Facility-Based Care is More Effective for Treating Breast-Cancer Related Lymphedema than Home-Based Care

The findings of a study published in JAMA Oncology suggest that for patients with breast cancer-related lymphedema (BCRL), a supervised, facility-based care program works more effectively than a home-based weight loss and/or exercise program.

In this randomized clinical trial, researchers evaluated 351 overweight breast cancer survivors (62% white, 35% black, 3% other races or ethnicities) with BCRL from the Women in Steady Exercise Research (WISER) Survivor clinical trial. Among the study subjects, 87 were placed in an exercise intervention group that comprised strength and resistance training twice per week and 180 minutes of walking per week, 87 were placed in a weight loss intervention group that consisted of 20 weeks of meal replacements as well as 52 weeks of lifestyle alteration counseling, 87 were selected to participate in a combined exercise and weight loss intervention group, while 90 were randomly allocated to a control group of facility-based lymphedema care with no home-based exercise or weight loss intervention. The programs were administered in conference rooms at academic community hospitals from March 12, 2012 to May 28, 2016, and subsequent follow-ups were performed for one year from the start of the intervention. The study’s primary endpoint was the 12-month change in the percentage of interlimb volume difference. The researchers analyzed data from September 26 to October 28, 2018.

Supervised Programs Yield Better Outcomes

According to the results of the study, among the study subjects the median time since breast cancer diagnosis was six years (range, 1-29 years). The average (SD) total upper extremity score changes from the objective clinical evaluation were −1.40 (11.10) in the control group, −2.54 (13.20) in the exercise group, −3.54 (12.88) in the weight loss group, and −3.84 (10.09) in the combined group. Score changes from the self-report survey were −0.39 (2.33) in the control group, −0.12 (2.14) in the exercise group, −0.57 (2.47) in the weight loss group, and −0.62 (2.38) in the combined group. Moreover, the research found that weight loss from baseline was −0.55% (95% CI, −2.22% to 1.11%) in the control group, −8.06% (95% CI, −9.82% to 6.29%) in the combined group, −7.37% (95% CI, −8.90% to −5.84%) in the weight loss group, and −0.44% (95% CI, −1.81% to 0.93%) in the exercise group.

These results, as the study authors wrote, “indicate that weight loss, home-based exercise, and combined interventions did not improve BCRL outcomes. They added that a “supervised facility-based program of exercise may be more beneficial than a home-based program for improving lymphedema outcomes.”