Lymphoedema is a common long-term side effect of breast cancer treatment, but in recent years, advances in research are seeing improvements for patients in managing the condition.
About one in five breast cancer patients who have had lymph nodes surgically removed or irradiated go on to develop lymphoedema, which is an accumulation of lymphatic fluid in the tissue, usually in the hand, arm or breast of the treated side.
If left untreated, lymphoedema can be painful, disfiguring and irreversible. However, a growing body of research indicates that patients at risk or with lymphoedema don’t need to avoid everyday activities or necessary medical procedures.
The possible side effects of breast cancer treatment, such as lymphoedema, will be discussed during the next Breast Cancer Trials Q&A. Leading breast cancer researchers will be answering questions on side effects, current research and clinical trials, including lymphoedema expert Professor John Boyages.
“In the past, [the advice] was more to protect the patient by not moving the arm,” Professor John Boyages tells Women’s Agenda, noting that now, the research is showing that exercise is an important factor in managing lymphoedema.
“Exercise is very important, and weight control is very important. We know that women who are overweight, with a BMI over 30, have a higher risk of lymphoedema.”
A breast cancer specialist with 40 years’ experience, Professor Boyages recommends to his patients “to try to walk three or four times a week (30 minutes to an hour) and try to do two sessions of muscle strengthening exercise”.
“Now, often that means getting motivated. It may mean getting a personal trainer, perhaps, but sometimes it’s just, when you’re boiling the kettle to make yourself a cup of tea– doing some squats or some push-ups against the kitchen benches,” he says, highlighting the everyday habits that patients can incorporate into their routines to manage treatment side effects.
In 2017, Professor Boyages was awarded the Order of Australia for his significant service to radiation oncology and breast cancer care. Now, a radiation oncologist at the ICON Cancer Centre in Sydney Adventist Hospital, he is working hard to dispel the many myths that continue to persist around the management of lymphoedema for breast cancer patients. In 2012, he established the world-recognized ALERT lymphoedema centre at Macquarie University.
He’s even written a book on the subject matter called, Lymphoedema: Taking Control, which is a guide on the condition for patients, caregivers, lymphoedema therapists and other health professionals (bcpublish.com).
Describing lymphoedema, Professor Boyages says our body’s lymphatic system is “a bit like a waste disposal system”.
“It carries germs from our throat to our neck. So, if we get a cold, or we get a sore neck, the glands become sore,” he says, adding that “the same happens in breast cancer”.
“When you’ve got cancer in the breast, then the cancer can spread through these little lymphatics to the lymph nodes.”
One of the biggest myths that Professor Boyages sees patients hold is that everybody who has their lymph nodes treated will develop lymphoedema.
Rather, he emphasises that not everyone will go on to develop the condition, and patients’ risk can be assessed with reasonable accuracy.
When it comes to prevention, he says the first thing medical professionals do is categorise people into risk categories to try to catch the condition early on.
“The real strategy is to try and find [the lymphoedema] before the patient or the doctor can see it,” he says. “That’s early detection.”
“We use a device called a SOZO™ bioimpedance test widely available in Australia to detect fluid increases in the at-rsk arm as small as a tablespoon of water. If the lymphoedema index (known as L-Dex) measure is raised 6.5 units compared to a baseline measure we institute early intervention with a 4-week 12-hour a day compression garment and self-massage, and that could help prevent it from actually progressing and even reverse it.”
Thankfully, awareness of the condition is fairly high, as Professor Boyages reckons about nine out of ten patients he works with will have been told about lymphoedema.
Nevertheless, Professor Boyages would recommend that breast cancer patients seek an assessment from their doctors, nurses and lymphoedema team to know what symptoms to look out for.
“Those symptoms could be the tightness of their rings. It could be the heaviness and pain of the arms, tingling that just feels weird. They should get an assessment and to look out for what’s called cellulitis, which is a really serious skin infection,” he says.
“The arm (or treated breast) can get red, hot and angry from a really bad infection, which causes sweats and fevers, and people can get very sick.” Urgent antibiotics are required.
“Patients need to be aware, particularly if they’ve got established lymphoedema, if they’re flying overseas, to wear a compression garment on the plane, to take a box of antibiotics with them in their carry-on luggage,” he says, adding that patients should even consider wearing a garment when exercising if they’ve got lymphoedema.
Join Breast Cancer Trials on Wednesday 24th September, from 5:00-6:30pm (AEST), for a free online Q&A, as our panel of experts discuss the side effects of breast cancer treatment and what researchers are doing about it. To register click here.