International Journal of Radiation Oncology*Biology*Physics
Clinical investigationBreastEfficacy of complete decongestive therapy and manual lymphatic drainage on treatment-related lymphedema in breast cancer
Introduction
One of the complications of breast cancer treatment is lymphedema of the ipsilateral arm. No consistent operational definition of clinically significant lymphedema has been published. The lack of consensus leads to confusion regarding the incidence of lymphedema after breast cancer treatment and difficulty in measuring treatment efficacy. The management of lymphedema in breast cancer patients has been based on results from case studies, clinical experience, anecdotal information, and only a few randomized trials. Several therapeutic interventions exist to treat this potentially distressing and disabling condition, but no consensus has been reached as to what constitutes optimal or definitive treatment of lymphedema (1). The aim of this study was to evaluate the results of the first 2 years of a program for patients with lymphedema secondary to breast cancer, who have completed a minimum of 1 year of follow-up.
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Methods and materials
The Winnipeg Regional Health Authority (WRHA) and CancerCare Manitoba jointly established the WRHA Breast Health Center in 1999 in response to the need for the centralization of breast diagnostic services for women of Winnipeg and Manitoba. Approximately 800 women annually are diagnosed with breast cancer in the Province of Manitoba, population approximately 1.1 million (2). Included in this program was the development of a comprehensive service for the assessment and management of lymphedema
Patient characteristics
The program received 250 patient referrals during the study period from surgeons, medical and radiation oncologists, and general practitioners. For the purposes of this study, lymphedema was defined as present if the patient was referred and the affected arm was not smaller than the unaffected arm. Of the 250 patients, 81 were excluded because follow-up measurements at 1 year were not available (Table 1), 31 were excluded because the affected arm was smaller than the normal arm at baseline, and
Discussion
The awareness of lymphedema has evolved during the past two decades. Lymphedema is an external manifestation of lymphatic system insufficiency and deranged lymph drainage. Breast cancer treatment is the most common cause of secondary lymphedema. Loss of the cross-sectional lymphatic transport system occurs, leading to accumulation of fluid. Some believe that a reduction in barrier function occurs because of the loss of lymph node function. This encourages penetration of bacteria and stimulates
Conclusion
A program offering some or all components of CDT to patients with lymphedema after treatment of breast cancer was associated with a significant reduction in the mean and median arm volume evident at 1 year after the beginning of treatment. Our patients had a 47% absolute reduction in lymphedema volume. The lack of a control group did not allow us to exclude the possibility that these reductions would have occurred spontaneously. One-third of the patients in this study had never undergone
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Cited by (0)
Supported by HSC Medical Staff 2004 fellowship funds.
Conflict of interest: none.