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]
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).
