A new clinical trial has found that physiotherapy (physical therapy) begun as a preventive measure soon after breast cancer surgery can reduce the risk of secondary lymphedema, i.e., fluid buildup caused by injury to the lymphatic system. Lymphedema is characterized by painful fluid retention and arm swelling. The study initially included 120 women, of whom 116 completed follow up. The women were divided into two groups. An intervention group was treated by a physiotherapist with manual lymph drainage, massage of scar tissue, and shoulder exercises. This group also received education regarding strategies for limiting lymphedema, including advice on how to avoid further injury and prevent infection. A control group received only the education regarding lymphedema. Both programs lasted three weeks and the patients were followed up at four weeks, three months, six months and one year after surgery.
The main outcome measure was incidence of lymphedema, defined as an increase of more than 2 cm in arm circumference (compared with the non-affected arm). Of the 116 women who completed the trial, 18 developed lymphedema (16%): four in the intervention group (7%) and 14 in the control group (25%). In addition, lymphedema was diagnosed four times earlier in the control group than in the intervention group. The authors conclude that early physiotherapy could be an effective intervention in the prevention of lymphedema in women for at least one year after surgery for breast cancer involving dissection of axillary lymph nodes. Further research is needed to determine whether early physical therapy offers longer-term protection against secondary lymphedema.
Lymphedema can become chronic
Lymphedema eventually affects a majority of patients who undergo axillary node dissection and some women with sentinel lymph node dissection. Radiation to the lymph nodes increases a woman’s risk of developing lymphedema, as does being very overweight. Although most women eventually experience a reduction in symptoms, lymphedema can become chronic. Chronic lymphedema has no cure and patients may have a life-long need to wear compression garments and undergo labor intensive treatments to prevent worsening of swelling and pain. Therefore, treatment that could potentially reduce the risk of lymphedema is worth exploring. This is the first study to suggest that active, preemptive physical therapy be undertaken soon after surgery to prevent lymphedema.