Arm and shoulder disability and pain after breast cancer surgery reduced by exercise

The debilitating arm and shoulder disability and pain that some women who have had breast cancer surgery experience as a side effect of their surgery can be reduced by following a physiotherapy-led exercise program after their operation, according to a new study published in The BMJ.

Research led by the University of Warwick with the University Hospitals of Coventry and Warwickshire NHS Trust and Baylor College of Medicine showed an improvement in shoulder and arm mobility and reduction in pain amongst women who were recovering after non-reconstructive breast cancer surgery after taking part in the structured PROSPER rehabilitation program.

In non-reconstructive breast cancer surgeries, surgeons aim to remove the cancer and often some nodes in the armpit to control the cancer. This targeted treatment can leave patients with shoulder and arm problems, including chronic pain, restricted movement and arm swelling (known as lymphoedema). Past research has shown that as many as one-third of women recovering from breast cancer surgery can struggle to return to everyday tasks such as lifting bags and driving.

Usual care is to provide an advice leaflet explaining exercises to do after breast cancer surgery. As part of the Prevention of Shoulder Problems Trial (PROSPER), researchers worked with physiotherapists and breast cancer patients to design an exercise program for those at higher risk of developing shoulder problems. The PROSPER exercise program consists of an assessment with a physiotherapist one week post-surgery, followed by a prescribed program of stretching and range of motion and resistance exercises.

“After breast cancer surgery, arm and shoulder disability impacts the functioning and quality of life for many women,” said Dr. Alastair Thompson, professor and section chief of breast surgery in the Michael E. DeBakey Department of Surgery at Baylor College of Medicine and co-associate director for clinical research at the Dan L Duncan Comprehensive Cancer Center. “Using a physiotherapy led exercise program introduced a week or so after surgery led to better upper limb function, less pain and lower costs, up to a year later without any adverse impacts. This randomized trial demonstrates the benefits of early, supported exercise after breast surgery and that it should become standard practice in women treated for breast cancer.”

“We know that some women present to physiotherapy services and pain clinics further down the line with shoulder restriction and pain problems, so we wanted to test a rehabilitation program to find out if this could help at an early stage,” said Dr. Julie Bruce, principal investigator of the trial and professor with the Warwick Clinical Trials Unity at the University of Warwick. “This is a proven cost-effective program that we know can help women undergoing certain breast cancer procedures.”

The study was funded by the National Institute for Health Research (NIHR), the research partner of the NHS, public health and social care. For a full list of authors and funding, see the publication.