Surprising result from recent research on Mild Lymphedema

LynnInColorado

I have been anxious to see some hard data showing how effective Decongestive Therapy is.  I don't think I'll stop my daily MLD.  What do you think?  

"A trial that randomized women with early lymphedema to receive either complex decongestive therapy (CDT) or compression garments was unable to show that CDT is better than the more conservative, less expensive approach. Several cohort studies have suggested that CDT — which consists of manual lymphatic massage or drainage, daily bandaging, exercise, and skin care — is superior to compression sleeves for the treatment of lymphedema. However, a group of Canadian researchers who thought the evidence for such superiority was not good enough decided to conduct a randomized trial to find a definitive answer."

The lead author is quoted here.

"I actually thought that our study was going to show that complex decongestive therapy was better, but, in fact, it didn't seem to be any more beneficial than elastic compression sleeves, which are much, much cheaper," said lead author Ian S. Dayes, MD, from McMaster University in Hamilton, Ontario.

Click here: Results at this link.

• ©American Society of Clinical Oncology

Randomized Trial of Decongestive Lymphatic Therapy for the Treatment of Lymphedema in Women with Breast Cancer.

Abstract

Purpose: Because of its morbidity and chronicity, arm lymphedema remains a concerning complication of breast cancer treatment. Although massage-based decongestive therapy is often recommended, randomized trials have not consistently demonstrated benefit over more conservative measures.

Patients and Methods: Women previously treated for breast cancer with lymphedema were enrolled from six institutions. Volumes were calculated from circumference measurements. Patients with a minimum of 10% volume difference between their arms were randomly assigned to either compression garments (control) or daily manual lymphatic drainage and bandaging followed by compression garments (experimental). The primary outcome was percent reduction in excess arm volume from baseline to 6 weeks.

Results: A total of 103 women were randomly assigned, and 95 were evaluable. Mean reduction of excess arm volume was 29.0% in the experimental group and 22.6% in the control group (difference, 6.4%; 95% CI, −6.8% to 20.5%; P = .34). Absolute volume loss was 250 mL and 143 mL in the experimental and control groups, respectively (difference, 107 mL; 95% CI, 13 to 203 mL; P = .03). There was no difference between groups in the proportion of patients losing 50% or greater excess arm volume. Quality of life (Short Form-36 Health Survey) and arm function were not different between groups.

Conclusion: This trial was unable to demonstrate a significant improvement in lymphedema with decongestive therapy compared with a more conservative approach. The failure to detect a difference may have been a result of the relatively small size of our trial.

LynnInColorado

Here is part of the National Lymphedema Network's comment on the above.

NLN Commentary:
When LE is caught early, it may respond to less treatment and that is good. When lymphedema progresses to a later stage, it generally requires more intensive treatment. This study suggests that patients who develop BCRL within the first year after surgery may need less therapy than previously thought. However, it is important to receive an evaluation by a professional with specialized training in lymphedema management regarding risk reduction. When any swelling is present, it is important to receive individualized treatment recommendations by a lymphedema-trained professional. Patients with swelling should be routinely followed so treatment can be promptly initiated in the event the lymphedema progresses.

http://www.lymphnet.org/resources/hot-topics-resea...

LymphActivist

It is important to lymphedema patients seeking proper treatment of
their medical condition before it becomes disabling, and to the medical
institutions and insurers who can be mislead into paying for substandard
medical treatment and then dealing with the consequences of that
undertreatment.

The study compared elastic compression alone against the standard
decongestive therapy which uses
elastic compression after manual lymph drainage and bandaging. In almost every respect decongestive
therapy including manual lymph drainage and compression bandaging outperformed
compression garments alone – for new patients as well as long-time patients
with lymphedema.

“This trial was
unable to demonstrate a significant improvement in lymphedema with decongestive
therapy compared with a more conservative approach. The failure to detect a
difference may have been a result of the relatively small size of our trial,”
the researchers wrote. Statistically-speaking this is correct. Significant
differences cannot be shown with so small a study. But let us look at the results that were reported with the
standard CDT compared with the compression only:

•
absolute volume reduction 250 VS 143 mL à 74% more fluid removed

•
patients with lymphedema 1 year or less: 188 VS 162 mL à 16% more
fluid removed;

•
patients with lymphedema more than 1 year: 328 VS 114 mL à 288% more
fluid removed.

Another recently studied lymphedema care delivery model
based on lymphedema early detection and intervention would provide manual lymph
drainage (MLD) to the limb of a breast cancer patient from day 2 after
treatment and throughout the first year. This concept is applied in a six-month
study to trial groups undergoing sentinel lymph node biopsy (SLNB) and axillary
lymph node dissection (ALND), with and without radiotherapy. The investigators
measured percent excess arm fluid and provided intervention to all members of
the intervention group. While average excess fluid due to lymphedema in the
women in the control group, who received no MLD, grew monotonically from zero to +10% at 6 months, the
average excess fluid dropped monotonically
in the MLD group from +1% to -1.5%. “This study demonstrates that regardless of
the surgery type and the number of the lymph nodes removed, MLD effectively
prevented lymphedema of the arm on the operated side. Even in high risk breast
cancer treatments (operation plus irradiation), MLD was demonstrated to be
effective against arm volume increase.” [Zimmermann 2012].

So instead of selecting patients who have already experienced
10% excess fluid, would we be better off providing MLD as a preventive protocol
to all breast cancer treatment survivors so they never reach 10% excess fluid?

LynnInColorado

Thank you for responding. Could you tell me the source of the 2nd sentence in the 2nd paragraph?  

I encourage Lymphedema community members who are interested in up to date information about lymphedema to refer to the National Lymphedema Network web site at http://www.lymphnet.org and/or sign up for updates here  http://www.nlm.nih.gov/medlineplus/lymphedema.html