For women at high risk for upper-limb disability after nonreconstructive breast cancer surgery, a structured exercise program is clinically effective and cost-effective, according to a study published online Nov. 10 in The BMJ.
Julie Bruce, Ph.D., from the University of Warwick in Coventry, England, and colleagues conducted a superiority, randomized controlled trial with economic evaluation at 17 U.K. National Health Service cancer centers involving 392 women undergoing nonreconstructive breast cancer surgery. The participants were randomly assigned to usual care with structured exercise or usual care alone (196 to each).
The researchers found that upper-limb function improved after exercise versus usual care (mean Disability of Arm, Hand and Shoulder, 16.3 versus 23.7; adjusted mean difference, 7.81). Exercise was favored over usual care for secondary outcomes, including lower pain intensity at 12 months (adjusted mean difference on numerical rating scale, −0.68) and fewer arm disability symptoms at 12 months (adjusted mean difference on Functional Assessment of Cancer Therapy-Breast+4, −2.02). Patients allocated to exercise had no increase in complications, lymphedema, or adverse events. Lower costs per patient were seen with exercise (on average, −£387), which was cost-effective compared with usual care.
“We found robust evidence that early, structured, progressive exercise is safe and clinically effective for women at high risk of developing shoulder and upper limb problems after nonreconstructive breast surgery,” the authors write.