Efficacy of complex decongestive therapy on breast cancer-related lymphedema: A cross-sectional study

Abstract

Aim: Lymphedema is a protein-rich interstitial fluid accumulation which occurs as a result disruption of lymphatic circulation. Breast cancer is a major reason of secondary cancer lymphedema. Breast cancer related upper extremity lymphedema result from the obstruction or disruption of the lymphatic system due to axillary lymph node dissection and/or radiation therapy of axillary region. A variety of conservative therapies have been aimed to decrease the limb swelling and its associated problems have been developed. Conservative treatments are complex decongestive therapy (CDT). The aim of our study was to investigate efficacy of CDT on the occurrence of breast cancer related lymphedema.

Methods: Between 2009 and 2018, 47 consecutive patients with histologically proven breast cancer were first treated with breast surgery, axillary lymph node dissection and radiotherapy and/or chemotherapy. These were analyzed collectively with retrospective data of our medical records who had 15-30 set of CDT and who had complete assessments before and after the treatment. CDT consists of the following components; skin care, manual lymphatic drainage, bandaging and exercises. Patients were treated with active therapy schedule (manual massage for lymphatic drainage and exercise therapy, 45-60 min per day) by the same trained physiotherapist. Volumetric quantification by circumference measurement of affected and healthy extremities was used for diagnosis and follow-up of lymphedema in all patients.

Results: The data of the 47 patients complying with the criteria specified in this retrospective study were evaluated. When the volumetric changes in the affected extremity were examined before and after lymphedema treatment, it was determined that the amount of lymphedema decreased after CDT (P=0.001). 31 (66%) patients received radiotherapy after mastectomy. When the patients were compared in terms of volumetric changes in extremities before and after CDT according to getting postoperative radiotherapy, it was determined that the changes in the patients who did not get radiotherapy were significantly higher than those getting radiotherapy (P=0.01).

Conclusion: Our study results show that CDT can be used for the management of breast cancer related lymphedema of limb. A thorough cost-effective analysis of protocol for CDT should be performed in a future study. In addition, as the factors underlying treatment delay were not included in this study, we believe future studies examining this area may be beneficial.