Prospective trial of complete decongestive therapy for upper extremity lymphedema after breast cancer therapy.

Abstract

Lymphedema is a well-described complication of therapy for breast cancer. Patients who present with lymphedema may experience pain and body image issues and are at increased risk for developing cellulitis. Complete decongestive therapy (CDT) is a four-component therapy for lymphedema. Data regarding CDT as an intervention in the immediate after the diagnosis period and prolonged follow-up are limited; we prospectively analyzed results of CDT in this cohort of patients. Twenty patients were enrolled in CDT immediately after their diagnosis of lymphedema. The Functional Assessment of Cancer Therapy quality of life (QoL) measure and a visual analogue scale for pain were completed before, on the 10th day of, and on the last day of treatment. Each patient underwent a daily 60- to 90-minute treatment session, 5 days per week for 2-4 weeks. Treatment consisted of skin and nail care, manual lymphatic drainage, a multilayer compression bandage, and therapeutic exercise. Edema of the affected limb was reassessed weekly. On reaching a measurement plateau, the patient was discharged from active treatment and began a maintenance phase. The patient was reassessed for girth, volume, and body weight at 3 months. These measurements plus the QoL and pain measures were also reassessed at 6 months and 1 year after treatment. Patients completed 2-4 weeks of treatment (median, 2 weeks). Those classed as severe decreased from 7 to 1. Median girth reduced 1.5 cm and median volume reduced 138 mL. Decreasing girth correlated significantly with decreasing visual analogue scale scores for pain, but not with increasing QoL. Increasing grade correlated significantly with girth reduction and volume reduction. Compliance with the treatment regimen at home decreased with time on the program. During follow-up, girth and volume reverted slightly but stabilized at about 1 cm and 100 mL below baseline, respectively. Although the increase in QoL was not significant, it was noted that during the entire treatment and follow-up period, QoL consistently increased, ending about 5% above baseline, and pain scores gradually decreased, ending with 54% (and median) of patients at 0 pain. CDT is effective in treating lymphedema. Success in girth reduction contributes to less pain. Grade is a useful indicator of severity; class is not. Increased number of treatment sessions provides marked improvements in girth, volume, and weight but result in poorer compliance. Longer latency more successfully reduces girth, volume, and pain and increases QoL. QoL and pain are improved by treatment and continue to improve after treatment has ended.