Complete decongestive therapy for arm lymphedema

Cutaneous B-Cell Lymphoma and Lymphedema, Cutaneous T-cell lymphoma and Lymphedema, Hodgkins Lymphoma, Kidney and Renal Cancer, Cervical Cancer, Renal Cell Carcinoma, Breast Cancer, Ovarian Cancer, Testicular, arm swelling, Skin Cancer, angiosarcoma, kaposi's sarcoma, gallium scan, axillary node dissection, gynecological cancer, axillary reverse mapping, lymphatic cancers, inguinal node dissection, cancer treatment, Complete decongestive therapy for arm lymphedema, lymphedema therapy, intensive decongestive physiotherapy, breast cancer related lymphedema, upper limb lymphedema

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Complete decongestive therapy for arm lymphedema

Postby patoco » Fri Jun 22, 2007 8:21 am

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

Int J Radiat Oncol Biol Phys. 2007 Mar

Koul R, Dufan T, Russell C, Guenther W, Nugent Z, Sun X, Cooke AL.
Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, MB, Canada. rashmi.koul@cancercare.mb.ca

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.

Keywords: Lymphedema, Breast cancer, Combined decongestive therapy, Manual lymphatic drainage

http://www.redjournal.org/article/PIIS0 ... X/abstract

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Long-term management of breast cancer-related lymphedema after intensive decongestive physiotherapy.

Breast Cancer Res Treat. 2007 Mar

Vignes S, Porcher R, Arrault M, Dupuy A.
Department of Lymphology, Hôpital Cognacq-Jay, Site Broussais, 102 rue Didot, 75014, Paris, France, stephane.vignes@hopital-cognacq-jay.fr.

Keywords: Breast cancer - Lymphedema - Physiotherapy - Compliance - Elastic garment - Low stretch bandage

BACKGROUND: Treatment of lymphedema is based on intensive decongestive physiotherapy followed by a long-term maintenance treatment. We analyzed the factors influencing lymphedema volume during maintenance treatment.

METHOD: Prospective cohort of 537 patients with secondary arm lymphedema were recruited in a single lymphology unit and followed for 12 months. Lymphedema volume was recorded prior to and at the end of intensive treatment, and at month 6 and month 12 follow-up visits. Multivariate models were fitted to analyze the respective role of the three components of complete decongestive therapy, i.e. manual lymph drainage, low stretch bandage, and elastic sleeve, on lymphedema volume during the 1-year maintenance phase therapy.

RESULTS: Mean volume of lymphedema was 1,054 +/- 633 ml prior and 647 +/- 351 ml after intensive decongestive physiotherapy. During the 1-year maintenance phase therapy, the mean lymphedema volume slightly increased (84 ml-95% confidence interval [CI]: 56-113).

Fifty-two percent of patients had their lymphedema volume increased above 10% from their value at the end of the intensive decongestive physiotherapy treatment phase. Non-compliance to low stretch bandage and elastic sleeve were risk factors for an increased lymphedema after 1-year of maintenance treatment (RR: 1.55 [95% CI: 1.3-1.76]; P < 0.0001 and RR: 1.61 (95% CI: 1.25-1.82); P = 0.002, respectively). Non-compliance to MLD was not a risk factor (RR: 0.99 [95% CI: 0.77-1.2]; P = 0.91).

CONCLUSION: During maintenance phase after intensive decongestive physiotherapy, compliance to the use of elastic sleeve and low stretch bandage should be required to stabilize lymphedema volume.

http://www.springerlink.com/content/82nph5737w4h84h0/

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Predictive factors of response to intensive decongestive physiotherapy in upper limb lymphedema after breast cancer treatment: a cohort study.

Breast Cancer Res Treat. 2006

Vignes S, Porcher R, Champagne A, Dupuy A.
Department of Lymphology, Hôpital Cognacq-Jay, Université Paris, France. stephane.vignes@hopital-cognacq-jay.fr

Key words: breast cancer - lymphedema - physiotherapy - predictive factors

BACKGROUND: Lymphedema is a frequent complication after breast cancer treatment. Reduction of lymphedema volume is obtained during an intensive phase with daily physiotherapy. Response to treatment remains unknown prior treatment. We purposed to analyze predictors of response of lymphedema treatment throughout the first course of physiotherapy.

DESIGN: Patients with secondary arm lymphedema were recruited in a single lymphology unit between 2001 and 2004. For each patient, the following data were recorded: characteristics of breast cancer treatment, patient characteristics, body mass index and lymphedema volume prior and at the end of treatment.

RESULTS: Three hundred and fifty-seven women (mean age: 53+/-11 years) were included. Initial excess volume of lymphedema was correlated to body mass index and duration of lymphedema. Mean duration of intensive decongestive therapy was 11.8+/-3.3 days. Mean excess volume of lymphedema was 1067+/-622 ml prior treatment and 663+/-366 ml after treatment (p<0.001), percentage of excess volume of lymphedema was 59+/-34% and 36+/-19%, respectively. Absolute volume reduction was 404+/-33 ml (p<0.001). Body mass index and duration of lymphedema before treatment were the two predictors of absolute reduction of lymphedema volume. Higher was the body mass index or the duration of lymphedema, more important was the absolute reduction of lymphedema volume. Mean relative percentage of volume reduction was 36+/-14% whatever mass index or the duration of lymphedema was.

CONCLUSION: Duration of lymphedema from cancer treatment and body mass index were the only two predictors of absolute reduction of lymphedema volume after intensive decongestive physiotherapy. For all patients this latter treatment is highly effective in management of secondary upper limb lymphedema after breast cancer.

http://www.springerlink.com/content/l532039566l37721/

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Breast cancer-related lymphedema--what are the significant predictors and how they affect the severity of lymphedema?

Breast J. 2006 Nov-Dec

Soran A, D'Angelo G, Begovic M, Ardic F, Harlak A, Samuel Wieand H, Vogel VG, Johnson RR.
Magee-Womens Hospital, Pittsburgh, Pennsylvania 15213, USA. asoran@magee.edu

According to the American Cancer Society, there are currently 2 million breast cancer (BC) survivors in the USA and 20% of them cope with lymphedema (LE). The primary aim of this study was to determine the predictive factors of BC-related LE. The secondary aim was to investigate the impact of predictors on the severity of LE.

The study design was intended to be a 1:2 matched case-control study. Instead, we stratified on age (+/-10 years), radiation therapy (y/n), and type of operation (SM/MRM/MRM with tram). Patients who underwent BC surgery between 1990 and 2000 at UPMC Magee-Womens Hospital were reviewed for LE. Data were collected on 52 women with LE and 104 female controls. Logistic regression was utilized to assess the relationship between risk factors and LE. Ordinal logistic regression was performed to determine the association between risk factors and severity of LE.

Severity was defined according to the volume difference between affected and unaffected limbs. Risk factors considered were occupation/hobby (hand use), TNM stage, number of dissected nodes, number of positive nodes, tumor size, infection, allergy, diabetes mellitus, hypertension, hypothyroidism, chronic obstructive pulmonary disease, and body mass index (BMI). LE was mild in 43 patients and was moderate/severe in nine patients.

The level of hand use in the control group was categorized as low in 56 (54%), medium in 15 (14%), and high in 33 (32%) patients. The corresponding frequencies were 14 (33%), 6 (14%) and 23 (53%) for patients with mild LE and 3 (33%), 1 (11%), 5 (56%) for patients with moderate/severe LE (p < 0.05). Infection of the operated side arm was reported by two (2%) patients in the control group, 14 (33%) patients with mild LE and five (56%) patients with moderate/severe LE (p < 0.05). The mean BMI was 26.1 kg/m(2) (SD 4.9) for the control group, 29.0 kg/m(2) (SD 5.9) for the mild LE group and 30.9 kg/m(2) (SD 7.5) for patients with moderate/severe LE (p < 0.05).

The results of this stratified case-control study demonstrated that the risk and severity of LE was statistically related to infection, BMI, and level of hand use.

http://www.blackwell-synergy.com/doi/ab ... 06.00342.x

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Complex decongestive physiotherapy for patients with chronic cancer-associated lymphedema.

J Formos Med Assoc. 2004 May

Liao SF, Huang MS, Li SH, Chen IR, Wei TS, Kuo SJ, Chen ST, Hsu JC.
Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua 500, Taiwan.

BACKGROUND AND PURPOSE: Lymphedema of the limbs after cancer therapy is the most common cause of lymphedema in developed countries. There is no cure for chronic cancer-associated lymphedema. Multidisciplinary complex decongestive physiotherapy (CDP) is commonly used as a primary treatment. This prospective study assessed the efficacy of intensive CDP treatment in chronic cancer-associated lymphedema.

METHODS: Thirty women who had unilateral upper or lower limb chronic lymphedema after breast or pelvic cancer therapy were enrolled in the study. All patients received CDP once per day, in consecutive full treatment sessions, which took place between 4 and 21 times. Assessment of the results of therapy included measuring the circumference, calculated volume, and edema ratio (excess volume/unaffected side volume) of the limb volume. The main outcome measure was the percentage reduction in excess limb volume.

RESULTS: The pretreatment edema ratio demonstrated a high correlation with the patient's age (r = 0.508, p = 0.004) and the duration of the lymphedema (r = 0.634, p < 0.000). After the intensive CDP, the limb circumference, calculated volume, and edema ratio were significantly reduced compared with their pretreatment values (p < 0.000). The mean percentage reduction of excess volume was 67.8 +/- 33.2% in all patients.

CONCLUSIONS: Intensive CDP was effectively able to reduce the limb volume of patients with chronic cancer-associated lymphedema. Further follow-up study is needed to confirm the effectiveness of CDP in the maintenance phase, and its long-term effectiveness in Taiwanese.

PMID: 15216399 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/sites/entre ... stractPlus

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