Early Exercise After Breast Cancer Surgery Improves Outcomes

Axillary lymph node dissection with or without comprehensive nodal irradiation causes arm and shoulder disability in breast cancer patients. With the advent of sentinel lymph node biopsy for staging, this procedure is becoming less common. In this multicenter U.K. trial, investigators assessed the effect of a structured exercise program on functional outcomes in patients at high risk for upper limb disability related to breast cancer nodal surgery and radiotherapy. A total of 392 patients were randomized to usual care alone or usual care plus a structured exercise program starting 7 to 10 days after surgery and consisting of 3 to 6 sessions designed to restore movement in the shoulder, improve strength, and increase activity.

Upper limb function as measured by the Disability of Arm, Hand and Shoulder (DASH) questionnaire at 1 year — the primary outcome — was significantly improved in the exercise group compared with usual-care group (adjusted mean difference on the 100-point scale, 7.81; 95% confidence interval, 3.17–12.44; P=0.001). Secondary outcomes of pain and disability symptoms were improved in the exercise group. There were no increases in complications or lymphedema in the exercise group. Economic modeling showed the intervention was cost effective compared with usual care.