Evidence Update: Lymphedema and Shoulder Pain
TurningPoint clinicians have long been aware that there is a relationship between long-standing lymphedema and shoulder pain and problems. In a study published last month, researchers in Korea examined the relationship between lymphedema and shoulder joint changes in breast cancer patients. Forty-seven breast cancer patients with lymphedema were assessed. The duration of the arm swelling and shoulder pain were recorded. Ultrasound examination of the shoulder joint was performed in all patients to detect any changes in the soft tissue around the shoulder joint. Interestingly, abnormalities were found in 87% of the 47 participants. These changes included thickening of the bursa and small tears in the rotator cuff tendons. The changes tended to be more significant in patients who had lymphedema for a longer period of time. The authors concluded that there is a relationship between shoulder problems and lymphedema and that clinicians should adopt an early management approach for shoulder pain in patients with breast cancer-related lymphedema, http://affectivebrain.com/?attachment_id=5775. TurningPoint’s lymphedema screening program which facilitates early detection and management of lymphedema, along with providing rehabilitation for shoulder issues when they occur, should reduce the impact of lymphedema on long-term shoulder issues. Yang DH et al. The Influence of Arm Swelling Duration on Shoulder Pathology in Breast Cancer Patients with Lymphedema. PLoS One. 2015 Nov 16;10(11):e0142950. doi: 10.1371/journal.pone.0142950. eCollection 2015.
Evidence Update: Breast Reconstruction and Lymphedema Risk
Patients often ask us if breast reconstruction after mastectomy increases their risk of lymphedema. Several studies in the past suggest that breast reconstruction does not increase lymphedema risk. In a recent study published in October, researchers compared the number of patients who developed lymphedema in three surgical groups: mastectomy alone, immediate expander or implant and immediate reconstruction with autologous tissue (patients’ own tissue, such as TRAM flap). Immediate reconstruction refers to reconstruction performed at the time of the mastectomy. In this study, 616 patients with breast cancer who had a total of 891 mastectomies were prospectively screened for lymphedema and followed for an average of 22 months. Arm measurements were performed preoperatively and during postoperative follow-up using a Perometer like the one used at TurningPoint. For the purpose of this study, lymphedema was defined as 10% or more arm volume increase* compared to preoperative. Researchers controlled for variables that are known to increase lymphedema risk, such as the number of nodes removed, BMI and radiation so that they could compare the groups on the basis of reconstruction procedure alone. The study found reduced lymphedema risk in patients with immediate expander/implant reconstruction compared to mastectomy alone and autologous reconstruction. The mechanism by which immediate expander/implant reconstruction appears to reduce lymphedema risk is not known, and further research is needed. However, based on this study and others, it is safe to conclude that immediate reconstruction does not appear to increase lymphedema risk and, in the case of expanders/implants, may actually decrease lymphedema risk. Miller CL et al. Immediate Implant Reconstruction Is Associated With a Reduced Risk of Lymphedema Compared to Mastectomy Alone: A Prospective Cohort Study. Ann Surg. Oct 10, 2015 [Epub ahead of print] *(Note to TurningPoint patients: In TurningPoint’s model of lymphedema surveillance and management, 10% lymphedema is considered to be moderate lymphedema. When we are measuring you in the clinic, we define lymphedema as an increase of more than 3-5% above your baseline measures and we take into consideration visible swelling and symptoms of lymphedema such as heaviness sensation of the arm).
Evidence Update: Massage Therapy Helps Relieve Cancer-Related Pain
Pain related to cancer and its treatment is a common problem among patients with cancer. Conventional treatment does not always relieve cancer pain satisfactorily. A recent publication analyzed and published research on the effect of massage therapy and cancer pain. Twelve available studies that included 559 total participants were reviewed. The authors found significant reductions in cancer pain with massage, especially for surgery related pain. Comparing massage therapy with no massage treatment or conventional care, massage therapy was effective in relieving pain in cancer patients. The analysis suggests that massage therapy has significant positive effects for cancer pain relief, particularly for the short term. Further well-designed, large studies with longer follow-up periods are needed to be able to draw firmer conclusions regarding the effectiveness. Lee S, Kim Jy et al. Meta-Analysis of Massage Therapy on Cancer Pain. Integrative Cancer Therapies 14 (2015): 297-304.
Evidence Update: Older Cancer Patients Miss Benefit of Physical Therapy
A recent study published by researchers at The University of North Carolina examined the utilization of occupational and physical therapy (OT/PT) services in older cancer patients. The records of 592 patients with cancer were examined. The average age was 71, and 63% of the patients had breast cancer. Most of the patients (64.5%) had at least one functional deficit and 41% had at least two functional deficits all potentially requiring OT/PT. These deficits were measured with standard scales and tests, and included reduced physical health, difficulties with activities of daily living and reduced social activities, reduced memory or concentration and/or a history of falls. Of cancer patients with functional deficits only 9% received OT/PT within 12 months of a noted deficit. The authors concluded that a minority of older cancer patients, even with defined functional deficits that could benefit from rehabilitation, were referred for OT/PT care. TurningPoint began to beat the drum for breast cancer patients to be routinely referred for rehabilitation care back in 2003. Strides have been made but much work remains. Pergolotti M et al. The prevalence of potentially modifiable functional deficits and the subsequent use of occupational and physical therapy by older adults with cancer. J Geriatr Oncol. 2015 May;6 (3):194-201.
