For women who have breast-cancer surgery that involves the dissection of axillary lymph nodes, the development of secondary lymphedema is all too common. A recent study has revealed that an early post-surgery physiotherapy program that includes manual lymph drainage, scar massage and assisted shoulder exercises significantly reduces the development of secondary lymphedema for at least one year after surgery.
“Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial,” involved 116 women, shortly after they received unilateral breast-cancer surgery with axillary lymph node dissection.
Women without axillary lymph node dissection were excluded from the study, as were those with bilateral breast cancer, systemic disease, locoregional recurrence or any contraindication to physiotherapy.
The study’s participants were randomly assigned to either the intervention group or control group. Those in the intervention group received manual lymph drainage, progressive massage of the scar and assisted stretching exercises, along with an educational strategy.
Women in the control group received only the educational strategy, which included instruction with printed materials about the lymphatic system and methods of reducing the risk of secondary lymphedema, such as avoiding trauma or injury, preventing infection, avoiding arm constriction and the use and exercise of the arm.
Both programs lasted three weeks, with three sessions per week
The main outcome measure in this study was the incidence of clinically significant secondary lymphedema, marked by an increase in arm circumference by 2 or more centimeters at two adjacent points, compared with the unaffected arm.
Subjects’ arms were measured at four weeks after surgery, which was shortly after the completion of the intervention; and three, six and 12 months after surgery.
This research showed that the incidence of secondary lymphedema was significantly higher in the control group than the intervention group at the one-year follow-up point. In the control group, there were 14 cases of secondary lymphedema at 12 months, or 25 percent. In the intervention group, there were four cases of secondary lymphedema at 12 months, or 7 percent.
The volume ratio between arms had increased in both groups at the 12-month follow-up visit. In the control group, the volume of the affected arm was, on average, roughly 5 percent greater than the unaffected arm. In the intervention group, the volume of the affected arm was, on average, less than 2 percent greater than the unaffected arm. This translates to a statistically significant difference in arm volume between the two groups one year post-surgery.
In addition, secondary lymphedema developed four times faster in the control group as compared to the intervention group.
“Early physiotherapy could help to prevent and reduce secondary lymphoedema in patients after breast cancer surgery involving dissection of axillary lymph nodes, at least for one year after surgery,” state the study’s authors. “This result emphasizes the role of physiotherapy in the awareness, prevention, early diagnosis and treatment of secondary lymphoedema.”
Authors: María Torres Lacomba, María José Yuste Sánchez, Álvaro Zapico Goñi, David Prieto Merino, Orlando Mayoral del Moral, Ester Cerezo Téllez and Elena Minayo Mogollón.
Sources: Physiotherapy Department, School of Physiotherapy, Alcalá de Henares University, Madrid, Spain; Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain; Medical Statistics Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, England; Physiotherapy Department, Provincial Hospital, Toledo, Spain. Originally published online in British Medical Journal (2010).