Abstract
Background
Advances in early detection and multimodal therapy have increased the population of long-term breast cancer survivors, underscoring the importance of survivorship care focused on health-related quality of life (HRQoL). Although exercise and educational interventions show short-term benefits, their long-term sustainability remains unclear. This study evaluated the longitudinal effects of these interventions on HRQoL and psychological outcomes after initial treatment.Methods
This secondary analysis of the Setouchi Breast Project-10 randomized controlled trial included 342 patients with stage 0-III breast cancer within one year of treatment completion, assigned to usual care (n = 114), education (n = 120), or exercise (n = 108). HRQoL was assessed using FACT-B and its subscales, and psychological outcomes using HADS at baseline and 2, 4, 6, and 12 months. Responder analyses based on minimally important differences and mixed-effects models for repeated measures were conducted.Results
The education group showed greater early improvement in the FACT-B Trial Outcome Index at 2 months versus control (51% vs. 32%, p = 0.003). Although MID analyses suggested deterioration in some global domains at 12 months in the exercise group, longitudinal analyses demonstrated sustained improvement in the breast cancer subscale in both intervention groups. No consistent between-group differences were observed in global HRQoL or HADS scores.Conclusions
This exploratory secondary analysis suggests that physician-led educational interventions and structured exercise may contribute to maintaining breast cancer-specific HRQoL, particularly in disease-specific domains. However, global HRQoL and psychological outcomes did not show consistent improvements, and a tendency toward deterioration was observed in some indicators for the exercise group at 12 months. These findings should be interpreted with caution, but they suggest that low-cost educational approaches could be a resource-efficient option in survivorship care.