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New theory for treatment after cancer

August 12, 2009 3:40:21 PM PDT
There's a new theory in how some breast cancer survivors should proceed after treatment. Instead of taking it easy, a new study says they should hit the gym. A complication of breast surgery in a number of women is lymphedema, swelling of the arm after removal of lymph nodes in the armpit to catch the cancerous ones. The more removed, the more is the problem. Patients were told to baby that arm. But an article in Thursday's New England Journal of Medicine says more, not less use of the arm is better.

Joan Petrelli and Stephanie Kruse have something in common. Each has had breast cancer and each had more than 20 lymph nodes removed under the arm on the side of the cancer.

Each has to wear a compression sleeve on the arm, to deal with lymphedema, arm swelling from fluid not able to return through the lymph nodes to the heart. The standard advice to avoid even more swelling is not to lift more than 10 pounds.

"If I do, I will feel it the next day, or the day after," Petrelli said. "The arm will swell."

"My husband opens jars," Kruse said. "He does everything for me. He does the cooking, cleaning everything."

So both women do minimal exercise with the affected arm. But the new study says they don't have to. It looked at two groups of women with lymphedema. One went to a YMCA and, with trainers, worked out their torso, legs and both arms. After a year, this full workout group had fewer flare-ups of lymphedema and more overall strength than the standard exercise women.

No limit was placed on how much weight women could progress to for any exercise. If a flare-up of lymphedema happened, the women temporarily stopped arm exercises, but continued the rest.

Contracting the arm muscles probably helped push excess fluid out of tissues and back to the heart, hypothesized breast surgeon Dr. Mary Jean Warden. One other expert said advice to women to date has been, "all wrong." Dr. Warden feels the new study will change practice.

"It will allow us to be more aggressive with exercise, and there won't be anymore restrictions on exercise," Dr. Warden said.

Dr. Warden certainly recommends that women talk with their doctors before changing their regimen for lymphedema. The condition is not just cosmetic, but can result in arm infections, blood clots in the arm and, rarely, a type of cancer. Having it under better control is healthier for women with the problem.

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WEB PRODUCED BY: Bill King


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