The acquisition of lymphedema following breast cancer can be devastating both, physicially and psychologically for the breast cancer patient. The key to successful management of arm lymphedema is both early diagnosis and intervention (treatment).
Many patients ask however, if lymphedema treatment/therapy actually improves the quality of life for BC patients. What clinical evidence is there that supports this view and that patients can take to their oncologists and other doctors so that they can be prescribed treatment?
This page includes abstracts and articles providing that evidence. In our external links section, there are other related studies.
Lymphology. 2007 Sep
Kim SJ, Yi CH, Kwon OY. Department of Physical Therapy, Yongdong University, Chungbuk, Republic of Korea.
There is increasing interest in the health-related quality of life (QOL) of patients with chronic lymphedema. The aim of this study was to ascertain whether complex decongestive therapy (CDT) for upper limb lymphedema results in long-term changes in lymphedema and QOL, and to determine whether the treatment-induced change in the percentage excess volume (PCEV) is correlated with any changes in QOL. Fifty-three patients who had lymphedema were treated with CDT. PCEV and QOL were recorded before and 1 month after CDT, and at a 6-month follow-up visit. PCEV was significantly (p<0.05) decreased at 1 month, but significantly (p<0.05) increased at 6 months compared to 1 month [but still significantly reduced (p<0.05) from baseline]. The QOL scores at 1 and 6 months were significantly higher than the score at baseline, indicating an improvement in the QOL. Significant changes were evident in the single domains of physical functioning, role-physical, mental health, and general health. The change in PCEV was associated with a change in physical functioning, vitality, bodily pain, and general health at 1 and 6 months (p<0.05). This study suggests that QOL significantly improved with upper limb lymphedema during the maintenance phase, which was necessarily correlated with the reduction in limb volume.
Ann Surg Oncol. 2007 Jun
Hamner JB, Fleming MD. Department of Surgery, University of Tennessee Health Sciences Center, 956 Court Avenue, Room G228, Memphis, Tennessee 38163, USA. email@example.com
BACKGROUND: Despite recent advances in breast-conserving surgery, upper-extremity lymphedema remains a problem for patients after the treatment of breast cancer. This study examines the results of a protocol of therapy for lymphedema in breast cancer patients.
METHODS: A total of 135 patients with lymphedema after breast cancer treatment were provided a protocol of complete decongestive therapy (CDT). This involved manual lymphatic drainage, compression garments, skin care, and range-of-motion exercises. Therapy was divided into an induction phase involving twice-weekly therapy for 8 weeks and maintenance therapy individualized to patient needs. Absolute volume and percentage of volume of lymphedema was compared before and after treatment. Also assessed was the degree of chronic pain and the need for pain medication.
RESULTS: Mean initial lymphedema volume was 709 mL, and the percentage of lymphedema was 31%. The induction phase of CDT reduced this to 473 mL and 18%, respectively. Before therapy, 76 patients had chronic pain and 41 required oral pain medication. CDT reduced this to 20 and 11, respectively. The degree of pain was also assessed on a numerical scale from 0 to 10. Those patients with chronic pain initially rated their pain at an average of 6.9. After treatment, this was reduced to 1.1. CONCLUSIONS: Lymphedema continues to be a problem for patients with breast cancer. A program of lymphedema therapy can reduce the volume of edema and reduce pain in this population.
Cancer J. 2004 Jan-Feb
Mondry TE, Riffenburgh RH, Johnstone PA. Breast Health Center, Naval Medical Center, San Diego, California 92134-1005, USA. PURPOSE Lymphedema is a well-described complication of therapy for breast cancer. Patients who present with lymphedema may experience pain and body image issues and are at increased risk for developing cellulitis. Complete decongestive therapy (CDT) is a four-component therapy for lymphedema. Data regarding CDT as an intervention in the immediate after the diagnosis period and prolonged follow-up are limited; we prospectively analyzed results of CDT in this cohort of patients.
MATERIALS AND METHODS: Twenty patients were enrolled in CDT immediately after their diagnosis of lymphedema. The Functional Assessment of Cancer Therapy quality of life (QoL) measure and a visual analogue scale for pain were completed before, on the 10th day of, and on the last day of treatment. Each patient underwent a daily 60- to 90-minute treatment session, 5 days per week for 2-4 weeks. Treatment consisted of skin and nail care, manual lymphatic drainage, a multilayer compression bandage, and therapeutic exercise. Edema of the affected limb was reassessed weekly. On reaching a measurement plateau, the patient was discharged from active treatment and began a maintenance phase. The patient was reassessed for girth, volume, and body weight at 3 months. These measurements plus the QoL and pain measures were also reassessed at 6 months and 1 year after treatment.
RESULTS: Patients completed 2-4 weeks of treatment (median, 2 weeks). Those classed as severe decreased from 7 to 1. Median girth reduced 1.5 cm and median volume reduced 138 mL. Decreasing girth correlated significantly with decreasing visual analogue scale scores for pain, but not with increasing QoL. Increasing grade correlated significantly with girth reduction and volume reduction. Compliance with the treatment regimen at home decreased with time on the program. During follow-up, girth and volume reverted slightly but stabilized at about 1 cm and 100 mL below baseline, respectively. Although the increase in QoL was not significant, it was noted that during the entire treatment and follow-up period, QoL consistently increased, ending about 5% above baseline, and pain scores gradually decreased, ending with 54% (and median) of patients at 0 pain.
CONCLUSIONS: CDT is effective in treating lymphedema. Success in girth reduction contributes to less pain. Grade is a useful indicator of severity; class is not. Increased number of treatment sessions provides marked improvements in girth, volume, and weight but result in poorer compliance. Longer latency more successfully reduces girth, volume, and pain and increases QoL. QoL and pain are improved by treatment and continue to improve after treatment has ended.
Lymphology. 2002 Jun
Pereira de Godoy JM, Braile DM, de Fátima Godoy M, Longo O Jr. Department of Cardiology and Vascular Surgery, São José do Rio Preto University School of Medicine, São Paulo, Brazil. firstname.lastname@example.org
Evaluation of the health-related quality of life (QOL) is becoming commonplace, seeking to provide information about the everyday well-being of a patient. This work examined the QOL of 23 consecutive patients with lymphedema of the upper or lower extremities. Five were men and the other eighteen were women. Their ages ranged from 19 to 74 years (mean 48.3). After clinical examination, and with informed consent of each patient, they were assessed by a psychologist and submitted to a QOL test (SF-36). For controls, twenty-three women and five men with age range of 28 to 66 years (mean 47) were similarly evaluated. The results showed the lymphedema group had a statistically significantly reduced QOL in both physical and mental health as well as social interaction.
Lymphology. 2002 Jun;
Weiss JM, Spray BJ. Cox Regional Center for Sports Medicine and Rehabilitation, Springfield, Missouri 65807, USA. Weissfour@aol.com Lymphedema is a chronic disorder which can adversely affect quality of life (QOL). The purpose of this study was 1) to evaluate whether QOL was improved in patients with lymphedema following Complete Decongestive Therapy (CDT), and 2) whether limb volume change as a result of treatment correlated with change in QOL. Thirty-six patients with peripheral lymphedema from varying causes were enrolled in the study. The QOL of each participant, with regard to physical, functional, and psychosocial concerns, was measured by pre- and post-treatment questionnaires. Percent edema volume reduction was calculated for each patient with only one affected limb. QOL pre- and post-treatment scores were assessed by multivariate repeated measures analysis. QOL scores differed significantly (p<0.05) between pre- and posttreatment in all areas of inquiry. Patients with lower extremity lymphedema had significantly greater mean improvement in QOL scores compared with patients with upper extremity lymphedema (p=0.02). There was no correlation between percent edema volume reduction and post-treatment QOL improvement. This study suggests that significant improvements are made in the QOL of patients exhibiting peripheral lymphedema following CDT, which is not necessarily correlated with limb volume reduction.
Cancer Nurs. 2005
Strauss-Blasche G, Gnad E, Ekmekcioglu C, Hladschik B, Marktl W. Center of Physiology and Pathophysiology, Medical University of Vienna, Schwarzspanierstrasse 17, 1090 Vienna, Austria. email@example.com
The present study investigated the changes of quality of life, mood, and the tumor marker CA 15-3 associated with a 3-week inpatient breast cancer rehabilitation program incorporating spa therapy. One hundred forty-nine women, 32 to 82 years, participated in the study 3 to 72 months after breast cancer surgery. Quality of life (QoL, EORTC QLQ-C30), anxiety, and depression (HADS) were measured 2 weeks before, at the end, and 6 months after rehabilitation; CA 15-3 at the beginning, end, and at 6 months follow-up. Patients received an individualized rehabilitation program incorporating manual lymph drainage, exercise therapy, massages, psychological counseling, relaxation training, carbon dioxide baths, and mud packs. Quality of life and mood improved significantly, the greatest short-term improvements found for mood-related aspects of quality of life, the most lasting improvements found for physical complaints (eg, fatigue). Also, the tumor marker CA 15-3 declined significantly to follow-up. Patient characteristics, as well as the time since surgery, moderated rehabilitation outcome to a limited extent. Older patients, nonobese patients, patients with a greater lymphedema, and patients with an active coping style showed slightly greater improvements. Hot mud packs inducing hyperthermia did not affect CA 15-3. In conclusion, the combination of inpatient rehabilitation with spa therapy provides a promising approach for breast cancer rehabilitation.