Amelioration of chemotherapy-related aggravation of lymphedema through exercise: a case report

Research Objectives: This report presents a patient on repeated chemotherapy who showed dramatic improvement of lymphedema after body fat content decreased and muscle mass increased while on weekly-based diet modification and exercise.

Design: This is a case report.

Setting: From April 2021, she enrolled in a clinical study establishing the effect of exercise and diet adjustment in lymphedema treatment.

Participants: She was diagnosed with left invasive ductal carcinoma (T1, N0) on Oct 24, 2018. She received radiation therapy of 52.56Gy from Mar 22 to Apr 1st, 2019. After axillary LN dissection on Oct 30, 2020, a 10 cycle of chemotherapy on Doxorubicin and Docetaxel followed every 3 weeks from Nov 3, 2020. Lymphedema of the left upper limb developed shortly after the first chemotherapy that complex decongestive therapy was provided. Bulimia and aggravation of lymphedema followed after each chemotherapy that her weight increased from 58kg to 70.4kg in 6 months.

Interventions: Aerobic exercise, a moderate degree of perceived exertion for 150 min a week, was recommended. Daily calorie intake was recommended based on a daily diet log. The exercise and diet modification was executed for two months.

Main Outcome Measures: Upper limb circumferences, BMI, and results of bioimpedance analysis were collected every week for two months.

Results: During two months of exercise and diet intervention, her weight increased by 2.7kg and decreased by 2.7kg showing overall no change. During the intervention, body fat content decreased by 3%, while skeletal muscle mass increased from 2.2kg. The interlimb impedance ratio decreased the most while the skeletal mass index increased the most.

Conclusions: This case report supports the benefit of exercise in amelioration of chemotherapy-related aggravation of lymphedema. Although it is difficult to maintain exercise during chemotherapy, exercise may improve the quality of life and long-term outcomes of cancer survivors in the context of cancer rehabilitation. Further studies are needed to define the extent and effect of exercise during chemotherapy.

Author(s) Disclosures: All authors declare no conflict of interests.