Effect of manual lymphatic drainage on upper limb lymphedema after surgery for breast cancer

Czech version

Authors: K. Chmelová ¹; Marta Nováčková ²
Authors‘ workplace: Fyzioterapie – MU Dr. Martin Dlouhý, Praha ¹; Gynekologicko-porodnická klinika 2. LF UK a FN Motol, Praha ²
Published in: Ceska Gynekol 2022; 87(5): 317-323
Category: Original Article
doi: https://doi.org/10.48095/cccg2022317

Overview

Objective: Evaluation of the effect of manual lymphatic drainage on lymphedema of the upper limb after previous axillary lymphadenectomy/sentinel node biopsy during the maintenance phase of lymphedema after the breast cancer surgery. Material and methods: A total of 30 patients after surgical treatment of unilateral breast cancer underwent 10 manual lymphatic drainages within 8 consecutive weeks. All patients underwent upper limb circumference measurements before and after the study and completed two specialized EORTC questionnaires (QLQ-C30 and QLQ-BR23). Results: The average time between surgery and admission into this study was 32.5 months. In the beginning of the study, lymphedema was present for an average of 19.8 months. At the end of a series of manual lymphatic drainages, the average volume decrease of the limb with lymphedema was 3% (1.5–5.6%). In contrary, the average loss of volume on the healthy (control) upper limb was only 0.4%. The average reduction of lymphedema volume after therapy achieved 57% (37–88%). After a series of manual lymphatic drainages, the results of the EORTC QLQ-C30 questionnaire showed a statistically significant improvement in physical and role functions, fatigue, nausea and vomiting, pain, dyspnea and constipation, while the results of the EORTC QLQ-BR23 questionnaire showed a statistically significant improvement in the arm and breast symptoms. There was no statistically significant deterioration in any of the monitored parameters. Conclusion: The results of the study showed a positive effect of manual lymphatic drainage on the maintenance phase of lymphedema in patients after breast cancer surgery. The questionnaires showed a significant improvement in hand and arm symptoms as well as an improvement of the other functions and symptoms affecting quality of life. Further studies should be performed on groups of patients with the maintenance phase of upper limb lymphedema to confirm or disprove our results.

Keywords:

breast cancer – lymphedema – manual lymphatic drainage – axillary lymphadenectomy

Sources

1. Sung H, Ferlay J, Siegel RL et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021; 71 (3): 209–249. doi: 10.3322/caac.21660.

2. Halászová N, Crha I, Huser M et al. Zachování fertility u žen s karcinomem prsu před gonadotoxickou léčbou. Ceska Gynekol 2017; 82 (4): 287–292.

3. Grogan Fleege NM, Cobain EF. Breast cancer management in 2021: a primer for the obstetrics and gynecology. Best Pract Res Clin Obstet Gynaecol 2022; 82: 30–45. doi: 10.1016/j.bpobgyn.2022.02.004.

4. Halaška M, Strnad P, Chod J et al. Detekce pooperačního lymfedému u pacientek s karcinomem prsu. Ceska Gynekol 2007; 72 (4): 299–304.

5. Kassamani YW, Brunelle CL, Gillespie TC et al. Diagnostic criteria for breast cancer-related lymphedema of the upper extremity: the need for universal agreement. Ann Surg Oncol 2022; 29 (2): 989–1002. doi: 10.1245/s10434- 021-10645-3.

6. Mayrovitz HN. Noninvasive measurements of breast cancer-related lymphedema. Cureus 2021; 13 (11): e19813. doi: 10.7759/cureus.19813.

7. Cho Y, Do J, Jung S et al. Effects of a physical therapy program combined with manual lymphatic drainage on shoulder fiction, quality of life, lymphedema incidence, and pain in breast cancer patients with axillary web syndrome following axillary dissection. Support Care Cancer 2016; 24 (5): 2047–2057. doi: 10.1007/s00520-015-3005-1.

8. Hamner JB, Fleming MD. Lymphedema therapy reduces the volume of edema and pain in patients with breast cancer. Ann Surg Oncol 2007; 14 (6): 1904–1908. doi: 10.1245/s10434-006-9332-1.

9. Halaska MJ, Komarek V, Mala I et al. A method for detection of post-operative lymphoedema after operation for breast cancer: multifrequency bioelectrical impedance analysis. J Appl Biomed 2006; 4 (4): 179–185. doi: 10.32725/jab.2006.020.

10. Taylor R, Jayasinghe UW, Koelmeyer L et al. Reliability and validity of arm volume measurements for assessment of lymphedema. Phys Ther 2006; 86 (2): 205–214.

11. Aaronson NK, Ahmedzai S, Bergman B et al. The European organization for research and treatment of cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993; 85 (5): 365–376. doi: 10.1093/jnci/85.5.365.

12. Sprangers MA, Groenvold M, Arraras JI et al. The European organization for research and treatment of cancer breast cancer-specific quality of life questionnaire module: first reset from a three-country field study. J Clin Oncol 1996; 14 (10): 2756–2768. doi: 10.1200/JCO. 1996.14. 10.2756.

13. Fayers PM, Aaronson NK, Bjordal K et al. EORTC Quality of life group. European organization for research and treatment of cancer QLQ-C30 scoring manual. 3rd ed. Brussels: EORTC 2001.

14. Torres-Lacomba M, Navarro-Brazáles B, Prieto-Gómez V et al. Effectiveness of four types of bandages and kinesio-tape for treating breast-cancer-related lymphoedema: a randomized, single-blind, clinical trial. Clin Rehabil 2020; 34 (9): 1230–1241. doi: 10.1177/0269 215520935943.

15. Invernizzi M, Corti C, Lopez G et al. Lymphovascular invasion and extranodal tumour extension are risk indicators of breast cancer related lymphoedema: an observational retrospective study with long-term follow-up. BMC Cancer 2018; 18 (1): 935. doi: 10.1186/s12885-018-4851-2.

16. Devoogdt N, Geraerts I, Van Kampen M et al. Manual lymph drainage may not have a preventive effect on the development of breast cancer-related lymphoedema in the long term: a randomized trial. J Physiother 2018; 64 (4): 245–254. doi: 10.1016/j.jphys.2018.08.007.

17. Liang M, Chen Q, Peng K et al. Manual lymphatic drainage for lymphedema in patients after breast cancer surgery: a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99 (49): e23192. doi: 10.1097/MD.0000000000023192.

18. Ezzo J, Manheimer E, McNeely ML et al. Manual lymphatic drainage for lymphedema following breast cancer treatment. Cochrane Database Syst Rev 2015; 5: CD003475. doi: 10.1002/ 14651858.CD003475.pub2.

19. Huang TW, Tseng SH, Lin CC et al. Effects of manual lymphatic drainage on breast cancer-related lymphedema: a systematic review and meta-analysis of randomized controlled trials. World J Surg Oncol 2013; 11: 15. doi: 10.1186/1477-7819-11-15.

20. Tambour M, Holt M, Speyer A et al. Manual lymphatic drainage adds no further volume reduction to complete decongestive therapy on breast cancer-related lymphoedema: a multicentre, randomized, single-blind trial. Br J Cancer 2018; 119 (10): 1215–1222. doi: 10.1038/s41416-018-0306-4.

21. Andersen L, Højris I, Erlandsen M et al. Treatment of breast cancer-related lymphedema with or without manual lymphatic drainage: a randomized study. Acta Oncol 2000; 39 (3): 399–405. doi: 10.1080/028418600750013186.

22. Boris M, Weindorf S, Lasinski B et al. Lymphedema reduction by noninvasive complex lymphedema therapy. Oncology (Williston Park) 1994; 8 (9): 95–106.

23. Shao Y, Zhong DS. Manual lymphatic drainage for breast cancer-related lymphoedema. Eur J Cancer Care (Engl) 2017; 26 (5): e12517. doi: 10.1111/ecc. 12517.

24. Molski P, Kruczyński J, Molski A et al. Manual lymphatic drainage improves the quality of life in patients with chronic venous disease: a randomized controlled trial. Arch Med Sci 2013; 9 (3): 452–458. doi: 10.5114/aoms.2013.35343.