# Effects of a Multimodal Program on Frailty Syndrome and Psychological Alterations in Breast Cancer Women Treated with Aromatase Inhibitors

## TL;DR

A program combining exercise and education improves mental health and reduces frailty in breast cancer patients taking aromatase inhibitors.

## Contribution

The study demonstrates that a multimodal program can effectively reduce frailty and psychological symptoms in postmenopausal breast cancer patients on aromatase inhibitors.

## Key findings

- After the program, 63.5% of participants were no longer classified as frail or pre-frail.
- Significant improvements were observed in anxiety, depressive symptoms, and sleep quality.
- Marital status and attendance at training sessions were linked to better mental health outcomes.

## Abstract

Background/Objectives: Treatment with aromatase inhibitors can worsen frailty syndrome and psychological symptoms in women diagnosed with breast cancer (BC) receiving these drugs to prevent cancer recurrence. We analyze whether postmenopausal women with localized BC receiving aromatase inhibitors (AIs) treatment can achieve improvements in their mental health and their level of frailty through a multimodal program that includes supervised physical exercise and health education workshops. Methods: A total of 52 postmenopausal women with a prior diagnosis of BC and receiving hormonal treatment with AIs were included in the multimodal physical exercise and health education program and evaluated before and after it. The assessment included the following five frailty syndrome (FS) criteria: involuntary weight loss, weakness, low physical activity, slow gait speed, and low muscle strength. Mental health was assessed using the Goldberg scale, with its subscales for anxiety and depressive symptoms. The Athens scale was used to assess subjective sleep quality. Results: There was a significant difference in the number of robust, pre-frail and frail women after the program compared to the baseline. Six women did not fulfill any criteria for (robust) FS before the program (11.5%), and thirty-three women (63.5%) after the program did not fulfill any criteria for FS. A total of 33 (63.5%) women met one or two FS criteria (pre-frail) before the program, and 18 (34.6%) met one or two FS criteria after the program; thirteen (25%) women met three or more FS criteria (frail) before the program and one (1.9%) after it (p < 0.001). A statistically significant improvement on the Goldberg scale was observed (on both the subscales for anxiety and depressive symptoms) (p < 0.001). A statistically significant improvement was also noted on the Athens insomnia scale (p < 0.001). A multivariate regression model analysis identified marital status (being married) (p = 0.047, beta coefficient= −0.249, 95% CI −1.4844–−0.14) and the percentage of attendance at training sessions (p = 0.041, beta coefficient = −0.290, 95% CI 0.104–0.002) as associated variables, with a lower score on the Goldberg depression subscale. Conclusions: Mental health and frailty, common in postmenopausal women diagnosed with BC on hormonal treatment with AI, can be improved with multimodal programs of supervised physical exercise and health education.