Lymphedema is swelling of the arm, hand, or chest wall caused by a build up of lymph fluid in those tissues after breast cancer surgery. (Edema is the medical term for swelling.)
Many women wear elastic compression sleeves and/or gloves to gently compress the tissues and move excess fluid out of the arm area and ease lymphedema. Another treatment for lymphedema is decongestive therapy. During decongestive therapy, a specially trained therapist gently massages the skin and soft tissues affected by lymphedema. The affected arm usually is massaged for an hour once a day, 3 to 5 days a week, and then bandaged for the other 23 hours.
The study reviewed here found that women with lymphedema who had decongestive therapy had slightly less excess fluid in their arms compared to women who only wore a compression sleeve. Decongestive therapy seemed to offer more benefits for women who had had lymphedema for more than a year.
Between 5% and 25% of women develop some level of lymphedema after breast cancer surgery. Lymph fluid normally drains from body tissues through the lymph nodes and lymph channels. If some lymph nodes and channels are removed or damaged during surgery, lymph fluid may not drain properly and can collect in the tissues near the surgical site. Radiation therapy and chemotherapy can increase the risk of lymphedema.
Decongestive therapy also is known as manual lymphatic drainage or complex decongestive physiotherapy and is typically done once a day, 3 to 5 days a week, for several weeks depending on how swollen the arm or hand is. At the end of every massage session, the therapist wraps the arm or hand in customized bandages to keep excess fluid out of the arm and shape the arm to look less swollen. The therapist usually prescribes exercises to do while wearing the bandages.
Decongestive therapy is very different from traditional massage therapy, which focuses on muscles and deep tissues and can be quite forceful. Traditional massage therapy can sometimes make lymphedema worse rather than better.
In this study, 95 women who developed lymphedema after breast cancer surgery were randomly assigned to receive either decongestive therapy or wear a compression sleeve to treat the lymphedema. The women's affected arms were about 27% larger than their unaffected arms.
The 56 women treated with decongestive therapy had an hour-long massage once a day for 4 weeks. After the massage, they wore gauze and bandages on the affected arm for the other 23 hours. After the 4 weeks of decongestive therapy, the women wore compression sleeves and gloves 12 hours a day. The women also received general advice on skin care, exercise, and diet.
The other 39 women wore compression sleeves and gloves 12 hours a day. They also received general advice on skin care, exercise, and diet.
A year after lymphedema treatment ended, the arms of the women who received decongestive therapy were 29.3% smaller, compared a 22.6% reduction in arm size for women who used only compression sleeves and gloves. This difference in arm size was small enough (less than 7%) that it could have been due to chance and not because of the different treatments.
Still, when the researchers looked at the actual amount of fluid removed (rather than the percentage reduction in arm size), they said the difference between the two treatments was important. On average, the women who received decongestive therapy had more than 8 ounces of fluid removed from their arms, compared to less than 5 ounces for women who used only compression sleeves and gloves.
For some women who develop lymphedema, the swelling is mild and goes away over time with treatment. For other women, the swelling is severe and can be an ongoing problem. If you've developed symptoms of lymphedema after surgery, whether mild or severe, you may want to consider decongestive therapy. In addition to reducing the amount of excess fluid, many women find that decongestive therapy relieves some of the pain and stiffness associated with lymphedema. Many therapists feel that decongestive therapy helps ease lymphedema. Always check with your doctor to make sure that decongestive therapy makes sense for your specific situation.
You can learn more about the risks for lymphedema, steps you can take to minimize that risk, and tips for managing lymphedema in the Breastcancer.org Arm Lymphedema section.
CHICAGO (MedPage Today) -- Breast cancer patients with treatment-related lymphedema derived only a modest benefit from decongestive lymphatic therapy compared with a compression sleeve, results of a randomized multicenter Canadian study showed.
The massage-based decongestive therapy reduced fluid volume by less than 7% compared with a compression sleeve, a difference that did not achieve statistical significance.
However, the absolute difference between groups exceeded 100 ml, which gave decongestive therapy a significant advantage over the sleeve (P=0.02).
Women with longstanding lymphedema appeared to benefit most from decongestive therapy, said Ian Dayes, MD, of McMaster University in Hamilton, Ont.
"These results would suggest that there is a modest further reduction in absolute volume in those patients who received massage and bandaging compared with those patients who received elastic sleeve alone," Dayes said here at the American Society for Radiation Oncology.
"There certainly seems to be more relative benefit in those patients who have longstanding lymphedema as compared with those patients who had lymphedema for less than a year."
Despite extensive clinical experience with decongestive therapy, the treatment had never been evaluated in a randomized clinical trial.
To address that shortcoming, investigators at six Canadian centers enrolled 103 patients who had lymphedema following completion of breast cancer therapy. Eligible patients had at least a 10% difference in volume between the affected and contralateral arm.
Eight patients withdrew consent, and the remaining 95 had an imbalance in randomization, as 56 patients were assigned to decongestive therapy and 39 to the compression sleeve.
Decongestive therapy consisted of daily one-hour massage by a licensed therapist, continuing for four weeks. The patients wore gauze and bandages for the remaining 23 hours a day. After completing the massage therapy, patients were fitted for an elastic compression sleeve and glove, which they wore for 12 hours a day. They also received advice on skin care, exercise, and diet.
Control therapy consisted of the compression sleeve and glove and advice about skin care, exercise, and diet.
The primary outcome was the change in volume of the treated arm at the end of decongestive therapy, calculated from circumferential measurements.
The contralateral arm was used for comparison. Measurements were obtained at baseline, during and after treatment, and at weeks 12, 24, and 52. Secondary outcomes included absolute change in arm volume in milliliters, quality of life, and arm function as assessed by a standardized instrument.
At baseline, excess arm volume averaged 684 mL (27%) for all 103 patients, 698 mL (27%) for the 95 evaluable patients, 751 mL (29%) in patients assigned to decongestive therapy, and 624 mL (24%) in the control group.
At the study's completion, reduction in arm volume averaged 29.3% in the experimental group and 22.6% in the control group (P=0.32). The absolute reduction averaged 252 mL with decongestive therapy and 143 mL in the control group, a difference that achieved statistical significance (P=0.02).
A prespecified analysis of the results by duration of lymphedema also revealed a statistically significant absolute difference.
Among patients with lymphedema for less than a year, the absolute reduction in arm volume averaged 150 to 200 mL in both groups. However, women with lymphedema for a year or longer had a mean volume reduction of 320 to 330 mL with decongestive therapy versus a little more than 100 mL with the compression devices alone (P=0.02).
Scores on assessments of quality of life and arm function did not change significantly in either group and did not differ between groups.
Dayes said data from long-term follow-up will be analyzed and reported in the future.
Dayes and co-investigators had no disclosures.
Primary source: American Society for Radiation Oncology Source reference: Dayes I, et al "DELTA: a randomized trial of decongestive lymphatic therapy for women with lymphedema following treatment for breast cancer" ASTRO 2009; Abstract 112.
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