There are currently more than 3.2 million breast cancer survivors in the United States. During Breast Cancer Awareness Month, related news in the media typically includes patient stories, celebrations, and treatment options. Not as well covered in the lay media, though, is another aspect of the disease that affects survivors—i.e., the risk of developing lymphedema.
This life-altering abnormal accumulation of fluid just underneath the skin is one of the most common side effects following treatment for breast cancer and can affect a person's ability to complete daily tasks, as well as self-image. If left untreated, breast cancer-related lymphedema will continue to progress, causing more serious side effects over time. Research has found that the best treatment for lymphedema is to minimize the risk of developing it.
“Strength After Breast Cancer” is an evidence-based rehabilitation program designed to minimize a woman's risk of developing lymphedema. The program begins with educating survivors about all aspects of lymphedema and giving participants an individualized assessment of strength, range of motion, and upper body issues. Physical therapists then work with patients in small-group settings to teach techniques that will restore strength and encourage a healthy exercise regimen that will last a lifetime. Slowly progressive strength training has been shown to reduce the risk of developing lymphedema and can reduce the risk of lymphedema symptoms worsening.
The program is a joint creation of Kathryn H. Schmitz, PhD, MPH, Senior Fellow in the Center for Clinical Epidemiology and Biostatistics at Abramson Cancer Center of the University of Pennsylvania, and therapists from Good Shepherd Penn Partners, a Philadelphia-based post-acute therapy provider. A grant awarded to Dr. Schmitz from the National Cancer Institute funded the effort to translate the results of a large clinical trial into a program that could be broadly disseminated to breast cancer survivors across the U.S. and beyond.
The program is based on the results of the randomized, controlled Physical Activity and Lymphedema (PAL) trial, which assessed the safety of progressive strength training in breast cancer survivors who participated in a supervised, slowly progressive strength training program.
Results published in The Journal of the American Medical Association (2010:304:2699-2705) and the New England Journal of Medicine (2009;361:664-674) showed that supervised, slowly progressive strength training is safe for breast cancer survivors. Additionally, women who performed strength training were less likely to develop lymphedema than those who were not strength training.
‘Innovative Practice Model’
In the past five years, Strength after Breast Cancer has grown into one of the largest exercise programs for breast cancer survivors in the country and is recognized by the American Physical Therapy Association as an innovative practice model. At this five-year milestone, a new examination of the PAL trial data and the program will soon be published in the Journal of the National Cancer Institute. Giving light to the common challenge of translating research findings into real-world tactics, the new data highlight that participants in Strength After Breast Cancer received the same benefits as participants in the original PAL trial.
Prior to the PAL trial, misconceptions existed around exercise in breast cancer survivors. Standard of care included discouraging survivors from lifting objects greater than about five pounds, which left many survivors unable to perform simple daily tasks, such as handling groceries or even holding children. Despite the clinical evidence, many health care providers still discourage this activity, instilling unnecessary fear and limitations on survivors; yet, if done properly, exercise can be extremely beneficial.
Specialists in the Strength After Breast Cancer program work to ensure that participants learn correct form when strength training and stress common errors that may lead to injury. Participants are encouraged to “start low and progress slow,” as the program is shown to work best when therapists collaborate with patients to build a regimen based on their individual needs and health goals.
Lymphedema is a life-long condition. One way to minimize the risk of developing lymphedema is a simple exercise routine. Moving forward, I challenge all those working with cancer patients to encourage those at risk, or already diagnosed, to adopt an appropriate, supervised exercise regimen and to meet with a physical therapist early—ideally, at the time of diagnosis. When any degree of physical therapy is included in the overall treatment package, patients are more likely to experience a pleasant and safe recovery.
I have had the pleasure of working closely with survivors and their caregivers since the inception of the program at Good Shepherd Penn Partners in 2011. Day after day, participants continually express their gratitude for providing them with the tools to take back their strength. Empowering cancer survivors' to improve their health is crucial for complete restoration.