Original articleEvaluation of a new approach to the treatment of lymphedema resulting from breast cancer therapy
Introduction
The World Health Organization estimates that worldwide there are more than 1,050,000 new cases of breast cancer every year making this the commonest form of cancer in women [1]. In Brazil, about 49,240 new cases were estimated for 2010 [2]. Despite of the high incidence of this disease, the survival rate of women treated in the initial stages of the disease has been increasing. Data from GLOBOCAN 2008, the international agency for research on cancer, shows that breast cancer is the most common among women and represents 23% of all new cancer cases and 14% of deaths in this population [3]. About half of all cases of deaths occur in developing countries. Overall, incidence rates are high in Northern Europe, Australia, New Zealand and North America and intermediate in South America, the Caribbean, North Africa, southern Africa and Asia. Factors that contribute to the variation in incidence are largely due to differences in reproduction, hormonal factors and the availability of services for early detection.
The incidence in some countries such as the USA, UK, France, and Australia has diminished since the beginning of the millennium, not only partly due to less post menopausal hormone therapy [4] but also because of early detection by mammography and adequate treatment [5]. In many African and Asian countries, however, including Uganda, South Korea and India, incidence and mortality rates have been increasing with changes in reproductive patterns, physical inactivity and obesity; these are the main factors dealt with to improve awareness and for prevention [4], [6].
One of the complications of breast cancer treatment is lymphedema which affects up to 50% of patients [4], [7]. Lymphedema is characterized by a type of edema caused by an abnormal accumulation of fluids and other substances in the tissues resulting from failure of the lymphatic drainage system [5], [6], [8], [9]. Currently there is concern in respect to sequels resulting from surgery and radiotherapy, as the limitations caused by lymphedema directly affect the quality of life of women [7], [8], [10], [11].
Limitations include a reduction in joint mobility with decreases in the amplitude of movements, an increase in the weight of the arm and pain; many sufferers experience serious difficulties to perform daily tasks [9], [12]. Psychological morbidity is also an important aspect as patients suffer from the moment they are told about the disease and during the entire treatment period and with the consequent sequels. Sequels that commonly develop in mastectomized women demand multidisciplinary care both in their prevention and treatment [10], [13].
As there is no consensus on a single therapy to treat lymphedema, an association of methods is recommended [11], [14]. Frequent evaluations are necessary in order to monitor the evolution of the patient and the application of the different techniques used. In spite of the association of several techniques in the treatment of lymphedema, there is still a need for safe alternatives that guarantee greater independence for these patients. A meta-analysis suggests that compression garments and compression bandaging are effective in reducing limb lymphedema volume in edema caused by several types of cancer. Specific to breast cancer, a statistically significant beneficial effect was found with the addition of manual lymph drainage to compression therapy to reduce upper extremity lymphedema volume [12], [15].
The aim of this study was to evaluate a new form of intensive therapy with a single 3 to 4-h weekly session to treat breast cancer-related lymphedema.
Section snippets
Patients and method
A prospective study of 66 women with breast cancer-related lymphedema was performed in the Godoy Clinic in São José do Rio Preto, Brazil from March 2007 to December 2008 with an average follow-up time of 12.3 months. The ages of the patients ranged from 35 to 83 years old with a mean of 58.8 years. The diagnosis of lymphedema was made by physical evaluation and water-displacement volumetry (a difference of > 200 mL between arms). All patients were submitted to total mastectomy, axillary lymph node
Results
A significant reduction in the volume of the lymphedematous arms was seen for all patients. Table 1 shows the ages, initial and final volumes of the arms and the number of months of treatment. The mean initial volume of the lymphedematous arms was 2223.3 mL and for normal arms it was 1664.3 mL giving a mean difference between the two limbs of 559 mL. The mean volume of the limbs after treatment was 1831.5 mL. A significant reduction (p < 0.0001) of 70.1% (388.8 mL; 95% confidence interval: 324.8 to
Discussion
This study describes a new multidisciplinary approach to treat breast cancer-related lymphedema using occupational therapy and compression as the main basis of treatment. No publications were found in the MEDLINE, OVID and Scopus electronic databases that utilize an approach similar to this. Thus it is difficult to compare these results with other studies. The intensive approach of 3 to 4 h weekly, allows a greater interaction between the treatment team and patients and also among the patients
Conclusion
In our experience, this model of treatment appeared efficacious in decreasing and maintaining the reduction in volume of arm in breast cancer-related lymphedema.
Learning point
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An intensive multidisciplinary treatment of lymphedema using new therapeutic approaches.
Conflict of interests
The authors state that they have no conflicts of interest.
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