ORLANDO — Women who are taught a series of exercises aimed at improving their arm mobility after lymph node dissection for breast cancer regain full range of motion (ROM) in both arms sooner than women who receive education alone, a secondary analysis of the Lymphedema Education and Prevention study suggests.
“Most women who have had lymph node dissection get an instruction sheet on exercise after they are discharged from surgery but little else,” Electra Paskett, PhD, professor of cancer research at the Ohio State University, Cleveland, said in a statement.
“We hope this study brings awareness to the need to follow up with women who have had lymph node surgery and who experience range of arm motion problems as a result,” she added.
The study was presented here at the Cancer Survivorship Symposium (CSS) Advancing Care and Research and was highlighted in a premeeting presscast.
“As a breast cancer survivor myself who experienced 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,” Paskett commented at the briefing.
“Our take-home message here is that all women receiving lymph node dissection, whether it’s axillary or sentinel, should receive physical therapy to regain ROM more quickly after surgery and help maintain physical function,” Paskett concluded.
Commenting on the study, American Society of Clinical Oncology expert Timothy Gilligan, MD, moderator of the presscast, noted that loss of arm mobility is a big quality-of-life issue for women who have axillary node dissection for breast cancer.
“The good news here is that physical therapy can help and women should be aware of this and have access to physical therapy in order to benefit from this kind of intervention,” Gilligan said.
Gilligan added that “knowing that exercise after surgery can help women with breast cancer quickly restore their full ROM is an important step forward in their care.”
Study Details
A total of 568 women from 41 sites involved in the Lymphedema Education and Prevention study (CALGB 70305) were randomly assigned to the education plus exercise group or the education alone group. The education component included information about the signs and symptoms about lymphedema as well as risk reduction strategies.
Those who received an additional exercise session met with a lymphedema specialist, usually a physical therapist, and were taught stretching and breathing exercises to improve ROM following either axillary or sentinel node dissection.
They were also fitted with an elastic compression sleeve and gauntlet, told when to wear it, and were given 2-lb hand weights and a take-home video that demonstrated all the exercises they were taught during the session with the physical therapist.
Arm mobility was assessed by using self-administered survey where patients reported their ROM for both the affected arm and the unaffected arm before surgery and again 12 and 18 months afterward.
ROM was described as very little, about half, nearly full, overhead, and full.
The two study groups were uneven to begin with. “Before surgery, women in the ‘education + exercise’ group were less likely to report full ROM for both arms,” investigators observe.
Specifically, before surgery, 58% of women in the dual intervention group reported full ROM in their left arm compared with 75% of those in the education alone group; for the right arm, the percentages were 57% and 76%, respectively (P = .0004 for both arms).
After the surgery, more women in the dual intervention group had full motility.
“At 12 months post-surgery, women in the education plus exercise arm were significantly more likely to report full ROM compared to the education only arm,” Paskett reported.
The fact that women in the dual intervention group started with worse full ROM but then ended up with better ROM than the other group “does speak to the benefit of this intervention,” she added in a comment to Medscape Medical News.
Table. Full ROM at 12 Months After Surgerya
| Arm | Education + Exercise (%) | Exercise Alone (%) | ||
|---|---|---|---|---|
| Left | 91 | 84 | ||
| Right | 90 | 80 | ||
| aP = .02. | ||||
By 18 months, 93% of both groups reported full ROM for both arms, Paskett observed.
Analysis of the affected arm where surgery had been performed also showed a benefit in favor of those who received additional exercise training.
Compared with baseline, women in the education plus exercise group had a 32% increase in full ROM at 12 months compared with only a 6% increase in full ROM in the education alone group.
At 18 months, full ROM increased 37% in the education plus exercise group vs only 3% increase in the education only group.
Paskett declares she has stock and other ownership interests in Pfizer and Meridian Biosciences Inc and has received research funding (via her institution) from Merck. Gilligan reports receiving travel, accommodation, and expenses from WellPoint.
Cancer Survivorship Symposium (CSS) Advancing Care and Research. Abstract 123. Presented on February 17, 2018.
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