Issues/questions about laser therapy for LE swelling?

carol57

I am reviewing a slew of LE patient infomation booklets and flagging statements and recommendations that I am not sure are accurate, or are guilty of sins of omission.  (Sorry Kira and Binney, because you just know I'm going to be knocking on your cyber doors asking about some of the suspect statements).

I have a question about a statement in the National Cancer Institute's Lymphedema PDQ, which says:  "Laser therapy may help decrease lymphedema swelling and skin hardness after a mastectomy. A hand-held, battery-powered device is used to aim low-level laser beams at the area with lymphedema.''  

Kira, I searched 'laser' in our LE forum here and came up with a post by you that said in part, 'don't get me started with laser therapy.'  I kind of remembered seeing that, which is what prompted me to raise an eyebrow when I read the statement in the PDQ.  Are we talking about the same laser therapy, and if so, are there studies to support the NCI's statement?

If laser therapy works, then a) I want to do it and b) I want to use laser hair removal under my 'affected' pit.  I highly suspect that both a) and b) would not be good ideas.  Am I right?

Carol 

Outfield

Carol,

Laser was recommended to me by a friend, so I asked my CLT about it and did some searching.  I found no information verifying its longterm safety in breast cancer patients (my CLT said there's the same question about US, but that's a different story and I didn't try to chase that one down). 

Theoretically it might be a problem.  Your sending a lot of energy into an area that may harbor a few straggler tumor cells.  Will it make them behave differently? 

I'm sure Kira's going to give you a better substantiated answer, but I like to go right to Pubmed with questions like this..

carol57

Thanks, Outfield.  I'm suspicious as well and am just surprised that the NCI PDQ on LE describes it as an LE treatment without any mention of  absence of longer term effectiveness and safety studies. 

kira66715

Carol, one of my favorite moments at the 2010 NLN conference was watching Andrea Cheville of Mayo Clinic carefully review all the published literature on the laser and conclude that we have absolutely NO evidence it works or that it is safe.

And yet, it's sold directly to patients.

Here is my take on it on SUSO--it was offered to me, right after rads, by a reputable LE clinic because they'd bought one.....I wrote the anti-laser patient perspective in the NLN newsletter a few years back.

http://www.stepup-speakout.org/Lasers_for_lymphedema_treatment.htm

The place for it seems to be in helping with fibrosis, but again, there are no long term studies to support that.

Sheila Ridner and Ellen Poage have had a study going for a couple of years, and even though they treat patients for free, they haven't accrued enough patients. 

We've had some horrible fights on this board about it.

Don't want to go there again.

Kira

Outfield

There's scrutiny of the process by which medical devices are approved in both this country and the UK.  Even for devices like replacement hips and pacemakers, the process for approval here in the US can be very easy compared to that of a medication.

Nordy

I am someone that has tried the laser. Does this surprise anyone? Lol. I first contacted a PT that I know that has been treating lymphedema patients since 1992. She is part of a longstanding lymphedema practice and I know I can get good information from her. Regarding the laser - it is the low level laser that is used for the purpose of lymphedema - not the type that is used for hair removal - two totally different entities(sorry!). Anyway, the results they were having in their office at the time were three different outcomes, and pretty much equally spread out. About a third of their patients have good results, a third have a little improvement and a third have no change whatsoever - in their practice no patient had gotten worse. So.... guess which group I fell into... Oh, that's right, the one where the laser does absolutley nothing... Lolollol! Of course, I don't know why I always think everything will work! I should know by now, but I refuse to give up. Oh, but it did not make it worse either, so that is a good thing. On the other hand, the LMT that I went to for treatment (who is not the PT that I consulted ahead of time with) said that she has a patient come see her for a series of treatments every summer because it works so well for her. So, who knows. I will say this, insurance would not cover so I paid out of pocket. But then again, my insurance doesn't like to cover anything!

carol57

Well then, in light of these posts, I am even more surprised that NCI portrays it as a treatment without any mention of the lack of consistent, long-term results that corroborate its use as a treatment.  Or at least that the jury is still out.  Sorry Kira if this topic has unleashed dissent in the past.  I know that people get emotional when it comes to these kinds of questions.  Carol

ma111

Carol,

The laser used for hair removal is a different laser then used for scars. The laser for scars only works if it is the scar that is preventing the fluid from going down to the adb to be reabsorbed. It is a new treatment in my area and my therapists told me about it.

carol57

ma111, Just curious--did your therapsists say that the idea is that the laser breaks down the scar tissue?

ma111

She didn't say, just that it makes it softer allowing the fluid to go through, sorry.