to unravel the contribution of peripheral structural and mechanical properties of soft tissues (such as scar stiffness and fibrosis at the breast and shoulder region) to upper limb function in breast cancer survivors. Specifically, we will investigate the role of these factors both in the short term (i.e., within 1 month after surgery) and in the long term (i.e., more than 6 months after surgery and/or radiotherapy). Also, we will investigate whether soft tissue problems in the short term or prognostic for upper limb function in the long term. We will examine both objective and subjective measurements of upper limb function to comprehensively assess it. Unraveling the role of soft tissue factors for upper limb function at different time points after breast cancer surgery and gaining a complete understanding of upper limb function, both subjectively and objectively, is the first crucial step toward the development of prevention and treatment strategies for this issue after breast cancer. In the long term, our aim with this research is to improve the quality of life of women following breast cancer treatment.

Researcher(s)

• Promoter: De Groef An
• Co-promoter: Dams Lore

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating and prevalent side effect of neurotoxic cancer treatment. The most common CIPN symptoms are sensory and motor symptoms in the hands and/or feet. CIPN may interfere with daily activities as well as with cancer treatment. Although there is proof of concept for exercise in the prevention of CIPN, the quality of the evidence is rather low. As a result, exercise is not included in the current international evidence-based guidelines for the prevention of CIPN (as no other strategy) and exercise is not routinely recommended or prescribed in clinical practice for patients starting chemotherapy. An additional gap is knowledge on the barriers and facilitators of an exercise program during chemotherapy treatment for the prevention of CIPN. This knowledge is crucial for optimizing exercise interventions and adherence, as well as for making integration of exercise into clinical practice more effective in context of the prevention of CIPN. Therefore, the primary goal of the current project is to study the effect of an exercise program on symptoms of CIPN in breast and colon cancer patients receiving taxane- or platinum-based chemotherapy. The exercise program is patient-tailored based on exercise guidelines in oncology. A prospective randomized controlled trial with short (3 months) and long-term (6 months) follow up will be conducted with self-reported CIPN symptoms (QLQ-CIPN20, sensory subscale) as primary outcome. Secondary scientific objectives are the effect of the exercise program on CIPN signs (objective examination), mental and social functioning (self-reported) and relative dose intensity of chemotherapy (objective examination). Tertiary scientific objective is to perform a process evaluation. The aim of this process evaluation is to investigate the barriers and facilitators of the exercise program in patients receiving taxane- or platinum-based chemotherapy by examining adherence to the exercise program as well as how patients and healthcare providers perceive the implementation of the exercise program. Such process evaluation may aid in identifying determinants of exercise program attrition and offering recommendations for valorisation.

Researcher(s)

• Promoter: Dams Lore
• Co-promoter: De Groef An
• Co-promoter: Meeus Mira

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating and prevalent side effect of chemotherapy. The most common symptoms are sensory changes in the hands and/or feet. CIPN may interfere with daily activities as well as with the continuation of cancer treatment. Despite the significance of CIPN, there are no evidence-based interventions available that aim to reverse the underlying mechanisms of CIPN. Multimodal exercise is a promising strategy, however, clinical evidence in attenuating CIPN symptoms is limited. It would be groundbreaking if a novel multimodal exercise program consisting of neurodynamic exercises and aerobic and resistance training is effective in attenuating CIPN. Therefore, the goal of this project is to gain in-depth knowledge on how a multimodal exercise program (neurodynamic + aerobic and resistance training) may attenuate CIPN in patients receiving taxane-or platinum-based chemotherapy by investigating 1) the effect of exercise on CIPN symptoms and signs, 2) on CIPN biomarkers (Neurofilament Light Chain, Brain Derived Neurotrophic Factor, Nerve Growth Factor, inflammatory cytokines) and 3) whether changes in CIPN biomarkers caused by exercise are associated with attenuation of symptoms of CIPN. A prospective randomized controlled trial with mediation analyses will be conducted with self-reported CIPN symptoms as primary outcome and CIPN signs as secondary outcome (quantitative sensory testing), both at short-and long-term.

Researcher(s)

• Promoter: Meeus Mira
• Co-promoter: De Groef An
• Fellow: Dams Lore

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

Breast cancer related lymphedema or BCRL is due to its chronicity and impact an extremely dreaded complication after breast cancer treatment. The prevalence rate of objective BCRL is declining due to the major shift into the treatment approach of breast cancer. However, prevalence rate of subjective BCRL is much higher than that of objective BCRL. Subjective BCRL is defined as the diagnosis of BCRL based on the patient's sensation of a difference in size at the arm and/or trunk without any objectively measurable swelling. At this moment, it is not clear how many breast cancer patients experience subjective BCRL and what the underlying mechanisms may be. We hypothesize that four mechanisms might be associated with the presence and the severity of subjective BCRL, including sensory processing problems (1. nociceptive and/or 2. neuropathic and/or 3. central) and the presence of disturbed lymphatic transport without clinical manifestation (4. subclinical BCRL). To understand who and why patients after breast cancer treatment report subjective BCRL, a multi-center longitudinal study will be performed. This will be the first study investigating in 230 breast cancer patients the prevalence rate and underlying mechanisms of subjective BCRL at different time points (starting pre-surgery up to 6 months post-radiotherapy), using state-of-the art and innovative assessment methods for both different types of BCRL and their underlying mechanisms.

Researcher(s)

• Promoter: De Groef An
• Co-promoter: De Vrieze Tessa

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

The current state-of-the art advocates for a biopsychosocial rehabilitation approach for persistent pain after breast cancer treatment. Within this approach pain science education is combined with promotion of an active lifestyle based on self-regulation techniques. We argue for testing an innovative eHealth self-management support program for this purpose. The assumption is that this delivery mode reduces barriers to pain self-management support, through bringing timely support near to people, creating a safe environment as opposed to hospital settings, providing a multidimensional support model taking into account the biopsychosocial needs of patients, and lowering costs. This program can provide patients with the knowledge, proactive, cognitive and self-management skills to master their situation and journey towards less pain and pain-related disability and participation in normal life again. Therefore, the general aim of the proposed project is to investigate the effectiveness of an eHealth self-management support program for pain-related disability (I) in breast cancer survivors with persistent pain (P). The program makes use of an innovative chatbot format for delivering pain science education and motivating and monitoring physical activity. The eHealth program is automated and personalized using comprehensive decision-tree-based algorithms in order to promote pain self-management support. The primary scientific objective of the study is to determine the effectiveness of this eHealth self-management support program for persistent pain after breast cancer treatment compared to 1) usual care (i.e. superiority of the eHealth self-management support program) (C1) and 2) a comprehensive pain rehabilitation program delivered face-to-face in a physical therapy setting (i.e. non-inferiority of the eHealth self-management support program) (C2) on pain-related disability (O).

Researcher(s)

• Promoter: De Groef An
• Co-promoter: Meeus Mira
• Co-promoter: van Olmen Josefien
• Co-promoter: Wens Johan
• Co-promoter: Willem Lander

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

Upper limb (UL) dysfunctions after breast cancer treatment are complex and multifactorial. Increasing proof of concept is available for local soft tissues problems as underlying mechanism of UL dysfunctions during and after breast cancer treatment. These problems include structural changes (tissue composition, thickness and volume) and altered mechanical properties (tissue stiffness and impaired gliding). The challenge is to properly assess these properties to get a true understanding of their contribution to UL dysfunctions. Up to know, only (subjective) methods with limited validity were used. Also, longitudinal assessments of all properties together are lacking. Therefore, a comprehensive set of innovative, high-quality and objective ultrasound techniques for assessment of both structural and mechanical properties will be developed and adopted. More specific, the research objectives are 1) developing and testing a comprehensive assessment protocol for the quantification (i.e. severity) of soft tissue properties with ultrasound techniques; 2) exploring the clinical relevance of ultrasound findings by comparing them with other clinical outcomes and 3) determining the value of soft tissue properties (evaluated with ultrasound) as a diagnostic and prognostic biomarker for UL dysfunctions up to one year post-breast cancer surgery. With these insights, tailoring currently available and/or new therapies to the exact underlying mechanism(s) of UL dysfunctions will improve.

Researcher(s)

• Promoter: Meeus Mira
• Fellow: De Groef An

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

Up to 40% of women experience chronic pain after treatment for breast cancer, and this pain is often very disabling. However, chronic pain after breast cancer remains under-recognised and under-treated. An effective and patient-tailored approach of (chronic) pain after breast cancer indeed requires a thorough knowledge and evaluation of the pain. In daily clinical practice, however, guidelines for a comprehensive diagnosis of pain in cancer patients and survivors are lacking. Further research in this topic is crucial for an efficient, preventive as well as curative, approach of pain after breast cancer. Besides the high prevalence and the important impact of pain in this population, the breast cancer population is also an ideal population to study chronic pain and its natural time course in different stages, since most patients start pain-free, but almost half of them end up with chronic pain. Therefore, this study aims to map biomarkers (both predictive, prognostic and diagnostic) for chronic pain after breast cancer treatment. We will study possible biopsychosocial biomarkers in relation to (chronic) pain and monitor their temporal changes from the moment of diagnosis until 1 year after surgery. The potential biomarkers are situated within the medical imaging of the brain, measurements of pain sensitivity and psychological variables.

Researcher(s)

• Promoter: Meeus Mira
• Co-promoter: De Groef An

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

Impaired upper limb function, i.e. experiencing difficulties in performing activities of daily living with the upper limb, is with a prevalence rate of 50% at one year after surgery, very common following breast cancer treatment. Upper limb dysfunctions after breast cancer treatment are complex and multifactorial with a variety of possible contributing factors. Both in research and clinical practice, there is no doubt about the change in soft tissue properties due to breast cancer treatments, in particular surgery and radiotherapy. Problems with soft tissues include structural changes (including tissue composition and tissue volume) and altered mechanical properties (including tissue stiffness and impaired gliding of tissues relatively to each other). The challenge is to properly assess structural and mechanical properties of soft tissues to get a true understanding of their contribution to upper limb dysfunctions. Up to now, (subjective) methods with limited validity, in particular for deeper structures, were used. Soft tissue properties can be evaluated objectively in vivo by means of ultrasonography (US) and a wide range of add-ons, such as 3D freehand US volume measurement, speckle tracking and shear-wave elastography. The specific benefits of US (with its add-on techniques) allow a comprehensive objective assessment of both structural and mechanical properties of soft tissues at once. This will enable gaining knowledge on their role in upper limb function after breast cancer treatment, and as such moving the field of understanding soft tissue problems after breast cancer forward, as well as opening new avenues to better screening, prevention and treatment approaches of upper limb dysfunctions. Therefore, the aim of this project is to develop and test the reliability of a comprehensive assessment protocol for the quantification (i.e. severity) of soft tissue properties with different US techniques. With the developed protocol, in the future, we will be able to determine the role of these different soft tissue properties as a diagnostic and prognostic biomarker for upper limb dysfunctions during and after breast cancer treatment.

Researcher(s)

• Promoter: De Groef An

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

The aim is to develop a multidisciplinary good clinical practice guideline on oncological post-acute care in primary care, according to the international standards for the development of an evidence-based guideline and the criteria used by the Belgian Centre for Evidence-Based Medicine (CEBAM) for the validation of guidelines.

Researcher(s)

• Promoter: van Olmen Josefien
• Co-promoter: De Groef An
• Co-promoter: Van Royen Paul
• Co-promoter: Wens Johan

Research team(s)

• Primary and interdisciplinary care Antwerp (ELIZA)

Project type(s)

• Research Project

Abstract

Both in research and in clinical practice, interest in pain science educational interventions for treatment of persistent pain after breast cancer treatment has increased significantly over the past decades. Modern Pain Science Education (PSE) explains the neurophysiology of (chronic) pain, the nervous system's ability to modulate and perpetuate the pain experience, and highlights the influence of other factors (such as sleep, thoughts, feelings, and culture) on pain. Despite emerging evidence, some important issues should be addressed about current methods of delivery of PSE. First, the provision of individual face-to-face sessions requires considerable resources and may be prohibitive to participation if breast cancer survivors have limited means, mobility, motivation/courage or access to such services. Second, given the complex biopsychosocial nature of persistent pain after breast cancer treatment, a personalized approach is warranted. Therefore, more blended educational approaches and eHealth modalities with individualized information might be more suitable for this specific population. In order to tackle these issues, the general aim of this project is to deliver proof of concept for the use of apps using an Embodied Conversational Agent (ECA) or virtual agent in a health care setting, with specific emphasis on cancer aftercare. More specific, this project focus on an ECA-based app, the PECAN-app, for the delivery of individually-tailored PSE intervention in order to promote pain self-management and to reduce the high burden of persistent pain after breast cancer treatment. Consequently, the two-fold aim of the proposed project is: 1) To evaluate consumers' preferences for and the content and shaping of an ECA-based app, the PECAN app, to deliver PSE for cancer survivors with persistent pain through a qualitative study; and 2) To gather proof of concept for a) the convenience with and acceptability of an intervention with an ECA-based app for the delivery of PSE in breast cancer survivors with persistent pain; and b) a large efficacy trial in terms of estimates of efficacy and feasibility of methods through a pilot randomised controlled trial and qualitative study.

Researcher(s)

• Promoter: De Groef An

Research team(s)

• Movement Antwerp (MOVANT)

Project website

Project type(s)

• Research Project

Abstract

In addition to fatigue, pain is the most common frequent persistent symptom in cancer survivors. Pain following cancer leads to poor quality of life and impaired daily functioning. Identifying the origin or mechanism of the pain is a critical step in clinical decision-making. Awareness on the presence of so called central sensitisation pain in cancer survivors has increased past decades. In this case pain can be explained by enhanced processing of nociception (sensitization) within the peripheral and/or central nervous system and by altered pain modulation. Central sensitization pain relies on different mechanisms than typical nociceptive and neuropathic pain and therefore warrants a different treatment strategy. Unfortunately, up to now, no validated tool for the identification of central sensitization pain in daily clinical practice is available. Therefore, the aim of the proposed project is to develop a tool for the identification of central sensitisation pain in cancer survivors with persistent pain several months after finishing treatment. First, the tool will be developed and validated in a cohort of cancer survivors with persistent pain recruited in a hospital setting. Second, pilot testing to prepare a large-scale validation study in a non-hospital setting will be performed. The present project will be an important step in improving pain management in cancer survivors with persistent pain.

Researcher(s)

• Promoter: Meeus Mira
• Fellow: De Groef An

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project