Manual Drainage Fails to Prevent Lymphedema in Breast Cancer Patients

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Elsevier Global Medical News. 2011 Jan 10, K Wachter

SAN ANTONIO (EGMN) - Adding manual lymph drainage to exercise therapy did not prevent lymphedema in a study of 160 breast cancer patients who underwent axillary lymph node dissection.

Researchers reported that the incidence of lymphedema following axillary lymph node dissection (ALND) was similar whether or not women had manual drainage in a randomized trial presented at the annual San Antonio Breast Cancer Symposium.

Based on these findings and previous data, "breast cancer patients have to perform exercise therapy immediately started after the axillary dissection to prevent arm lymphedema," said Nele Devoogdt, a physical therapist at University Hospitals Leuven in Belgium.

Manual lymph drainage involves stretching/massaging the skin around lymph nodes to improve resorption by the lymph capillaries, increase lymph transport (by stimulating lymph collectors), and to create collateral pathways of lymph transport, Ms. Devoogdt said. Although manual lymph drainage is used in several countries, including Belgium, to prevent lymphedema, the preventive effect has not been previously demonstrated in a peer-reviewed randomized trial.

For this study, the researchers recruited 160 breast cancer patients, who underwent ALND in one arm. Both arms were assessed prior to the procedure to assess the natural difference in size.

A total of 79 patients were randomized to exercise therapy and manual lymph drainage, while 81 patients had only exercise therapy. Both groups were given lifestyle guidelines for minimizing lymphedema.

Patients in both groups attended 1-2 sessions per week (29 exercise therapy sessions on average). In the treatment group, manual lymph drainage was performed 1-3 times per week (34 sessions on average).

At 1 month post-ALND, patients started treatment and an arm assessment was performed. Arm assessments followed at 3 months, 6 months (at which point treatment was stopped), and 12 months.

The primary outcome measure was the incidence of arm lymphedema - defined as a circumference increase of at least 2 cm at two successive measurements. The researchers found no significant difference in lymphedema incidence between the two groups at any time point. At 3 months, the incidence was 7% in the drainage group, compared with 5% in the exercise-only group; at 6 months, the incidence was 12% and 10%, respectively; and at 12 months, it was 23% and 18%.

Secondary outcomes also showed no significant differences in time to lymphedema, increase in arm volume, mental and physical health-related quality of life, and functional problems related to arm lymphedema.

The investigators reported that they have no relevant financial relationships.

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