Breast cancer exercise advice may change

“Exercise advised for lymphoedema after breast cancer,” reports BBC News.

The headlines follow the publication of new draft recommendations by the National Institute for Health and Care Excellence (NICE), which is updating its guidance on the diagnosis and treatment for people with advanced breast cancer. The move follows new evidence on the safety and benefits of exercise for breast cancer-related lymphoedema. NICE has developed two new draft recommendations, which have been published for consultation, to directly address this issue.

What is lymphoedema?

Lymphoedema is a painful and incurable condition that causes chronic swelling.

It occurs when lymph nodes or vessels are damaged or blocked, which lymph fluid unable to pass through them. Fluid then builds up and causes swelling.

Lymphoedema may occur as a result of cancer treatment – such as surgery or radiotherapy – or because cancer cells block the lymph system.

NICE estimates that each year in the UK, nearly 10,000 people with breast cancer will go on to develop lymphoedema in the arm, following treatment. Cancer Research UK estimates that 20% of people develop lymphoedema after breast cancer treatment that includes surgery to remove lymph nodes or radiotherapy to the lymph nodes in the armpit.

Why has NICE released new draft guidance on lymphoedema?

NICE has released new draft guidance to provide clearer advice to patients on exercise and breast cancer-related lymphoedema.

Previously, people with, or who were at risk of, breast cancer-related lymphoedema were advised to be cautious with the affected (or potentially affected) arm, and to avoid strenuous activities, such as demanding exercise or carrying heavy weights.

NICE carried out a review of the evidence on exercise and people who have or who are at risk of developing breast cancer-related lymphoedema. The review found a lack of evidence to suggest avoiding such exercise is beneficial, with the majority of studies being short-term and without sufficient follow-up or patient-focused outcomes, such as quality of life.

What are the draft recommendations?

The draft recommendations say that doctors and nurses should discuss with people who have, or who are at risk of, breast cancer-related lymphoedema that: 

• current evidence indicates that exercise does not prevent, cause or worsen lymphoedema
• exercise may improve their quality of life

Do the recommendations include specific types or frequency of exercise?

No. The NICE recommendations are based on studies that included resistance exercises, aerobic exercise, stretching, weightlifting and water-based exercise.

How was this reported in the media?

The BBC accurately covered the story, including helpful advice from a nurse from Breast Cancer Care.