Common Lymphedema Therapy Works Well on Long-Term Symptoms

A study in The Breast Journal that looked at medical records shows that complete decongestive therapy lessens arm swelling as well in people who have been treated for post-mastectomy lymphedema in the past as it does in people who’ve never been treated for it.

Background

About 1 in 4 people with breast cancer who have a mastectomy get lymphedema. Lymphedema happens when surgery or other trauma causes a change in the way the lymphatic system drains. After breast cancer surgery, this extra lymph fluid often causes swelling of the hand, arm, breast or torso, on the same side the person had breast surgery.

Lymphedema can cause discomfort, pain, infection and limited range of motion. Treatment seeks to lessen swelling. A common lymphedema treatment is complete decongestive therapy, also called complex decongestive therapy or decongestive lymphatic therapy. It involves skincare to prevent infection, a gentle massage called manual lymphatic drainage, and compression bandages that put pressure on the affected area to keep lymph fluid moving. Breathing exercises are often recommended as well.

Past studies have shown complete decongestive therapy works well in people who have never been treated for lymphedema. The researchers on this study wanted to know if it works as well in people who have been treated for lymphedema before but are still experiencing lymphedema symptoms.

Design

Researchers looked back at the medical records of 72 people who had physical therapy for lymphedema at the University of Texas MD Anderson Cancer Center between January 2004 and January 2005. Each person had previously had a mastectomy with axillary lymph node dissection to treat breast cancer.

The researchers divided the medical records into two groups:

• Records of people who were treated for lymphedema before 2004, and then treated again between January 2004 and January 2005 (38 people)
• Records of people who were only treated for lymphedema between January 2004 and January 2005 (34 people)

The records showed age, body mass index, number of lymph nodes removed, other cancer treatments, other health problems, and lymphedema risk factors were similar between the two groups.

Everyone whose record was used had four to 12 complete decongestive therapy sessions over 4 to 6 weeks between January 2004 and January 2005, about two to three sessions per week. Licensed physical therapists certified in lymphedema therapy ran all the sessions.

At their first treatment session between January 2004 and January 2005,  all participants filled out a questionnaire that was a standard part of lymphedema treatment at University of Texas MD Anderson Cancer Center.

The questionnaire asked about

• their breast cancer treatment
• their lymphedema risk factors
• when they first experienced symptoms associated with lymphedema
• what those symptoms were

The therapist wrote a description of the lymphedema and measured both arms with a perometer, a machine that evaluates the amount of extra fluid in the affected arm and the unaffected arm, before and after performing complete decongestive therapy. Measuring the unaffected arm is a standard part of lymphedema therapy. It’s done so there is something to compare the affected arm to. The therapist also talked to the participants about doing deep breathing exercises, caring for the skin on the hand and arm, and doing gentle massage at home.

At each session after the first one, the participant received manual lymphatic drainage for 45-50 minutes. They then received 10 minutes of arm compression using bandages and exercises. At the end of the 4 to 6 weeks, participants were fitted with a compression garment, a piece of clothing that puts pressure on the affected area to keep lymph fluid moving. They were told to wear it during the day and take it off at night.

Results

After they received 4 to 6 weeks of therapy, on average, the participants’ affected arms were less swollen by

• 32 percent in those who had lymphedema treatment before 2004, and then again between 2004 and 2005
• 38 percent in those who had lymphedema treatment only between 2004 and 2005

The difference between the two percentages was not statistically significant, which means it could have happened by chance. Because of that, the researchers concluded complete decongestive therapy worked well in both the previously treated group and the group that received treatment for the first time.

Limitations

This was a small study of fewer than 80 people and it looked at medical records to learn about therapy that was performed in the past. This is called a retrospective study. It is less reliable than randomized controlled studies, which randomly assign people to different treatments and then monitor progress throughout treatment. Since this study wasn’t randomized, there may have been differences between the groups of people that affected how well therapy worked.

What This Means for You

Seeing lymphedema symptoms appear again after you’ve been treated for it can be very disappointing. But it’s a common experience. Lymphedema is a long-term, often life-long side effect that requires regular care. So it may be comforting to hear being treated with complete decongestive therapy when symptoms do return can reduce swelling as well as it did the first time. Talk to your healthcare providers about whether more complete decongestive therapy is right for you.

Remember that after treatment with a lymphedema therapist ends, you must take steps at home to keep lymphedema under control. That can include being trained to do manual lymphatic drainage yourself or having a caregiver learn how to do it for you. It can also include using compression bandages or garments such as lymphedema sleeves, exercising, and maintaining a healthy weight.

For more information, read our Guide to Understanding Lymphedema.

Mehtap B, Palmer L, Guo Y. Effectiveness of decongestive lymphatic therapy in patients with lymphedema resulting from breast cancer treatment regardless of previous lymphedema treatment. The Breast Journal. 2017;23(2):154–158;doi:10.1111/tbj.12710.