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

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.

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

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.

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

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