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Exercise intervention improves arm mobility after lymph node dissection
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A lymphedema prevention program that included guided exercise and education improved recovery of arm range of motion among women with breast cancer who received lymph node dissection, according to a secondary analysis of the phase 3 randomized Lymphedema Education and Prevention study scheduled for presentation at the Cancer Survivorship Symposium.
The use of axillary or sentinel lymph node dissection — or surgery that removes lymphatic tissue between the breast and underarm — for breast cancer treatment can damage lymph nodes, causing fluid buildup in tissues and arm swelling. This often-disabling arm swelling, called lymphedema, can impair arm movement temporarily or permanently.
“Our results show that women in the education plus exercise group reported regaining full range of both in both arms sooner than women in the education-only group, and that women in the exercise group reported better improvement in range of motion from baseline from the affected arm,” Electra D. Paskett, PhD, professor of cancer research at The Ohio State University and association director for population sciences at Comprehensive Cancer Center of The Ohio State University, said during a press conference. “Our take-home message is that all women receiving lymph node dissection, whether full or sentinel, should receive physical therapy to regain range of motion after surgery and thus help maintain physical function.”
Researchers and colleagues randomly assigned 568 women from 41 participating sites to an education-only intervention (n = 253) — which included information about lymphedema symptoms and risk-reduction strategies — or education with exercise (n = 315). The exercise included arm stretching and breathing exercises with a physical therapist.
Paskett and colleagues sought to determine whether this lymphedema prevention program also would impact range of motion in the affected and unaffected arm.
“Most women who have lymph node dissection get an instruction sheet on exercise after they are discharged from surgery, but little else,” Paskett said in a press release. “As a breast cancer survivor myself who experienced arm swelling after surgery, I thought it was important to try to determine if women were receiving adequate follow-up to deal with certain health issues, including the loss of the range of motion in their arms.”
Patients completed self-administered surveys presurgery and at 12 months and 18 months postsurgery to assess range of motion for each arm, rated as very little, about half, nearly full, overhead and full.
Before surgery, fewer women assigned education and exercise reported full range of motion for both arms (left, 58% vs. 75%; right, 57% vs. 76%; P = .0004 for both arms).
However, by 12 months, women in the exercise group were more likely to report full range of motion than women in the education-only group (left, 91% vs. 84%; right, 90% vs. 83%; P = .02 for right arm).
By 18 months, nearly 93% of both groups had full range of motion for both arms.
When researchers evaluated how much range of motion improved specifically in the arm where surgery occurred, they observed a 32% improvement in the exercise group compared with a 6% improvement in the education-only group at 12 months. At 18 months, this improvement increased to 37% in the exercise group compared with 13% in the education group.
“We hope this study brings awareness to the need to follow-up with women who have had lymph node surgery and experience range-of-arm-motion problems as a result,” Paskett said. “Exercise certainly helped most women quickly get back to their full range of arm motion, but because most health insurance plans do not cover this type of intervention, there has been little effort to try to find remedies that are effective.” – by Alexandra Todak
Reference:
Paskett ED, et al. Abstract 123. Presented at: Cancer Survivorship Symposium; Feb. 16-17, 2018; Orlando, Florida.
Disclosures: Paskett reports stock and other ownership interests in Meridian Bioscience, Inc. and Pfizer, as well as research funding from Merck. The other authors report no relevant financial disclosures.
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Timothy Gilligan, MD, MSc, FASCO
This is an important issue, and a big quality-of-life issue for women who undergo axillary lymph node dissection for breast cancer. The good news here is that physical therapy can help. Women should be aware of this, and they should have access to physical therapy so they can benefit from this kind of work.
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