Impact of Exercise and Weight Loss on Breast Cancer Lymphedema Outcomes

Lymphedema is a common complication of curative breast cancer treatment, occurring in as many as 50% of patients undergoing axillary lymph node dissection. Because lymphedema occurs more commonly in patients with excess body weight, current guidelines recommend weight loss and home-based exercise as a strategy to manage breast cancer-related lymphedema. However, this recommendation has not been evaluated in a randomized clinical trial until now. The randomized WISER study, recently published in JAMA Oncology, evaluated a combination of home exercise and weight loss as a treatment for lymphedema in 351 breast cancer survivors. Patients were randomized to either 1 year of home-based exercise, a weight loss program involving 20 weeks of meal replacements and 52 weeks of lifestyle counseling, both exercise and weight loss intervention, or no exercise or weight loss intervention.

Patients undergoing weight loss intervention either alone or in combination with a home-based exercise program lost significantly more weight in 12 months than patients in the control group (P < .001). Despite this, there was no significant difference between any of the treatment groups in interlimb volume change, the primary study outcome. Compared to patients who received no intervention, the percentage change from baseline in lymphedema outcomes was 0.66% for patients undergoing both exercise and weight loss intervention, 0.53% for patients in the weight loss only group, and 0.04% for patients in the exercise group. There were also no differences between groups in clinical lymphedema assessment values or self-reported lymphedema outcomes.

The investigators concluded that weight loss in obese patients with breast cancer-related lymphedema does not improve symptoms or clinical outcomes, in contrast to current clinical recommendations. While recognizing that a facility-based, supervised exercise program, such as the one used in the Physical Activity and Lymphedema (PAL) trial may be more effective, the authors suggest that current guidelines recommending exercise and weight loss to lymphedema patients should be updated.

Read more about this study on Medscape Oncology.

JAMA Oncology. 2019 August 15. [Epub ahead of print.]

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