Randomized Controlled Trial of Weight Training and Lymphedema in Breast Cancer Survivors

Rehana L. Ahmed, William Thomas, Douglas Yee, Kathryn H. Schmitz

PURPOSE: Lymphedema is a common condition that breast cancer survivors face. Despite a lack of supporting evidence from prospective observational studies, occupational and leisure time physical activity are feared to be possible risk factors for lymphedema onset or exacerbation. We examined effects of supervised upper- and lower-body weight training on the incidence and symptoms of lymphedema in 45 breast cancer survivors who participated in the Weight Training for Breast Cancer Survivors study.

METHODS: Participants were on average 52 years old, 4 to 36 months post-treatment, and had axillary dissection as part of their treatment. Thirteen women had prevalent lymphedema at baseline. The intervention was twice-a-week weight training over a period of 6 months. Lymphedema was monitored at baseline and 6 months by measuring the circumference of each arm, and by self-report of symptoms and clinical diagnosis.

RESULTS: None of the intervention-group participants experienced a change in arm circumferences 2.0 cm after a 6-month exercise intervention. Self-reported incidence of a clinical diagnosis of lymphedema or symptom changes over 6 months did not vary by intervention status (P = .40 and P = .22, respectively).

CONCLUSION: This is the largest randomized controlled trial to examine associations between exercise and lymphedema in breast cancer survivors. The results of this study support the hypotheses that a 6-month intervention of resistance exercise did not increase the risk for or exacerbate symptoms of lymphedema. These results herald the need to start reevaluating common clinical guidelines that breast cancer survivors avoid upper body resistance activity for fear of increasing risk of lymphedema.

Journal of Clinical Oncology, Vol 24, No 18 (June 20), 2006: pp. 2765-2772 – full text

Filed under: Breast cancer, Exercise, Rehabilitation

Effects of Pilates Exercises on Shoulder Range of Motion, Pain, Mood, and Upper-Extremity Function in Women Living with Breast Cancer: A Pilot Study

Keays, KS, S. R. Harris, J. M. Lucyshyn and D. L. Macintyre

BACKGROUND AND PURPOSE: The purpose of this study was to examine the effects of Pilates exercises on shoulder range of motion (ROM), pain, mood, and upper-extremity (UE) function in women who had been treated for breast cancer. Participants: The participants were 4 women who had undergone axillary dissection and radiation therapy for stage I to IV breast cancer. METHODS: A nonconcurrent, multiple-baseline, single-subject research design was used to examine the effects of Pilates exercises on the 4 outcomes. RESULTS: Visual analyses of the data suggest a modest effect of the Pilates exercise program in improving shoulder abduction and external rotation ROM. Statistically significant improvement in shoulder internal and external rotation in the affected UE was shown for the one participant with pre-existing metastatic disease. The improving baselines seen for pain, mood, and UE function data made it impossible to assess the effects of Pilates exercises on those outcomes. No adverse events were experienced. DISCUSSION AND CONCLUSION: Pilates exercises may be an effective and safe exercise option for women who are recovering from breast cancer treatments; however, further research is needed.

Physical  Therapy. 2008 04; 884: 494-510

Full text available in  through MTABC member only website (link) under the research tab and then library.

Filed under: Breast cancer, Rehabilitation

Effect of Exercise on Upper Extremity Pain and Dysfunction in Head and Neck Cancer Survivors: A Randomized Controlled Trial.

McNeely, ML, M. B. Parliament, H. Seikaly, et al.

BACKGROUND: Shoulder pain and disability are well recognized complications associated with surgery for head and neck cancer. This study was designed to examine the effects of progressive resistance exercise training (PRET) on upper extremity pain and dysfunction in postsurgical head and neck cancer survivors. METHODS: Fifty-two head and neck cancer survivors were assigned randomly to PRET (n = 27) or a standardized therapeutic exercise protocol (TP) (n = 25) for 12 weeks. The primary endpoint was change in patient-rated shoulder pain and disability from baseline to postintervention. Secondary endpoints were upper extremity strength and endurance, range of motion, fatigue, and quality of life. RESULTS: Follow-up assessment for the primary outcome was 92%, and adherence to the supervised PRET and TP programs were 95% and 87%, respectively. On the basis of intention-to-treat analyses, PRET was superior to TP for improving shoulder pain and disability (-9.6; 95% confidence interval [95% CI], -16.4 to -4.5; P = .001), upper extremity strength (+10.8 kg; 95% CI, 5.4-16.2 kg; P < .001), and upper extremity endurance (+194 repetitions x kg; 95% CI, 10-378 repetitions x kg; P = .039). Changes in neck dissection impairment, fatigue, and quality of life favored the PRET group but did not reach statistical significance. CONCLUSIONS: The PRET program significantly reduced shoulder pain and disability and improved upper extremity muscular strength and endurance in head and neck cancer survivors who had shoulder dysfunction because of spinal accessory nerve damage. Clinicians should consider the addition of PRET in the rehabilitation of postsurgical head and neck cancer survivors.

Cancer. 2008 Jul 1; 1131: 214-222 – full text

Filed under: Cancer area, Head and neck, Rehabilitation

Severity of Acute Pain After Breast Surgery Is Associated With the Likelihood of Subsequently Developing Persistent Pain

Hickey, Oonagh T; Burke, Siun M; Hafeez, Parvaiz; Mudrakouski, Aliaksandr L; Hayes, Ivan D; Shorten, George D

Objectives: Persistent postsurgical pain (PPSP) after surgery for breast cancer has a prevalence of 20% to 52%. Neuroplastic changes may play a role in the aetiology of this pain. The principal objective of this study was to examine the relationship between acute pain after surgery for breast cancer and the likelihood of subsequently developing PPSP.

Methods: Twenty-eight women undergoing surgery for breast cancer completed visual analogue scales for pain and anxiety, the McGill Pain Questionnaire (long form) and the Hospital Anxiety and Depression Scale. Analgesic requirements and adverse effects of analgesic therapy were noted. Quantitative sensory testing was carried out perioperatively using an electrical stimulus, and the sensation perception, pain perception, and pain tolerance thresholds were measured bilaterally at the T4 dermatomes and at the contralateral L5 dermatome. Patients with and without PPSP 3 months postoperatively were compared in terms of these parameters.

Results: Eight participants (28.6%) reported PPSP. Those who subsequently developed PPSP reported greater pain scores on the McGill Pain Questionnaire 5 days postoperatively than those that did not (pain rating index, P=0.014; present pain intensity, P=0.032). None had sought medical attention for their persistent pain. Patients with and without PPSP were similar in terms of mental status (anxiety and depression), analgesic consumption, adverse effects of analgesic therapy, and changes on QST.

Discussion: Patients who developed PPSP experienced pain of greater intensity on the fifth postoperative day than those that did not.

Clinical Journal of Pain. 26(7):556-560, September 2010.

Full text available in  through MTABC member only website (link) under the research tab and then library.

Filed under: Breast cancer

Massage therapy for cancer palliation and supportive care: a systematic review of randomised clinical trials

Ernst E.

INTRODUCTION: Massage is a popular adjunct to cancer palliation. This systematic review is aimed at critically evaluating all available randomised clinical trials of massage in cancer palliation. MATERIALS AND METHODS: Six databases were searched to identify all trials of classical massage for cancer patients. Studies of other types of massage, e.g. reflexology, aromatherapy, were excluded. Fourteen trials met all inclusion criteria.

DISCUSSION: Collectively, they suggest that massage can alleviate a wide range of symptoms: pain, nausea, anxiety, depression, anger, stress and fatigue. However, the methodological quality of the included studies was poor, a fact that prevents definitive conclusions.

CONCLUSION: The evidence is, therefore, encouraging but not compelling. The subject seems to warrant further investigations which avoid the limitations of previous studies.

Supportive Care in Cancer, Volume 17, Number 4 / April, 2009 – abstract

Filed under: Palliative care, Review, Therapies , Cancer palliation, Effectiveness, Massage, Systematic review

Developing a model for complementary therapy for patients with cancer

Hews, S

An initiative offers complementary therapies to patients with cancer using a model of integrated care

This article outlines an initiative to offer complementary therapy to patients with cancer, describing how the service was set up and funded, and the model of care. It also highlights some findings from research evidence.

Nursing Times;105: 8, 14–15.- full text

Filed under: CAM, integrated care

Shoulder dysfunction in breast cancer patients

Physical therapist Nicole Stout Gergich discusses shoulder dysfunction in breast cancer patients. Bruce Jancin of Elsevier Global Medical News (EGMN) interviews Ms. Gergich at the annual San Antonio Breast Cancer Symposium.

Filed under: Breast cancer, Shoulder, Therapies

Massage therapy as a supportive care intervention for children with cancer

Hughes D; Ladas E; Rooney D; Kelly K

Abstract:

Purpose/Objectives: To review relevant literature about massage therapy to assess the feasibility of integrating the body-based complementary and alternative medicine (CAM) practice as a supportive care intervention for children with cancer.More than 70 citations were reviewed. Data Synthesis: Massage therapy may help mitigate pain, anxiety, depression, constipation, and high blood pressure and may be beneficial during periods of profound immune suppression. Massage techniques light to medium in pressure are appropriate in the pediatric oncology setting.Conclusions: Massage is an applicable, noninvasive, therapeutic modality that can be integrated safely as an adjunct intervention for managing side effects and psychological conditions associated with anticancer treatment in children. Massage may support immune function during periods of immunosuppression.Implications for Nursing: Pediatric oncology nurses are vital in helping patients safely integrate CAM into conventional treatment. Pediatric oncology nurses can help maximize patient outcomes by assessing, advocating, and coordinating massage therapy services as a supportive care intervention.

Oncology Nursing Forum, 2008 May; 35(3): 431-42 (80 ref)

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Filed under: Pediatrics, Review