Evidence Update: Therapeutic Benefits of Massage during Chemotherapy
Benefits of Therapeutic Massage during Chemotherapy Patients with cancer commonly experience disease or treatment side effects, including pain, fatigue, nausea, and anxiety. An expanding body of literature supports the use of therapeutic massage as an adjunct to conventional therapies to manage these side effects. A recent research study examined cancer patients’ perceptions of pain, fatigue, nausea, and anxiety provided during chemotherapy. The study included 58 patients who were receiving chemotherapy and/or biotherapy. Patients had a choice of a 20-minute hand and/or foot massage by a licensed massage therapist while they received chemotherapy. There was a statistically significant reduction in each of the following variables: pain, fatigue, nausea, and anxiety following massage. Results demonstrated a high level of satisfaction with therapeutic massage as part of their care. In order to be controlled for bias, further research should include comparison to a control group that did not receive the massage. This study, however, contributes to the building body of research that documents the benefits of massage for cancer patients, during and after treatment. Robinson JG. Therapeutic Massage During Chemotherapy and/or Biotherapy Infusions: Patient Perceptions of Pain, Fatigue, Nausea, Anxiety, and Satisfaction. Clin J Oncol Nurs. 2016 Apr;20(2):E34-40.
Evidence Update: Financial Burden of Breast Cancer
The Financial Burden of Breast Cancer A recent study examined the financial impact of lymphedema following a diagnosis of breast cancer. Researchers in Australia surveyed 361 women who had either breast cancer without lymphedema (209 patients) or breast cancer with lymphedema (152 patients). The results showed that both breast cancer and lymphedema result in significant out-of-pocket financial costs borne by women during and after treatment. For breast cancer patients with lymphedema, 80% indicated that their breast cancer diagnosis had affected them financially compared with 67% of patients without lymphedema. For patients with lymphedema, 56% indicated that lymphedema affected them financially and that costs increased with lymphedema severity. The cost of compression garments formed a large proportion of these costs, as well as attendance at physical therapy and treatment of cellulitis in patients with more significant lymphedema. Researchers noted the significant knowledge gap regarding the additional impact of lymphedema on breast cancer survivors. While this study was conducted in Australia, it applies equally to breast cancer patients in the United States. Insurance often does not cover compression garments and patients face significant out-of-pocket costs for therapy to treat lymphedema. The cost for management goes up when lymphedema is more significant. The education and surveillance for early detection offered to all our patients by TurningPoint helps maintain lymphedema, when it occurs, at as low a level as possible. This reduces the physical, emotional and financial impact of the condition. TurningPoint also reduces barriers to lymphedema care by providing financial assistance for treatment and garments for patients in financial need. Boyages J et al. Financial cost of lymphedema borne by women with breast cancer. Psycho-oncology. 2016 Aug 1. doi: 10.1002/pon.4239. [Epub ahead of print] Â
Evidence Update: Joint Pain and Aromatase Inhibitors
Joint Pain and Aromatase Inhibitors Aromatase inhibitors (AIs) have now been established as successful adjuvant therapy for breast cancer survivors who are post-menopausal and whose cancer is estrogen-receptor-positive. These include anastrozole (Arimidex), letrozole (Femara) and exemastane (Aromasin). Unfortunately, nearly half of women taking AIs report joint pain, or arthralgia. It is estimated that 20-30% of patients discontinue AI treatment due to joint pain. The pain and/or stiffness is usually symmetrical (i.e., on both sides) and often affects hands, feet, knees, hip and back. In a recent publication, researchers searched for and evaluated studies that examined the effect of several different ways of managing arthralgia related to AIs. Five types of interventions were identified that have been studied: pharmacological (drug) approaches, acupuncture, nutritional supplementation, relaxation techniques and physical exercise. Pharmacological approaches, including duloxetine (Cymbalta), immunotherapy and changing between AI options showed promise in relieving arthralgia symptoms. Acupuncture was promising in reducing pain in four studies. Two studies showed a possible positive impact of Yoga and Tai Chi on AI joint pain, function and quality of life. Several studies looked at exercise, primarily walking, and found a trend to decreasing pain with exercise, but this decrease was not statistically significant. Bottom Line: There may be several approaches to managing AI-related joint pain. Your medical oncologist will be helpful in choosing what is right for you. Acupuncture, yoga and tai chi appear to be helpful. Exercise, such as walking, shows promise in helping manage AI pain, but further study is needed. Keep in mind, that there are many other benefits of regular exercise for breast cancer patients (see this month’s nutrition section!). Consider joining us for this month’s education event ‘Bones, Joints and Breast Cancer’ and don’t forget that TurningPoint has a weekly Yoga class! Yang GS, et al. Interventions for the Treatment of Aromatase Inhibitor-Associated Arthralgia in Breast Cancer Survivors: A Systematic Review and Meta-analysis. Cancer Nurs. June 21, 2016. [Epub ahead of print]
Evidence Update: Pilates Based Exercise Beneficial
Pilates-Based Exercise Improves Upper Extremity Problems in Breast Cancer Patients It is well documented in the medical literature that breast cancer treatment, particularly surgery and radiation, contribute to upper extremity impairments, including decreased motion, weakness and difficulty doing usual functional tasks. A recent study examined the effectiveness of Pilates-based exercises, compared to combined exercise and home exercise as part of the rehabilitation of shoulder and arm issues for patients going through breast cancer treatment. Fifty-five patients were randomly allocated to one of the three groups: Pilates-based, combined exercise class and home program. The study was 8 weeks long and the Pilates-based and combined groups met three days per week for 40-45 minutes. The combined exercise class consisted of strengthening, stretching and range of motion exercises with a physical therapist. The home exercise group was instructed to do these same exercises at home. Pain, range of motion, strength and function were evaluated before and after the 8 week intervention. There were significant improvements in almost all parameters in both the Pilates-based and Combined Exercise group, and more significant improvements than in the home exercise group. This study showed that Pilates-based exercise results in significant improvement in upper extremity issues. There are, of course, many other benefits of Pilates-based exercise for breast cancer patients including Core strength and Balance. TurningPoint offers weekly Pilates classes with a Physical Therapist who is both an expert in breast cancer rehabilitation and a certified Pilates instructor. Pilates may be a great adjunct to your rehabilitation plan to help you get back to the things you love to do! Alpozgen AZ et al. Effectiveness of Pilates-based exercises on upper extremity disorders related with breast cancer treatment. Eur J Cancer Care (Engl). 2016 Jun 23. doi: 10.1111/ecc.12532. [Epub ahead of print]
