Evidence Update: TurningPoint-Avon Breast Center at Grady Partnership Continues at the American Society of Breast Surgeons
The results of a 2-year research joint project between TurningPoint, the Avon Breast Center at Grady Hospital, Emory University and Morehouse School of Medicine were presented by Dr. Lisa Lai at a recent meeting of the American Society of Breast Surgeons, held in Dallas, Texas. Dr. Lai is a surgeon doing Fellowship Training with Dr. Sheryl Gabram at the Avon Breast Center. Dr. Gabram is a TurningPoint Medical Advisory Board member. The goal of the research project was to examine the feasibility and impact of a prospective surveillance approach to breast cancer rehabilitation. Subjects were 110 patients with Stage 0 – III breast cancer. Most were inner-city and minority women. Shoulder range of motion, arm volume and function was measured before surgery, early post-operatively (2-4 weeks), 6 weeks and then at 3 month intervals for up to a year post-op. We found that approximately 1/3 of patients had early stage lymphedema and other upper extremity limitations that warranted rehabilitation intervention. Patients with higher breast cancer stage, greater numbers of lymph nodes removed and who received chemotherapy were found to have more treatment side effects that required more rehabilitation intervention. Patients with lower levels of function and higher pain levels at their early post-operative visit were more likely to need rehabilitation intervention. Our research team concluded that early identification and management of breast cancer treatment side effects (such as decreased function, limited range of motion and lymphedema) may decrease the impact of these issues and potentially improve quality of life. ASBS Poster April 2016 Photo above: Dr. Lisa Lai (left), Breast Cancer Surgical Fellow at Avon Breast Center at Grady and Emory University with members of TurningPoint’s physical therapy staff, l to r: Grayson Webb, Carrie Kozel and Lauren Bober. Dr. Lai visited TurningPoint recently to further increase her understanding of the role of rehabilitation for breast cancer patients.
Evidence Update: Water Exercise and Lymphedema
A recent study examined the effect of water versus land exercise in improving lymphedema. Eighty-eight eligible patients with secondary lymphedema after breast or gynecological cancer participated in this controlled clinical intervention study. Patients participated in either a water-based or land-based exercise program. Researchers measured subject’s arm volume, as well as BMI, function, well-being and body image. In patients who participated in water exercises, more women had reduced arm limb volume and there were also significant improvements for these women in lower BMI and decreased self-reported frequency of swelling. Women with arm lymphedema in the land exercise group showed more improvement in upper extremity function and range of motion. Researchers conclude that water exercise may be offered to patients when the goal is to reduced lymphedema while to improve daily shoulder function, land exercises are preferred. Your TurningPoint physical therapist can help you develop an exercise plan that is designed specifically to help meet your unique goals. Lindquist H et al. Water exercise compared to land exercise or standard care in female cancer survivors with secondary lymphedema. Lymphology. 2015 Jun;48(2):64-79.
Evidence Update: Resistance Training Reduces Fatigue and Increases Quality of Life in Breast Cancer Survivors
A recent study examined the benefits of resistance training (as an adjunct to usual care) on quality of life and fatigue in breast cancer survivors. Subjects in the study were 39 breast cancer survivors, with an average age of 52 years and average time since diagnosis of 12 months. Fatigue and quality of life were measured with standard self-report questionnaires. Subjects were divided into two groups, an exercise and control group (usual activity only). The exercise group received supervised resistance training 3 days per week for 16 weeks. Perceptions of fatigue and quality of life improved significantly in the resistance training group compared to controls. The authors concluded that resistance training significantly improves fatigue and quality of life in breast cancer survivors. Hagstrom AD et al. Resistance training improves fatigue and quality of life in previously sedentary breast cancer survivors: a randomised controlled trial. Eur J Cancer Care (Engl). 2015 Nov 23. doi: 10.1111/ecc.12422. [Epub ahead of print] Resistance training (often used interchangeably with “strength training”) is the process of stressing the body (usually with weights, resistance bands, or the bodyweight) to increase a muscle’s size, strength, and/or endurance.
Evidence Update: Body Image and Sexuality after Breast Cancer
A recent review of research examined the relationship between breast cancer and body image and sexuality. Breast cancer treatment commonly alters a woman’s reproductive and sexual functioning, body integrity, and the ways in which she self-identifies as a sexual being. Research has shown that women with breast cancer experience significantly greater rates of sexual dysfunction and poorer body image than do healthy women. Unfortunately, most breast cancer patients are dissatisfied with the amount and quality of care they receive from their healthcare providers around sexuality. Although a substantial proportion of survivors experience difficulties with sexual functioning, reproduction, and body image, each woman’s experience is individual and influenced by a range of factors including age, stage of breast cancer, types of treatment and relationship status. This review of research in the field suggests that a high proportion of women experience difficulties with sexual health and self-concept secondary to breast cancer, yet an overwhelming number report receiving inadequate or nonexistent care in these domains from their healthcare providers. The authors state that there is too wide a gap between the needs of this population and the healthcare system’s response to such needs. The authors conclude that oncology professionals across a range of disciplines must be better trained to identify, assess, and treat such difficulties, preferably using a multimodal approach that includes biological, as well as psychological and social strategies. Please join us for this month’s education event that will focus on body image and sexuality during and after breast cancer treatment. You will gain a better understanding of the relationship between breast cancer and these issues and leave knowing you are not alone and with some strategies to help you address these issues. Male DA. Sexual identity after breast cancer: sexuality, body image, and relationship repercussions. Curr Opin Support Palliat Care. 2015 Dec 29. [Epub ahead of print]
