Lymphedema, a chronic swelling condition common in breast cancer survivors, affects three million people in the U.S. In the past, most people believed that exercise might induce or worsen lymphedema. After reviewing the literature, University of Missouri researchers say the benefits of exercise outweigh the risks for breast cancer survivors and patients with lymphedema. Jane Armer, professor in the Sinclair School of Nursing, says patients at risk for lymphedema can exercise if they closely monitor their activities.
"Exercise can be beneficial and not harmful for breast cancer survivors," Armer said. "Each individual should balance the pros and cons of the activity she chooses, but keep in mind that being sedentary has risks and being active is beneficial in many ways, including possibly reducing the risk of cancer recurrence."
Lymphedema can occur any time after cancer treatment and is usually caused by the removal or radiation of lymph nodes as part of the treatment process. Armer found that patients who exercise had no greater risk for developing lymphedema than those who do not exercise. In addition, patients with lymphedema did not worsen their condition by exercising. She says future research is needed to determine whether exercise prevents the condition.
"Breast cancer survivors do not need to restrict their activity as we once thought," Armer said. "If patients want to be active, they should carefully condition their bodies by increasing repetitions of resistance exercises under proper supervision."
In another new literature review, Armer and her colleagues examined published literature pertaining to the surgical treatment of lymphedema. They found that in most studies surgery did not eliminate the need for traditional compression garments in patients with lymphedema.
"Many people think surgery will correct the underlying lymphatic problem, but that is not correct," Armer said. "There are several surgical techniques that may reduce the swelling associated with lymphedema. In most cases, it is recommended that patients undergo traditional therapy using specialized massage and compression garments and bandages to reduce fluid and swelling before considering surgery."
The literature reviews were the first two in a series of thirteen reviews to be published in conjunction with the American Lymphedema Framework Project (ALFP). Established in 2008, the ALFP aims to increase awareness of lymphedema, improve patient care and enhance training for professionals caring for persons at risk or with cancer-related lymphedema. The ALFP has two main goals: maintain up-to-date best practices supported with evidence-based lymphedema treatment guidelines for health practitioners, and create a minimum data set of all available lymphedema research and clinical data.
The first article, "Exercise in patients with lymphedema: A systematic review of the contemporary literature," was published in the Journal of Cancer Survivorship. The second, "The surgical treatment of lymphedema: A systematic review of the contemporary literature," was published in Annals of Surgical Oncology.
Tuesday, 20 November 2012
Sunday, 18 November 2012
Liver Cells, Insulin-Producing Cells, Thymus Can Be Developed in Lymph Nodes, Team Discovers
Lymph nodes can provide a suitable home for a variety of cells and tissues from other organs, suggesting that a cell-based alternative to whole organ transplantation might one day be feasible, according to researchers at the University of Pittsburgh School of Medicine and the McGowan Institute for Regenerative Medicine. In a report recently published online in Nature Biotechnology, the research team showed for the first time that liver cells, thymus tissue and insulin-producing pancreatic islet cells, in an animal model, can thrive in lymph nodes despite being displaced from their natural sites.
Hepatitis virus infection, alcoholic cirrhosis and other diseases can cause so much damage that liver transplantation is the only way to save the patient, noted senior investigator Eric Lagasse, Pharm. D., Ph.D., associate professor, Department of Pathology, Pitt School of Medicine. Children with DiGeorge syndrome lack functional thymus glands to produce essential immune cells, and diabetes can be cured with a pancreas transplant.
"However, the scarcity of donor organs means many people will not survive the wait for transplantation," said Dr. Lagasse, whose lab is at the McGowan Institute. "Cell therapies are being explored, but introducing cells into tissue already ravaged by disease decreases the likelihood of successful engraftment and restoration of function."
In the study, his team tested the possibility of using lymph nodes, which are abundant throughout the body and have a rich blood supply, as a new home for cells from other organs in what is called an "ectopic" transplant.
They injected healthy liver cells from a genetically-identical donor animal into lymph nodes of mice at various locations. The result was an enlarged, liver-like node that functioned akin to the liver; in fact, a single hepatized lymph node rescued mice that were in danger of dying from a lethal metabolic liver disease. Likewise, thymus tissue transplanted into the lymph node of mice that lacked the organ generated functional immune systems, and pancreatic islet cell transplants restored normal blood sugar control in diabetic animals.
"Our goal is not necessarily to replace the entire liver, for example, but to provide sufficient cell mass to stabilize liver function and sustain the patient's life," Dr. Lagasse said. "That could buy time until a donor organ can be transplanted. Perhaps, in some cases, ectopic cell transplantation in the lymph node might allow the diseased organ to recover."
Hepatitis virus infection, alcoholic cirrhosis and other diseases can cause so much damage that liver transplantation is the only way to save the patient, noted senior investigator Eric Lagasse, Pharm. D., Ph.D., associate professor, Department of Pathology, Pitt School of Medicine. Children with DiGeorge syndrome lack functional thymus glands to produce essential immune cells, and diabetes can be cured with a pancreas transplant.
"However, the scarcity of donor organs means many people will not survive the wait for transplantation," said Dr. Lagasse, whose lab is at the McGowan Institute. "Cell therapies are being explored, but introducing cells into tissue already ravaged by disease decreases the likelihood of successful engraftment and restoration of function."
In the study, his team tested the possibility of using lymph nodes, which are abundant throughout the body and have a rich blood supply, as a new home for cells from other organs in what is called an "ectopic" transplant.
They injected healthy liver cells from a genetically-identical donor animal into lymph nodes of mice at various locations. The result was an enlarged, liver-like node that functioned akin to the liver; in fact, a single hepatized lymph node rescued mice that were in danger of dying from a lethal metabolic liver disease. Likewise, thymus tissue transplanted into the lymph node of mice that lacked the organ generated functional immune systems, and pancreatic islet cell transplants restored normal blood sugar control in diabetic animals.
"Our goal is not necessarily to replace the entire liver, for example, but to provide sufficient cell mass to stabilize liver function and sustain the patient's life," Dr. Lagasse said. "That could buy time until a donor organ can be transplanted. Perhaps, in some cases, ectopic cell transplantation in the lymph node might allow the diseased organ to recover."
Saturday, 17 November 2012
Best Ways To Manage Lymphedema: Exercise And Complete Decongestive Therapy
Nearly 40 percent of breast cancer survivors suffer from lymphedema, a chronic condition that causes body limbs to swell from fluid buildup, as a result of lymph node removal and radiation therapy. A cure for lymphedema does not exist, so individuals with the condition must find ways to manage the symptoms throughout their lifetimes. Now, a team of researchers and clinicians working with a University of Missouri lymphedema expert has found that full-body exercise and complete decongestive therapy (CDT) are the best ways for patients to minimize their symptoms and maintain their quality of life.
"There's a sense of empowerment - of autonomy - that comes from meeting the challenge of living with lymphedema," said Jane Armer, an MU nursing professor. "Some breast cancer survivors say that they've become a new person after cancer because they met a challenge, and they like the stronger person they've become. The challenge of lymphedema is similar. It's something that is pervasive in every part of life. It takes problem solving and persistence to manage the condition without letting it interfere with their goals."
Armer and her colleagues reviewed published research about lymphedema self-management in order to determine which practices were most effective in managing the condition. The researchers found that full-body exercise, such as weight lifting and stretching, was likely to be effective in minimizing lymphedema symptoms. In addition, the researchers concluded that complete decongestive therapy (CDT), a comprehensive treatment approach that incorporates skin care, exercise, manual lymphatic drainage and bandaging of swollen limbs, also helps patients effectively manage the condition.
"Previous research suggests that, the earlier the interventions, the better the outcomes," Armer said. "If patients can learn how to successfully manage the condition early on, then they can continue those processes throughout their lives, and their outcomes will be better than those of individuals who resist participating in self-care."
"There's a sense of empowerment - of autonomy - that comes from meeting the challenge of living with lymphedema," said Jane Armer, an MU nursing professor. "Some breast cancer survivors say that they've become a new person after cancer because they met a challenge, and they like the stronger person they've become. The challenge of lymphedema is similar. It's something that is pervasive in every part of life. It takes problem solving and persistence to manage the condition without letting it interfere with their goals."
Armer and her colleagues reviewed published research about lymphedema self-management in order to determine which practices were most effective in managing the condition. The researchers found that full-body exercise, such as weight lifting and stretching, was likely to be effective in minimizing lymphedema symptoms. In addition, the researchers concluded that complete decongestive therapy (CDT), a comprehensive treatment approach that incorporates skin care, exercise, manual lymphatic drainage and bandaging of swollen limbs, also helps patients effectively manage the condition.
"Previous research suggests that, the earlier the interventions, the better the outcomes," Armer said. "If patients can learn how to successfully manage the condition early on, then they can continue those processes throughout their lives, and their outcomes will be better than those of individuals who resist participating in self-care."
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