Research Article| Volume 18, ISSUE 5, P505-511, October 2014

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Positive and cost-effectiveness effect of spa therapy on the resumption of occupational and non-occupational activities in women in breast cancer remission: A French multicentre randomised controlled trial


      Purpose of the research

      The main aim was to assess the effects of a spa treatment on the resumption of occupational and non-occupational activities and the abilities of women in breast cancer remission. A cost-effectiveness analysis (CEA) was also performed.

      Methods and sample

      A multicentre randomised controlled trial was carried out between 2008 and 2010 in the University Hospital of Auvergne and two private hospitals in Clermont-Ferrand, France. Eligible patients were women in complete breast cancer remission without contraindication for physical activities or cognitive disorders and a body mass index between 18.5 and 40 kg/m2. The intervention group underwent spa treatment combined with consultation with dietician whereas the control underwent consultations with the dietician only. Of the 181 patients randomised, 92 and 89 were included in the intervention and the control groups, respectively. The CEA involved 90 patients, 42 from the intervention group and 48 from the control group.

      Key results

      The main results showed a higher rate of resumption of occupational activities in the intervention group (p = 0.0025) and a positive effect of the intervention on the women's ability to perform occupational activities 12 months after the beginning of the study (p = 0.0014), and on their ability to perform family activities (p = 0.033). The stay in a thermal centre was cost-effective at 12 months.


      Spa treatment is a cost-effective strategy to improve resumption of occupational and non-occupational activities and the abilities of women in breast cancer remission.


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        • Auquier P.
        • Auray J.P.
        • Genot J.Y.
        • Hubert A.
        • Pelicier N.
        • Romestaing P.
        Etude Femmes Atteintes du Cancer du Sein et son entourage: FACE.
        Novartis: Service Santé et Proximologie. 2004; 1: 1-8
        • Bouknight R.
        • Bradley C.
        • Luo Z.
        Correlates of return to work for breast cancer survivors.
        Journal of Clinical Oncology. 2006; 24: 345-353
        • Brouwer W.B.
        • Koopmanschap M.A.
        • Rutten F.F.
        Productivity costs measurement through quality of life? A response to the recommendation of the Washington Panel.
        Health Economics. 1997; 6: 253-259
        • Chadeau A.
        Que vaut la production non marchande des ménages?.
        Revue économique de l'OCDE. 1992; 18: 96-113
        • Chauvin P.
        • Josselin J.M.
        • Grolier J.
        • Heresbach D.
        Bases théoriques des études coût-efficacité en médecine.
        Acta Endoscopia. 2010; 40: 183-186
        • De Boer A.
        • Taskila T.
        • Ojajarvi A.
        • Van Dijk F.
        • Verbeek J.
        Cancer survivors and unemployment a meta-analysis and meta-regression.
        Journal of the American Medical Association. 2009; 301: 753-762
        • Dilhuydy J.M.
        La réinsertion professionnelle des patientes traitées pour un cancer du sein.
        Oncologie. 2006; 8: 245-250
        • Dunbrack J.
        Breast Cancer: Economic Impact and Labour Force Re-entry.
        (Canadian Breast Cancer Network Report) CAPO-ACOP Edition, 2009
        • Falzon C.
        • Chalabaev A.
        • Brizzi C.
        • Ganga M.
        • Schuft L.
        • Arripe-Longueville F.
        Etude qualitative des barrières psychologiques à l'exercice physique chez les personnes atteintes de cancer.
        7ème journée de l'École Doctorale des Sciences du mouvement Humain, Marseille, France2011
        • Farley-Short P.
        • Vargo M.M.
        Responding to employment concerns of cancer survivors.
        Journal of Clinical Oncology. 2006; 24: 5138-5141
        • Franke A.
        • Reiner L.
        • Pratzel H.G.
        • Franke T.
        • Resch K.L.
        Long-term efficacy of radon spa therapy in rheumatoid arthritis–a randomized, sham-controlled study and follow-up.
        Rheumatology. 2000; 39: 894-902
        • Gordon L.G.
        • Scuffham P.
        • Battistutta D.
        • Graves N.
        • Tweeddale M.
        • Newman B.
        Cost-effectiveness analysis of two rehabilitation support services for women with breast cancer.
        Breast cancer Research and Treatment. 2005; 94: 123-133
        • Henry M.
        • Baas C.
        • Mathelin C.
        Why do women refuse reconstructive breast surgery after mastectomy?.
        Gynécologie Obstétrique et Fertilité. 2010; 38: 217-223
        • Johnsson A.
        The Rehabilitation Process After Breast Cancer Diagnosis: Factors of Importance for Return to Work.
        Karolinska Institutet document, 2008
        • Kennedy F.
        • Haslam C.
        • Munir F.
        • Peryce J.
        Returning to work following cancer: a qualitative explorary study into the experience of returning to work following cancer.
        European Journal of Cancer Care. 2007; 16: 17-25
        • Khan F.
        • Amataya B.
        • Pallant J.F.
        • Rajapaksa I.
        Factors associated with long-term functional outcomes and psychological sequelae in women after breast cancer.
        The Breast. 2012; 21: 314-320
        • Kwiatkowski F.
        • Mouret-Reynier M.A.
        • Duclos M.
        • Leger-Enreille A.
        • Bridon F.
        • Hahn T.
        • et al.
        Long term improved quality of life by a 2-week group physical and educational intervention shortly after breast cancer chemotherapy completion. Results of the “PACThe” randomized clinical trial of 251 patients.
        European Journal of Cancer. 2013; 49: 1530-1538
        • Laird N.M.
        Missing data in longitudinal studies.
        Statistics in Medicine. 1988; 7: 305-315
        • Liljas B.
        How to calculate indirect costs in economic evaluations?.
        Pharmacoeconomics. 1998; 13: 1-7
        • Main D.S.
        • Nowels C.T.
        • Cavender T.A.
        • Etschmaier M.
        • Steiner J.F.
        A qualitative study of work and work return in cancer survivors.
        Psycho-oncology. 2005; 14: 992-1004
        • Maunsell E.
        • Drolet M.
        • Brisson J.
        • Brisson C.
        • Mâsse B.
        • Deschênes L.
        Work situation after breast cancer : résults from a population-bases study.
        Journal of the National Cancer Institute. 2004; 96: 1813-1822
        • Nitkin P.
        • Parkinson M.
        • Schultz I.
        Cancer and Work: a Canadian Perspective. vol. 1. Canadian Association of Psychological Oncology, 2011: 1-51
        • Nowrouzi B.
        • Lightfoot N.
        • Cote K.
        • Watson R.
        Workplace support for employees with cancer.
        Current Oncology. 2009; 16: 15-22
        • Reimat A.
        Production associative et bénévolat informel: quelle signification économique pour les activités de production des retraités ? Innovations.
        Cahiers d'économie de l'innovation. 2002; 15: 73-98
        • Rochefort H.
        • Rouesse J.
        Cancers du sein, incidence et prévention.
        Bulletin de l'Académie Nationale de Médecine. 2008; 192: 303-380
        • Stewart De E.
        • Cheung A.M.
        • Duff S.
        • Wong F.
        • Cheng T.
        • Purdy L.
        Long-term breast cancer survivors: confidentiality, disclosure, effects on work and insurance.
        Psycho-oncology. 2001; 10: 259-263
        • Strauss-Blasche G.
        • Gnad E.
        • Ekmekcioglu C.
        • Hlaschik B.
        • Marktl W.
        Combined inpatient rehabilitation and spa therapy for breast cancer patients: effects on quality of life and CA 15-3.
        Cancer Nursing. 2005; 28: 390-398
        • Sultan-Taïeb H.
        • Tessier P.
        • Béjean S.
        Capital Humain et coûts de friction. Quels critères de choix pour l'évaluation des pertes de production?.
        Revue Economique. 2009; 60: 293-307
        • Taskila T.
        • Lindbohm M.
        Factors affecting cancer survivor's employment and work ability.
        Acta Oncologica. 2007; 46: 446-451
        • Taskila T.
        • Martikainen R.
        • Virtanen S.V.
        • Pukkala E.
        • Hietanen P.
        • Lindbohm M.
        The impact of education and occupation on the employment status of cancer survivors.
        European Journal of Cancer. 2004; 40: 2488-2493
        • Thery H.
        (Rapport présenté au Conseil économique et social)Les activités d'utilité sociale des retraités et des personnes âgées. vol. 1. 1993: 1-187
        • Van Den Berg B.
        • Brouwer W.
        • Koopmanshap M.
        Economic valuation of informal care: an overview of methods and applications.
        Journal of Health Economics. 2004; 51: 570-577
        • Van Den Berg B.
        • Brouwer W.
        • Van Exel J.
        • Koopmanshap M.
        • Van Den Bos G.A.
        • Rutten F.
        Economic valuation of informal care: lessons from the application of the opportunity.
        Social Sciences and Medicine. 2006; 8: 141-152
        • Van Weert E.
        • Hoekstra-Weebers J.
        • Grol B.
        • Otter R.
        • Arendzen H.J.
        • Postema K.
        • et al.
        A multidimensional cancer rehabilitation program for cancer survivors effectiveness on health related quality of life.
        Journal of Psychosomatic Research. 2005; 58: 485-496