As reported in JAMA Oncology by Schmitz et al, the WISER Survivor trial showed no benefit of home-based exercise and weight loss programs on lymphedema outcomes vs facility-based lymphedema care among overweight breast cancer survivors.

Study Details

In the trial, 351 overweight breast cancer survivors from the Philadelphia metropolitan area with breast cancer–related lymphedema were randomly assigned to facility-based lymphedema care (conducted in conference rooms at academic and community hospitals) with no home-based exercise or weight loss intervention (control group, n = 90), or home-based exercise (n = 87), weight loss (n = 87), or combined exercise and weight loss interventions (n = 87).

The home-based interventions consisted of a 52-week exercise program of strength/resistance training twice per week and 180 minutes of walking per week and a weight loss program of 20 weeks of meal replacements and 52 weeks of lifestyle modification counseling. The study was conducted between March 2012 and May 2016. Follow-up was conducted for 1 year from the start of the intervention. Lymphedema outcomes were assessed by clinical evaluation using the Clinical Lymphedema Evaluation of the Upper Extremity instrument (CLUE; score range = 0–72) and by self-reporting using the Norman Lymphedema Survey (range = 0 [no symptoms]–4). Median time since diagnosis was 6 years; 62% of patients were white and 35% were black.

Lymphedema Outcomes

The mean total upper extremity score changes at 12 months from objective clinical evaluation (overall P = .47) were -1.40 in the control group (baseline = 22.93), -2.54 in the exercise group (baseline = 26.06; P = .18 vs control), -3.54 in the weight loss group (baseline = 23.78; P = .71 vs control), and -3.84 in the combined group (baseline = 22.83; P = .96 vs control).

The mean overall upper extremity score changes at 12 months from the self-report survey (overall P = .36) were -0.39 in the control group (baseline = 3.38), -0.12 in the exercise group (baseline = 3.46; P = .46 vs control), -0.57 in the weight loss group (baseline = 3.23; P = .61 vs control), and -0.62 in the combined group (baseline = 3.22; P = .52 vs control).

Weight loss from baseline was -0.55% in the control group, -8.06% in the combined group (P < .001 vs control), -7.37% in the weight loss group (P < .001 vs control), and -0.44% in the exercise group (not significant vs control).

The investigators concluded, “Study results indicate that weight loss, home-based exercise, and combined interventions did not improve breast cancer–related lymphedema outcomes; a supervised facility-based program of exercise may be more beneficial than a home-based program for improving lymphedema outcomes.”

Kathryn H. Schmitz, PhD, MPH, of the Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey, is the corresponding author for the JAMA Oncology article.

Disclosure: The study was supported by the National Institutes of Health, National Cancer Institute, and others. Compression garments were donated by BSN Medical and discounted meal replacements were provided by Nutrisystem, Inc. For full disclosures of the study authors, visit jamanetwork.com.