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LymphActivist's Site
Dedicated to Lymphedema Patients and the Therapists Who Treat Them
LymphActivist's Site
Dedicated to Lymphedema Patients and the Therapists Who Treat Them
REVIEW - ZIMMERMANN (2012)
CAN EARLY MLD PREVENT BCRL?
In the opinion of this lymphedema patient advocate, this is one of the most important research papers to lymphedema patients that has been published recently. The paper entitled "Efficacy of manual lymphatic drainage in preventing secondary lymphedema after breast cancer surgery" by Zimmerman, Wozniewski, Szklarska, Lipowicz and Szuba, Lymphology 2012; 45:103-12 demonstrates that an early intervention of a program of manual lymphatic drainage (MLD) can potentially prevent the onset of lymphedema in patients surviving a wide spectrum of breast cancer treatments.
The study involved 67 women who underwent breast surgery for primary breast care. From the 2nd day after surgery, 33 randomly chosen women were given MLD, exercises and breath therapy 5 times per week for 2 weeks, and then from the 14th day until 6 months after the surgery, 2 times per week. The MLD was provided according to the principles of Vodder–Asdonk. The control group of 34 women practiced self-drainage, exercise and breath therapy to the same schedule.
Each therapy session was of 60 min. duration, with 30 min. of MLD and 25 to 30 min. of exercises and breath therapy. None of the women in either group wore compression at any time.
Measurements of both arms were taken before surgery and on days 2, 7, 14, and at 3 and 6 months after surgery. At 6 months after breast cancer surgery, among the women who did not undergo MLD, a significant increase in the arm volume on the operated side was observed (P = 0.0033) when compared with the arm volume prior to surgery. In the group of women without MLD, 6 months after surgery, 70.6% of the subjects suffered from lymphedema. At his time in there was no statistically significant increase in the volume of the upper limb on the operated side in women who underwent MLD.
These results confirmed earlier results by other researchers on edema prevention after treatment of breast cancer. Lacomba, et al. (2010) found that significantly fewer women receiving physiotherapy developed clinically important lymphedema after one year when compared with the controls. Box, et al. (2002) demonstrated that a physiotherapy program including exercises and progressive educational strategies may reduce the occurrence of secondary lymphedema 2 years after surgery.
This study demonstrated that regardless of the surgery type and the number of lymph nodes removed, MLD effectively prevented lymphedema of the arm on the operated side. It suggests that MLD administered early after operation for breast cancer should be considered for the prevention of lymphedema. This confirms Foeldi's 1998 recommendation for immediate MLD to regenerate damaged lymphatic vessels promptly and create lymphatic and venous–lymphatic connections before the occurrence of skin tissue changes and the presentation of clinical lymphedema, and before the need presents for compression.
REFERENCES:
Box RC, Reul-Hirche HM, Bullock-Saxton JE, et al.: "Physiotherapy after breast cancer surgery: Results of a randomized controlled study to minimize lymphoedema" Breast Cancer Res Treat. 2002;75:51-64.
Földi E: "The treatment of lymphedema" Cancer 1998;15(12 Supplement):2833-34.
Lacomba, MT, Yuste-Sanchez MJ, Goni AZ, et al: "effectiveness of early physiotherapy to prevent lymphoedema after surgery foe breast cancer: Randomized, single blinded, clinical trial" BMJ 2010;340:b5396.
This summary was largely abstracted from the referenced article and from private communications between R. Weiss and the primary author A. Zimmermann.