Tuesday, January 31, 2017

Exercise Does Not Prevent Lymphedema in Breast Cancer

The authors found that 31% of the patients wore the sleeve about 75% of the time. Forgetting to wear the sleeve and discomfort were the most frequently cited barriers to its use. For exercise, 55.4% of the patients performed stretching exercises one or more times a week; 47.4% performed strengthening exercises; and 48% performed stretching and lymph flow exercises. Being "too busy" was the most common reason for not doing the exercises.

The attitudes toward exercise were either neutral or favorable. For quality of life, the education-only group experienced a larger decrease in breast cancer anxiety compared to the education-and-exercise group (from baseline to 12 months, P = .04; to 18 months, P = .04). Not surprisingly, Dr Paskett noted, lymphedema status did affect quality of life. At 18 months, scores on the FACT-Band 4 lymphedema subscales were worse for those with lymphedema than those without it (P = .002). Strength Training No Longer Taboo In a discussion of the paper, Ann Partridge, MD, from the Dana Farber Cancer Center, Boston, Massachusetts, commented that these results are disappointing and that they could perhaps be explained by several hypotheses.

One is that the wrong type of exercise may have been used. "Maybe it was not the type of exercise that would benefit these patients," said Dr Partridge. "The physical therapists could have been more focused on range of motion and less on cardiovascular and strength training," she explained, adding that when this study was initiated, strength training was considered somewhat taboo for this population and that that view changed during the study period. Since this study began, research on the use of gradual strength training for breast cancer patients has been published, Dr Partridge pointed out. "These results suggest that not only is progressive weight training not bad for these patients, but it can also improve exacerbation of lymphedema. The study didn't look at prevention, but exercise did not cause it to occur."

Another hypothesis is that confounders may have affected the results. "Even though this was a randomized study, it could have been unbalanced," she said. "They tried to prevent contamination, but we all know that unless you are testing a novel, targeted therapy that you can only get in the cancer center, it is difficult to prevent this." For example, patients can go out and exercise, or they can see a physical therapist. "I think the researchers have collected those data on the patients who were not in this intervention, so we may have more information on that," she said. There are also unmeasured confounders. "One of the biggest predictors of lymphedema is the receipt of radiation to the breast and axillary region," Dr Partridge emphasized. "I should say that it was measured, but the impact has not yet been analyzed." The quality of life data showed that the women in the intervention group experienced more anxiety than the control patients. "Were they upset because they were not adherent, for example?" she questioned. "This really highlights the need for rigorous evaluation of interventions before we adopt them into clinical practice."

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