Physiotherapy helps prevent lymphedema after breast cancer surgery

NEW YORK (Reuters Health) - Early physiotherapy may help prevent lymphedema after breast cancer surgery, according to a new study published online January 13th in the British Medical Journal.

"Post-surgical intervention, including manual lymph drainage, shoulder physiotherapy exercises and educational strategies may prevent the onset of lymphedema for at least 1 year after breast cancer surgery," lead investigator Dr. Maria Torres-Lacomba, a physiotherapist at Alcala de Henares University in Madrid, Spain, told Reuters Health by email.

The randomized trial conducted by Dr. Torres-Lacomba and colleagues had 120 participants. Three to 5 days after unilateral breast cancer surgery with axillary lymph node dissection, they were assigned either to an early physiotherapy intervention or to a control group.

Three times a week for 3 weeks, women in the intervention group were seen by an oncology physiotherapist. Treatments included manual lymph drainage, massage of scar tissue and stretching exercises for the shoulder muscles.

Participants in both groups also received an educational program and instruction materials about causes and symptoms of lymphedema.

At 1 year, 25% of the women in the control group had developed secondary lymphedema compared with 7% of women in the physiotherapy intervention group (p = 0.01; risk ratio, 0.28). Furthermore, in the control group, the volume of the affected arm was an average of 5.1% greater than the volume of the unaffected arm - but in the intervention group, the average difference in volume between the affected and unaffected arms was only 1.6%.

The researchers also report that lymphedema developed four times earlier in the control group than in the early physiotherapy group. "The shape of the failure curves...suggests that the protective effect of early physiotherapy remained for a long time, whereas the proportion of patients with a diagnosis of secondary lymphedema in the control group increased progressively," they say.

Dr. Torres-Lacomba and colleagues conclude, "Secondary lymphedema is a chronic condition that has negative effects on the quality of life of patients...Further studies are needed to clarify whether early physiotherapy after breast cancer surgery can remain effective in preventing secondary lymphedema in the longer term."

Dr. Mei Fu, a doctor of nursing and lymphedema specialist at New York University who was not involved in the study, agrees that longer-term follow-up is necessary. Dr. Fu told Reuters Health, "We need to see whether the effects of the initial physiotherapy continue for 2, 3, or 5 years."

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