Ammitzbøll G1, Johansen C1,2, Lanng C3, Wreford Andersen E4, Kroman N3,5, Zerahn B6, Hyldegaard O7, Oksbjerg Dalton S1
1Danish Cancer Society Research Center, Survivorship Unit, Copenhagen, Denmark, 2Copenhagen University Hospital Rigshoispitalet, Department of Oncology, Copenhagen, Denmark, 3Copenhagen University Hospital Rigshoispitalet, Breast Surgery, Copenhagen, Denmark, 4Danish Cancer Society Research Center, Statistics and Pharmaepidemiology, Copenhagen, Denmark, 5Danish Cancer Society Research Center, Copenhagen, Denmark, 6Copenhagen University Hospital Herlev, Clinical Physiology and Nuclear Medicine, Copenhagen, Denmark, 7Copenhagen University Hospital Rigshoispitalet, Section for Hyperbaric Oxygen Treatment, Department for Anaesthetics and Operations, Center for Head and Orthopaedics, Copenhagen, Denmark
Background: To date, Breast cancer related lymphedema remains an unresolved problem affecting one third of women after breast cancer. As physiotherapists we can offer symptom management, but once persistent, lymphedema is there to stay. Research in the last decade has documented that strength training after breast cancer surgery does not cause or worsen lymphedema. Some have suggested resistance training might prevent lymphedema, but scientific proof is lacking.
Purpose: The primary aim of this study was to test in a randomized design, if progressive resistance training can prevent breast cancer related lymphedema in the first year after surgery. Secondary aims were to assess the effect on pain and quality of life.
Methods: Women, aged 18 to 75, undergoing breast cancer surgery with axillary lymph node dissection, were eligible for the study. Patients were recruited on the day of surgery and computer randomization allocated participants to intervention or usual care control. The intervention consisted of progressive resistance training 3 times a week; 20 weeks supervised followed by 30 weeks self-administered. All assessors were blinded to participant group allocation.
The primary outcome was Lymphoedema, assessed at baseline and 12-month follow-up by water displacement (and DXA scans for a subgroup) and clinical examination. Intention-to-treat analyses were done using two-tailed t tests and regression models.
The secondary outcomes were assessed with questionnaires at baseline, 20-week and 12-month follow-up, including the neuPP-scale to assess pain and the EORTC QLQ C-30 and Facit-fatigue scales for assessing quality of life. Statistical analyses included logistic regression models for binary outcomes and mixed effect models for continuous outcomes.
Results: With 158 women randomized, we found no group mean difference in change of lymphedema outcomes, either by inter limb volume difference (1.12%, 95% confidence interval (CI) -1.04; 3.27) or clinical examination (OR 1.04, CI 0.49; 2.18). Analyses of secondary outcomes showed a consistent tendency that participants in the intervention group experienced less pain, and that the intervention had caused a statistically significant improvement in quality of life.
Conclusion(s): We found no evidence that progressive resistance training could prevent lymphedema in the first year after breast cancer surgery, but our results support the increasing body of evidence justifying resistance training in the post-operative phase as a safe method to promote physical function and quality of life.
Implications: Results from this study reinforce the importance of implementing strength training in rehabilitation after breast cancer. We recommend supervision by physiotherapists initially to promote biomechanically correct movement patterns and individualize the exercise load and progression.
Furthermore, it underlines the need for more knowledge about lymphedema pathophysiology and to detangle the mechanisms and predispositions involved in lymphedema development before prevention can be achieved.
Keywords: oncology, musculoskeletal, upper limb
Funding acknowledgements: This study was funded by the Knæk Cancer Campaign in 2014, and the TRYG Foundation.
Purpose: The primary aim of this study was to test in a randomized design, if progressive resistance training can prevent breast cancer related lymphedema in the first year after surgery. Secondary aims were to assess the effect on pain and quality of life.
Methods: Women, aged 18 to 75, undergoing breast cancer surgery with axillary lymph node dissection, were eligible for the study. Patients were recruited on the day of surgery and computer randomization allocated participants to intervention or usual care control. The intervention consisted of progressive resistance training 3 times a week; 20 weeks supervised followed by 30 weeks self-administered. All assessors were blinded to participant group allocation.
The primary outcome was Lymphoedema, assessed at baseline and 12-month follow-up by water displacement (and DXA scans for a subgroup) and clinical examination. Intention-to-treat analyses were done using two-tailed t tests and regression models.
The secondary outcomes were assessed with questionnaires at baseline, 20-week and 12-month follow-up, including the neuPP-scale to assess pain and the EORTC QLQ C-30 and Facit-fatigue scales for assessing quality of life. Statistical analyses included logistic regression models for binary outcomes and mixed effect models for continuous outcomes.
Results: With 158 women randomized, we found no group mean difference in change of lymphedema outcomes, either by inter limb volume difference (1.12%, 95% confidence interval (CI) -1.04; 3.27) or clinical examination (OR 1.04, CI 0.49; 2.18). Analyses of secondary outcomes showed a consistent tendency that participants in the intervention group experienced less pain, and that the intervention had caused a statistically significant improvement in quality of life.
Conclusion(s): We found no evidence that progressive resistance training could prevent lymphedema in the first year after breast cancer surgery, but our results support the increasing body of evidence justifying resistance training in the post-operative phase as a safe method to promote physical function and quality of life.
Implications: Results from this study reinforce the importance of implementing strength training in rehabilitation after breast cancer. We recommend supervision by physiotherapists initially to promote biomechanically correct movement patterns and individualize the exercise load and progression.
Furthermore, it underlines the need for more knowledge about lymphedema pathophysiology and to detangle the mechanisms and predispositions involved in lymphedema development before prevention can be achieved.
Keywords: oncology, musculoskeletal, upper limb
Funding acknowledgements: This study was funded by the Knæk Cancer Campaign in 2014, and the TRYG Foundation.
Topic: Oncology, HIV & palliative care; Musculoskeletal: upper limb
Ethics approval required: Yes
Institution: The National Committe on Health Research Ethics
Ethics committee: The Capital Region Health Research Committee
Ethics number: H-15002714
All authors, affiliations and abstracts have been published as submitted.
