In addition to educating women on adverse effects, nurses should also consider communicating the added benefits from physical therapy to women with breast cancer who underwent lymph node dissection so they can gain back arm mobility sooner.
A study, presented at the 2018 Cancer Survivorship Symposium, showed that physical therapy intervention not only helped, but actually enabled women to have full range of motion back much sooner than without it.
Lymph node dissection, the surgical removal of one or more groups of lymph nodes, results in a 2- to 3-inch incision in the skin crease of a patient’s arm. Lymphedema, or swelling, can occur.
“Lymph node dissection, whether it is axillary or sentinel, often results in restrictions of arm movement, including range of motion. These restrictions on range of motion of the arm can be temporary or permanent,” Electra D. Paskett, PhD, MO, the Marion N. Rowley Professor of Cancer Research and Director of the Division of Cancer Prevention and Control at The Ohio State University, said during a press cast.
Therefore, Paskett and colleagues conducted a secondary analysis of the Lymphedema Education and Prevention (LEAP) study, a randomized-controlled trial designed to determine if a lymphedema prevention program could help patients to regain range of motion in both the affected arm as well as the unaffected arm.
Among 41 participating sites, women were randomized to receive either education only or education plus exercise. The 253 women who received education only were given information about lymphedema signs and symptoms, as well as risk reduction strategies. The 315 women who received education plus exercise were given the same information as well as arm stretching and breathing exercises and a visit with a physical therapist.
“The physical therapist discussed lymph flow, strengthening and breathing exercises; fitted women with an elastic compression sleeve and gauntlet and told them when to wear it; women were given 2-pound hand weights; and then they were given a take-home video that demonstrated all of the exercises that they were taught in this session,” Paskett explained.
For assessment, patients answered self-administered surveys to determine how well they could reach with each arm before surgery, and again at 12 and 18 months after surgery. Range of motion was reported as very little, about half, nearly full, overhead, and full range of motion.
Before surgery, women in the exercise arm were less likely to report full range of motion for both arms compared with the education only group, with only 58% compared with 75% in the left arm and only 57% compared with 76% in the right arm, respectively.
At 12 months after surgery, women in the exercise group reported greater range of motion compared with the education arm, with an improvement of 91% compared with 84% in the left arm and 90% compared with 83% in the right arm, respectively.
By 18 months, both groups had 93% of women who reported full range of motion in both arms.
The researchers used a fully adjusted model, which looked at the arm specifically affected by surgery, and included baseline weight, type of surgery, lymph node dissection, whether that arm was dominant, and whether the women also received radiation therapy and/or chemotherapy.
In this model, women who received both education and exercise experienced a 32% increase from before surgery to 12 months after, compared with just 6% of women who only received education on lymphedema. At 18 months, range of motion increased even more to 37% and 13%, respectively.
“Our take home message here is that all women receiving lymph node dissection, whether it is axillary or sentinel, should receive physical therapy to regain range of motion more quickly after surgery, and thus, help maintain physical functioning,” said Paskett.
Timothy Gilligan, MD, MSc, FASCO, an ASCO Expert in Survivorship Care and a medical oncologist at the Cleveland Clinic Taussig Cancer Institute, acknowledged how important these results are.
“This is an important issue. It is a big quality of life issue for women who have lymph node dissection for breast cancer,” said Gilligan, who moderated the press cast. “The good news here is that physical therapy can help. Women should be aware of this and have access to physical therapy so they can benefit from this.”