Physical Therapist Management of Lymphoedema Following Treatment for Breast Cancer

A Cochrane review [Abstract] 2 included 6 trials with a total of 208 patients to assess the efficacy and safety of manual lymphatic drainage (MLD) for breast-cancer related lymphedema (BCRL). MLD + compression bandaging versus compression bandaging alone showed reductions of 30% to 38.6% for compression bandaging alone, and an additional 7.11% reduction for MLD (MD 7.11%, 95% CI 1.75% to 12.47%; 2 RCTs; n=83, P=0.06).

MLD + standard physiotherapy versus standard physiotherapy showed improvements in both groups from baseline but no significant between-groups differences (1 trial, n = 42).

Three trials compared MLD + compression therapy to non-MLD treatment + compression therapy. In a study comparing compression sleeve + MLD to compression sleeve + pneumatic pump, volume reduction was larger in MLD group (MD 47.00 mL, 95% CI 15.25 mL to 78.75 mL; 1 RCT; n = 24). Edema volume was smaller in the MLD group in another trial comparing compression sleeve plus MLD to compression sleeve plus self-administered simple lymphatic drainage (MD -230.00 mL, 95% CI -450.84 mL to -9.16 mL; 1 RCT; n = 31). A third trial compared MLD + compression bandaging versus self-administered drainage + compression bandaging; no difference in volume reduction was detected (MD 11.80%, 95% CI -2.47% to 26.07%, n = 28).

A systematic review 1 including 13 studies with a total of 920 subjects was abstracted in DARE. One study (n=74) was an RCT. Compression garment appears to reduce limb size after 6 months of use, and the addition of electrical stimulation or pneumatic pumps do not improve the results. However, the Wright linear pump and the uniform pressure pump are effective in reducing limb size when followed by the use of compression garments. Complex physical therapy including massage, pneumatic pump, and compression garments showed positive results in the treatment of lymphoedema (2 studies).

Comment: The quality of evidence is downgraded by study quality (poor methodological quality in original studies) and and by imprecise results (limited study size).

References

• Megens A, Harris SR. Physical therapist management of lymphedema following treatment for breast cancer: a critical review of its effectiveness. Phys Ther 1998 Dec;78(12):1302-11. [PubMed][DARE]
• Ezzo J, Manheimer E, McNeely ML et al. Manual lymphatic drainage for lymphedema following breast cancer treatment. Cochrane Database Syst Rev 2015;(5):CD003475. [PubMed]