Exercise Does Not Prevent Lymphedema in Breast Cancer

Excerpt:

“Exercise does not appear to have any effect on the development of lymphedema in breast cancer patients, according to findings presented here at the Cancer Survivorship Symposium (CSS) Advancing Care and Research.

“Rates of lymphedema were almost the same for women randomly allocated to receive education only and for women allocated to receive education plus personalized exercise instruction from a physical therapist.

“At 18 months, there was no difference in the incidence of lymphedema. The lymphedema free rate was 58% in the education-only arm vs 55% in education-plus-exercise group.”

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Advanced Device Improves Health and Saves Costs for Patients with Lymphedema

“Lymphedema patients saw a nearly 80 percent reduction in their cellulitis episodes just by using an advanced pneumatic compression device at home, according to a study in JAMA Dermatology co-authored by Vanderbilt University School of Nursing Professor Sheila Ridner, PhD, MSHSA, FAAN, and University of Minnesota School of Public Health Associate Professor Pinar Karaca-Mandic, PhD.

“The reduction in episodes also led to a 37 percent reduction in lymphedema-related health care costs for study participants, Ridner said.

” ‘This could be a game-changer in the area of lymphedema care,’ said Ridner. ‘Up to 10 million people in the United States are living and oftentimes suffering with symptoms of lymphedema. The idea that a home advanced pneumatic compression device can provide relief, decrease the number of cellulitis episodes and save money is an important new option for patients.’ “


A Little Known Side Effect with a Huge Impact

“First, there was achiness, a pain that never went away. Then, her right arm and hand began to swell, a little at first and then a lot. Then Rebecca Thomas, a breast cancer survivor five years out from surgery, chemo and radiation, was hospitalized with a raging infection.

“ ‘The swelling wasn’t bad at first and I didn’t think much of it,’ said the 65-year-old food service worker from Seattle, who was diagnosed with cancer in 1988. ‘But I got a [cut] on my finger and bacteria got in there and I ended up with a very bad case of cellulitis. It got at least three times the normal size, my whole hand and arm. After that is when the trouble really set in.’

“Thomas’ ‘trouble’ was lymphedema, a condition that impacts millions of U.S. cancer survivors every year, particularly patients who undergo lymph node dissection as part of their treatment, like actress and ‘lymphedema ambassador’ Kathy Bates.


Which Breast Cancer Patients Need Lymph Nodes Removed? Ultrasound Narrows It Down

“Which breast cancer patients need to have underarm lymph nodes removed? Mayo Clinic-led research is narrowing it down. A new study finds that not all women with lymph node-positive breast cancer treated with chemotherapy before surgery need to have all of their underarm nodes taken out. Ultrasound is a useful tool for judging before breast cancer surgery whether chemotherapy eliminated cancer from the underarm lymph nodes, the researchers found. The findings are published in the Journal of Clinical Oncology.

“In the past, when breast cancer was discovered to have spread to the lymph nodes under the arm, surgeons routinely removed all of them. Taking out all of those lymph nodes may cause arm swelling called lymphedema and limit the arm’s range of motion.

“Now, many breast cancer patients receive chemotherapy before surgery. Thanks to improvements in chemotherapy drugs and use of targeted therapy, surgeons are seeing more women whose cancer is eradicated from the lymph nodes by the time they reach the operating room, says lead author Judy C. Boughey, M.D. a breast surgeon at Mayo Clinic in Rochester.”


Lymph Node Removal Presents Higher Lymphoedema Risk

“Cancer patients who have had lymph nodes removed or damaged due to surgery or treatments have an increased risk of developing secondary lymphoedema—a debilitating swelling of the limbs.

“Research involving endometrial cancer patients has found surgically removing a greater number of lymph nodes—along with other risk factors, such as treatment using radiation, chemotherapy or anti-inflammatory drugs—increases the risk of developing secondary lower limb lymphoedema (LLL).

“Lymphoedema is caused by extracellular fluid gathering around the cancer area or where nodes have been removed.

” ‘The swelling associated with lymphoedema has enormous personal and social costs to women who have had treatments for endometrial cancer,’ Queensland-based QIMR Berghofer Medical Research Institute lead researcher Dr Vanessa Beesley says.”


Lymphedema Home Treatment Improves Outcomes, Reduces Costs, Researchers Find

“Home therapy helps control symptoms and save on the costs of treating lymphedema, a painful, often debilitating side effect of life-saving cancer treatments, a new study has found.

“Patients with swelling caused by cancer-associated lymphedema can both reduce the severity of the disease and the overall cost of medical care by taking therapeutic steps at home, according to a study by researchers at the Stanford University School of Medicine.

“The study looked at the prevalence of lymphedema, a common side effect of cancer treatments, and found that the average annual cost of care for a patient with the condition decreased from $62,190 to $50,000 a year when the patient used pneumatic compression devices to treat the swelling.

” ‘Total health-care costs for these patients are very high, but can be profoundly reduced with treatment intervention, in this case a compression device,’ said Stanley Rockson, MD, professor of cardiovascular medicine at Stanford and senior author of the study, published online Dec. 3 in PLOS ONE. ‘This is clearly a compelling argument for increased coverage of similar home-care devices to reduce costs.’ “


Axillary Radiotherapy Reduced Morbidity in Breast Cancer with Positive Sentinel Node

The gist: Some women with breast cancer have some cancer cells in the sentinel lymph node. The standard treatment for a positive sentinel node is a surgery called axillary lymph node dissection. However, that procedure is associated with some harmful side effects. Recent research shows that an alternative treatment called axillary radiotherapy might be just as effective, with fewer side effects.

“Axillary radiotherapy and axillary lymph node dissection achieved similar rates of regional control in patients with breast cancer who have a positive sentinel node, according to results of a randomized phase 3 trial.

“However, radiotherapy was associated with significantly less morbidity.

“Axillary lymph node dissection has been the standard treatment for patients with breast cancer who have a positive sentinel node. Dissection provides excellent control but also is associated with harmful side effects, according to background information provided by researchers.

“In the current multicenter, open-label study, Mila Donker, MD, of the department of surgical oncology at Netherlands Cancer Institute, and colleagues assessed whether axillary radiotherapy provided comparable regional control with fewer side effects.”


Counseling Needed to Allay Fear of Lymphedema in Breast Cancer Survivors

“Individualized education and counseling should begin before surgery and continue throughout treatment for breast cancer survivors fearful of developing lymphedema, especially younger patients and those at higher risk after axillary lymph node dissection (ALND), a recent study found.

“More than 300 patients undergoing treatment for unilateral breast cancer were screened for lymphedema before and every 3 to 8 months after surgery and asked to fill out questionnaires assessing their fear. Higher preoperative fear score, age younger than 50 at diagnosis, and ALND were significantly associated with higher mean postoperative fear scores. The findings were published in the September issue of Oncology Nursing Forum.

“ ‘If and when fear of lymphedema is identified, nurses should evaluate whether that fear generates appropriate proactive behavior to prevent lymphedema or whether it negatively affects the survivor’s physical or mental state,’ the authors wrote. ‘In the latter case, such fear should alert nurses to counsel, educate, reassure, support, and reassess the patient on an ongoing basis.’

“The findings indicate that lymphedema—characterized by abnormal accumulation of fluid in the interstitial spaces of the arm, hand, shoulder, breast, or chest wall—is  distressing to many women regardless of whether or not they develop the condition, the authors said. In addition to physical symptoms such as swelling, heaviness and discomfort, and an increased risk of infection, many women experience psychological distress leading to poor body image, lower self-esteem, and increased anxiety.”


Patient-Reported Data Indicates That Radiation Therapy Does Not Increase Risk of Lymphedema in Node-Negative Breast Cancer Patients

“A secondary analysis of the National Surgical Adjuvant Breast and Bowel Project B-32 trial (Krag 2010) indicates that radiation therapy (RT) does not increase the incidence of lymphedema in patients with node-negative breast cancer, according to research presented today at the American Society for Radiation Oncology’s (ASTRO’s) 56th Annual Meeting.

“The original NSABP B-32 study was a randomized trial of sentinel node biopsy (SNB) versus SNB + axillary lymph node dissection (ALND) in 5,611 women with clinically node-negative breast cancer. The study was initiated to determine if SNB was as effective as ALND with fewer side effects.

“Although designed to assess the impact of type of axillary surgery specifically on lymphedema risk, the NSABP B-32 trial also provided the opportunity to evaluate the impact of radiation therapy (RT) on lymphedema risk. Lymphedema, swelling of the arm commonly caused by the removal of or damage to lymph nodes, is a significant concern for women undergoing breast cancer treatment.”