Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

Impact Of Exercise and Weight Management on Cancer-Related Lymphoedema (#40)

Kira Bloomquist 1 2 , Melanie Plinsinga 1 , Louise Koelmeyer 3 , Debbie Geyer 4 5 , Hildegaard Reul-Hirche 1 6 , Sandi c Hayes 1
  1. Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
  2. Center for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Zealand, Denmark
  3. Department of Health Sciences, Macquarie University, Sydney, New South Wales, Australia
  4. Lymphoedema Association Australia, Carrum Downs, Victoria, Australia
  5. Cremorne Medical Practice, Sydney, New South Wales, Australia
  6. Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

There is theoretical underpinning for the role of exercise and weight loss in the management of lymphoedema. Exercise has well known benefits on the musculoskeletal, cardiorespiratory and circulatory system. These same physiological systems play an important role in supporting lymphatic function and lymph flow. Consequently, exercise has been a focus in lymphoedema management trials over the past 20 years. This evidence base has been evaluated and summarized in a recent systematic review and meta-analysis.

To evaluate the role of exercise in managing lymphoedema, the review included 26 intervention studies, of which 22 exclusively included participants with breast cancer-related lymphoedema. The mean age of participants was 55 years, and on average they had been diagnosed with lymphoedema 3.5 years prior to study participation. The results showed that exercise neither reduced nor exacerbated lymphoedema or lymphoedema symptoms, including heaviness and tightness. Importantly, improvements in survivorship outcomes including pain, fatigue, upper-body function, quality of life and muscle strength were observed in planned subgroup analyses. These improvements are particularly noteworthy as those with lymphoedema have higher rates of cancer-related morbidity and treatment sequalae than those without lymphoedema.

Higher body mass index has been consistently identified as a risk factor for lymphoedema. This relationship has led to recommendations of weight maintenance or loss (in overweight or obese individuals) as a management strategy for cancer-related lymphoedema. However, to date, only 4 clinical trials, including 458 breast cancer survivors, have been conducted to test this hypothesis. Data from these trials have been included in a meta-analysis, with subsequent findings showing no reduction of interarm volume difference following weight loss.

Throughout this presentation, some of the strengths and limitations of these findings will be explored, and the clinical implications of findings for women with breast or gynecological cancer will be highlighted.