Breast cancer treatment often results in shoulder and arm pain, such as chronic pain, restricted shoulder movement, or lymphedema in the armpit area which can affect quality of life and slowing recovery. According to an U.K. study published on Nov. 10 in The BMJ, women who exercised soon after nonreconstructive Breast Cancer Surgery were less painful after one year and experienced more arm and shoulder mobility.
“Hospitals should think about educating physical therapists in the PROSPER programme to provide this prescribed, structured exercise program to women who are undergoing the axillary clearance surgery as well as those receiving radiotherapy to the axilla,” said lead author Julie Bruce, PhD, specialist in surgical epidemiology at the University of Warwick, Coventry, England.
About one-third of women experience adverse reactions to their lymphatic and musculoskeletal systems following breast cancer surgery and radiotherapy targeted at the axilla. A study of 241 women in Denmark found that pain remained for up to 7 years after the treatment for breast cancer. U.K. guidelines for the treatment of breast cancer suggest referral to physical therapy if such problems develop, but the best timing and intensity as well as the safety of postoperative exercise remain uncertain. A review of the literature from 2019 revealed insufficient evidence to justify the practice of exercise postoperatively after breast cancer surgery. In addition, there are concerns about this type of exercise, including increased risk of postoperative wound complications, as well as lymphedema.
“The study was designed to determine if the early postoperative exercise for women with a high risk of shoulder and arm problems after nonreconstructive surgery was safe, clinically, and cost-effective. Previous studies were limited, and no large high-quality, randomized controlled trials of the highest quality had been undertaken with this patient group in the U.K.,” Bruce said.
In UK PROSPER, a multicenter, randomized controlled trial, researchers examined the effects of an exercise program compared with the usual care of 392 women (mean age 58) who underwent breast cancer surgery at 17 National Health Service (NHS) cancer centers. Randomly, the patients were assigned to either usual care with structured exercise, or normal care with no structured exercise.
The structured exercise, which was introduced 7-10 days postoperatively included an exercise program led by physical therapy comprising stretching, strengthening, and physical exercise, with behavioral change techniques to help the adherence to exercise. Two additional appointments were scheduled 1 and 3 months later. The outcomes included the capacity to use the upper limbs as measured with the Disability of Arm Hand and Shoulder (DASH), questionnaire at 12 months, complications and health-related quality of life.
Women in the exercise group showed better upper limb function at 12 months than those who received normal care (mean DASH 16.3 exercise, 23.7 usual care; adjusted median difference 7.81 95% confidence interval, 3.17-12.44 =.001). Women who exercised had lower levels of pain and less symptoms of arm impairment than those who received standard care. They also had a higher quality of life.
“We observed that arm function, as measured by the DASH scale was improved over time. We discovered that the differences between treatment groups persisted at 12 months,” Bruce said. “There was no risk of neuropathic pain or lymphedema, so we concluded that the planned exercise program introduced from the seventh postoperative day was safe. Strengthening exercises were introduced from one month postoperatively.”
The authors also noted that the study was not complete as participants and physical therapists knew which treatment they received however, they emphasized that the study included a larger sample size than the previous studies, and also an extended period of follow-up.
“We are aware that some women develop late lymphedema. Our findings were based upon 12-month follow-up. Bruce stated that they hope to continue long-term monitoring of our patients’ samples in the future.
The authors received assistance from the UK National Institute for Health Research Technology Assessment Programme.
This article originally appeared on MDedge.com, part of the Medscape Professional Network.
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