Manual lymphatic drainage therapy in patients with breast cancer related lymphoedema
TL;DR: The results of this study will provide information on the effectiveness of Manual Lymphatic Drainage and its impact on the quality of life and physical limitations of these patients, as well as the improvement of the concomitant symptomatology.
Abstract: Background
Lymphoedema is a common and troublesome condition that develops following breast cancer treatment. The aim of this study is to analyze the effectiveness of Manual Lymphatic Drainage in the treatment of postmastectomy lymphoedema in order to reduce the volume of lymphoedema and evaluate the improvement of the concomitant symptomatology.
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TL;DR: A cross-sectional survey to describe the presentation of breast cancer-related lymphedema, treatment modalities used, and perceived effectiveness found some benefit was reported for all modalities, but no particular modality was considered extremely helpful.
Abstract: Limited high-quality research has focused on the efficacy of lymphedema treatments and symptomatic relief. With that in mind, the authors conducted a cross-sectional survey to describe the presentation of breast cancer-related lymphedema, treatment modalities used, and perceived effectiveness. An electronic validated questionnaire to assess the presentation of lymphedema, severity of swelling and discomfort, number of modalities tried, and the benefits gained from treatment was completed by the Review and Survey Group of the Breast Cancer Network of Australia. Thirty-five percent of participants reported the presence of lymphedema, a majority of which reported it to be mild or moderate for magnitude of swelling and for discomfort. The correlation was weak between magnitude of swelling and discomfort. Compression, massage, and exercise were the most commonly used modalities in these patients. Notably, chest wall or breast lymphedema--about which research is lacking--was as common as hand lymphedema. Women experienced discomfort and physical changes, although the severity of the two was not related. Some benefit was reported for all modalities, but no particular modality was considered extremely helpful. Oncology nurses are ideally positioned to monitor women for early signs of swelling and to advise women on the range of treatments available.
32 citations
TL;DR: In Russia, there is a long tradition of hands-on techniques that continues in the present day and includes mothers turning to providers trained in hand expression and breast massage techniques to resolve breastfeeding complications including engorgement, plugged ducts, and mastitis.
Abstract: Milk expression is a normal part of breastfeeding, but in developed countries in particular, the focus tends to center on mechanical expression In Russia, there is a long tradition of hands-on techniques that continues in the present day and includes mothers turning to providers trained in hand expression and breast massage techniques to resolve breastfeeding complications including engorgement, plugged ducts, and mastitis As observed over the course of several trips to Russia, Russian clinicians routinely combine hand expression with breast massage for the treatment of milk stasis, engorgement, and plugged ducts A better understanding of these hands-on techniques to assist in resolution of complications may provide additional treatment options for the lactation community
30 citations
Cites background from "Manual lymphatic drainage therapy i..."
...If the breasts are swollen, as in engorgement and mastitis, massage is often combined with steps facilitating fluid mobilization.(16) The mother is reclined....
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TL;DR: The basic principle of the management of lymphedema is so called complex decongestive physical therapy, which consists of a number of physical therapeutic approaches which are: manual lymph drainage, pneumatic pump drainage, low‐stretch bandaging, exercises, and skin care.
Abstract: The basic principle of the management of lymphedema is so called complex decongestive physical therapy. This therapy is divided into two phases: (i) edema reduction phase--an initial intensive treatment phase aiming for limb volume reduction; and (ii) maintenance phase--following long-term phase to sustain a manageable limb volume. The first phase consists of a number of physical therapeutic approaches which are: manual lymph drainage, pneumatic pump drainage, low-stretch bandaging, exercises, and skin care. Long-term maintenance phase consists of self-lymph drainage, low-stretch bandaging, or compressive garments, and sometimes when indicated pneumatic pump drainage, exercises, and skin care.
24 citations
TL;DR: This randomized controlled study seeks to provide data on an effective treatment for patients with breast cancer related arm lymphedema and which at the same time causes minimal patient inconvenience.
Abstract: Background: Physical therapy treatment of patients with lymphedema includes treatment based on the principles of ‘Complete Decongestive Therapy’ (CDT). CDT consists of the following components; skin care, manual lymphatic drainage, bandaging and exercises. The scientific evidence regarding what type of treatment is most effective is sparse. The objective of this study is to investigate whether CDT is equally effective if it includes manual lymphatic drainage or not in the treatment of arm lymphedema among patients with breast cancer. Methods/Design: A randomized, single-blind, equivalence trial. A total of 160 breast cancer patients with arm lymphedema will be recruited from 3 hospitals and randomized into one of two treatment groups A: Complete Decongestive Therapy including manual drainage or B: Complete Decongestive Therapy without manual lymphatic drainage. The intervention period will be approximately 4 weeks followed by a 6 month follow-up period (7 months from baseline). Primary outcome variable: the percentage volume reduction of lymphedema (%) from baseline to 7 months. Secondary outcome variables: Differences from baseline to week 4 and from week 4 to month 7 in circumference of the arm (cm), body weight (kg), patient sensation of heaviness (scale range: 0–10), patient sensation of tension (scale range: 0–10), and quality of life (EQ-5D-5 L-questionnaire). All measurements are standardized and will be performed before randomization, after 4 weeks and after 7 months. Discussion: This randomized controlled study seeks to provide data on an effective treatment for patients with breast cancer related arm lymphedema and which at the same time causes minimal patient inconvenience.
23 citations
Cites background from "Manual lymphatic drainage therapy i..."
...discomfort, social isolation [12], reduced quality of life [12,13] and higher incidence of erysipelas [12,14]....
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TL;DR: Relaxation techniques reduced the anxiety and depression scores and the volume of edema in the patients with lymphedema, requiring further studies in terms of cost-effectiveness.
Abstract: Objectives Lymphedema is sometimes accompanied by high degrees of anxiety and depression. This study aimed to assess the effects of relaxation techniques on the level of edema, anxiety and depression in women undergoing Comprehensive Decongestive Therapy (CDT). Design This clinical trial compared two treatment methods in 31 women with post-mastectomy lymphedema, including 15 cases who received CDT and 16 who received RCDT (Relaxation plus CDT). The edema volume, anxiety and depression scores were compared at the first and last sessions of the first phase of the treatment and six weeks afterwards. Results The edema, anxiety and depression scores were 63.6%, 54.1% and 65.5% in the RCDT group and 60.7%, 31.4% and 35.2% in the CDT group. There were significant differences between the two groups in terms of the reduction in depression (p = 0.024) and anxiety (p = 0.011) scores throughout the study. This significant relationship was due to the differences in the depression score in the 3rd and 9th weeks of the study between the two groups. Similarly, anxiety levels differed significantly between the two groups at the 9th week of the study (P = 0.013). Conclusion Relaxation techniques reduced the anxiety and depression scores and the volume of edema in the patients with lymphedema. The addition of this intervention to the therapeutic package for lymphedema patients requires further studies in terms of cost-effectiveness.
22 citations
References
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TL;DR: Chronic oedema arising for reasons other than cancer treatment is much more prevalent than generally perceived, yet resources for treatment are mainly cancer-based, leading to inequalities of care.
Abstract: Summary Background: Lymphoedema/chronic oedema is an important cause of morbidity in the population, but little is known of its epidemiology and impact on patients or health services. Aim: To determine the magnitude of the problem of chronic oedema in the community, and the likely impact of oedema on use of health resources, employment and patient’s quality of life.
499 citations
"Manual lymphatic drainage therapy i..." refers background in this paper
...Problems associated with lymphoedema include: pain, altered sensations such as discomfort and heaviness, difficulties with physical mobility, physiological distress, recurrent infections and social isolation [3,4]....
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TL;DR: Treatment for breast cancer is associated with considerable arm morbidity, which has a negative impact on QOL, andArm morbidity should be carefully monitored in future studies involving local treatment modalities for Breast cancer.
Abstract: PURPOSE: To determine the prevalence of and contributing factors for chronic arm morbidity including lymphedema in breast cancer patients after treatment and to assess the impact of arm morbidity on quality of life (QOL). PATIENTS AND METHODS: A four-question screening questionnaire was developed and mailed to a random sample of 744 breast cancer patients treated curatively in two cancer centers from 1993 to 1997. Patients were without recurrence and at least 2 years from diagnosis. Respondents were classified as with or without arm-related symptoms on the basis of the survey. Stratified random samples from each group were then invited for a detailed assessment of their symptoms and signs, including the presence of lymphedema. Their QOL was assessed by the European Organization for Research and Treatment of Cancer QOL Questionnaire C-30 and by a detailed arm problem questionnaire that assessed various aspects of daily arm functioning. RESULTS: Approximately half of all screened patients were symptomatic a...
344 citations
"Manual lymphatic drainage therapy i..." refers background in this paper
...In a study in which 744 patients with breast cancer were assessed with these quality of life scales, some imbalances regarding the quality of life in those patients with lymphoedema were found [ 8 ]....
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TL;DR: HRQOL was lower for BrCa survivors with diagnosed lymphedema and for those with arm symptoms without diagnosed lyMPhedema in the IWHS, according to a dose-response relation between number of arm symptoms and lower HRQOL.
Abstract: Purpose The impact of lymphedema or related arm symptoms on health-related quality of life (HRQOL) in breast cancer (BrCa) survivors has not been examined using a large population-based cohort. Patients and Methods The Iowa Women’s Health Study (IWHS) collected self-report data for lymphedema, arm symptoms, and HRQOL (Medical Outcomes Study Short Form-36) in 2004 and data for cancer diagnosis, treatment, and behavioral and health characteristics between 1986 and 2003. We studied 1,287 women, age 55 to 69 years at baseline, who developed unilateral BrCa. We used cross-sectional analyses to describe the prevalence of lymphedema and arm symptoms and multivariate-adjusted generalized linear models to compare HRQOL (physical functioning, bodily pain, general health, physical and emotional role limitations, vitality, social functioning, and mental health) between the following three survivor groups: women with lymphedema (n 104), women with arm symptoms without diagnosed lymphedema (n 475), and women without lymphedema or arm symptoms (n 708).
343 citations
TL;DR: It is suggested that CB on its own should be considered as a primary treatment option in reducing arm lymphedema volume, as well as manual lymph drainage massage in combination with multi-layered compression bandaging.
Abstract: Purpose. The purpose of this investigation was to compare the reduction in arm lymphedema volume achieved from manual lymph drainage massage (MLD) in combination with multi-layered compression bandaging (CB) to that achieved by CB alone.
235 citations
"Manual lymphatic drainage therapy i..." refers background in this paper
...On the other hand, the fact that CPT implies several techniques (manual lymph drainage, skin care and multilayer compression bandaging followed by a compression garment to reduce oedema and therapeutic exercises) makes it difficult to recognize which of them is the truly effective one in the treatment of lymphoedema [ 12-14 ]....
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TL;DR: The study showed that both groups obtained a significant reduction in edema and that MLD did not contribute significantly to reduce edema volume.
Abstract: A prospective randomized study was carried out to investigate whether the addition of manual lymphatic drainage (MLD) to the standard therapy could improve treatment outcome in women with lymphedema of the ipsilateral arm after breast cancer treatment. Forty-two patients were randomly assigned to receive standard therapy or standard therapy plus MLD 8 times in 2 weeks and training in self-massage. The standard therapy consisted of use of a compression garment, exercises and information about lymphedema and skin care. The efficacy of treatment was evaluated by reduction in lymphedema volume during treatment and by improvement in symptoms potentially related to lymphedema. The patients were followed-up for a total of 12 months. The study showed that both groups obtained a significant reduction in edema and that MLD did not contribute significantly to reduce edema volume.
220 citations