Clinical investigation
Breast
Efficacy of complete decongestive therapy and manual lymphatic drainage on treatment-related lymphedema in breast cancer

https://doi.org/10.1016/j.ijrobp.2006.09.024Get rights and content

Objective: To evaluate the results of combined decongestive therapy and manual lymphatic drainage in patients with breast cancer-related lymphedema.

Methods and Materials: The data from 250 patients were reviewed. The pre- and posttreatment volumetric measurements were compared, and the correlation with age, body mass index, and type of surgery, chemotherapy, and radiotherapy was determined. The Spearman correlation coefficients and Wilcoxon two-sample test were used for statistical analysis.

Results: Of the 250 patients, 138 were included in the final analysis. The mean age at presentation was 54.3 years. Patients were stratified on the basis of the treatment modality used for breast cancer management. Lymphedema was managed with combined decongestive therapy in 55%, manual lymphatic drainage alone in 32%, and the home program in 13%. The mean pretreatment volume of the affected and normal arms was 2929 and 2531 mL. At the end of 1 year, the posttreatment volume of the affected arm was 2741 mL. The absolute volume of the affected arm was reduced by a mean of 188 mL (p < 0.0001). The type of surgery (p = 0.0142), age (p = 0.0354), and body mass index (p < 0.0001) were related to the severity of lymphedema.

Conclusion: Combined decongestive therapy and manual lymphatic drainage with exercises were associated with a significant reduction in the lymphedema volume.

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.

Section snippets

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.

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