Manual lymph drainage may not have a preventive effect on the development of breast cancer-related lymphoedema in the long term: a randomised trial.

Devoogdt N1, Geraerts I2, Van Kampen M2, De Vrieze T2, Vos L2, Neven P3, Vergote I4, Christiaens MR3, Thomis S5, De Groef A2. J Physiother. 2018 Oct;64(4):245-254

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Manual lymph drainage may not have a preventive effect on the development of breast cancer-related lymphoedema in the long term: a randomised trial

Devoogdt N1, Geraerts I2, Van Kampen M2, De Vrieze T2, Vos L2, Neven P3, Vergote I4, Christiaens MR3, Thomis S5, De Groef A2. J Physiother. 2018 Oct;64(4):245-254

QUESTION:

What are the short-term and long-term preventive effects of manual lymph drainage (MLD), when used in addition to information and exercise therapy, on the development of lymphoedema after axillary dissection for breast cancer?

DESIGN:

Randomised controlled trial with concealed allocation, blinded assessors and intention-to-treat analysis.

PARTICIPANTS:

Adults undergoing unilateral dissection for breast cancer were recruited, with 79 allocated to the experimental group and 81 to the control group.

INTERVENTION:

The experimental group received guidelines about prevention of lymphoedema, exercise therapy and MLD. The control group received the same guidelines and exercise therapy, but no MLD. The interventions in both groups were delivered for 6 months.

OUTCOME MEASURES:

The primary outcome was cumulative incidence of arm lymphoedema defined in four ways (≥200ml,≥2cm,≥5%, and≥10% increase), which represent the difference in arm volume or circumference between the affected and healthy sides compared with the difference before surgery. Secondary outcomes included point prevalence of lymphoedema, change in arm volume difference, shoulder range of movement, quality of life and function.

RESULTS:

Incidence rates were comparable between experimental and control groups at all follow-up measurements. Sixty months after surgery, the cumulative incidence rate for the≥200ml definition was 35% for the experimental group versus 29% for the control group (RR 0.89, 95% CI 0.51 to 1.54, p=0.45); for the≥2cm definition 35% versus 38% (RR 0.93, 95% CI 0.59 to 1.45, p=0.73); for the≥5% definition 68% versus 53% (RR 1.28, 95% CI 0.97 to 1.69, p=0.08) and for the≥10% definition 28% versus 24% (RR 1.18, 95% CI 0.66 to 2.10, p=0.57). The secondary outcomes were comparable between the groups at most assessment points.

CONCLUSION:

Manual lymph drainage may not have a preventive effect on the development of breast cancer-related lymphoedema in the short and long term.

Main findings

  • MLD was started for a period of 20 weeks. During this period, 40 30-minute sessions were scheduled. Frequency was increased from one to three times a week, and then decreased to once a week. During MLD, neck and axillary lymph nodes were emptied, axilloaxillary anastomoses at the breast and back and lymphatics at the lateral side of the shoulder (Mascagni pathway) were stimulated, and the arm and hand were drained from proximal to distal.
  • 160 were included in the present study. Among these, 79 participants were randomised to the experimental group and 81 to the control group.
  • After 6 months of treatment and at the different follow-up assessments up to 60 months after axillary dissection, cumulative incidence rates for the different definitions of lymphoedema (ie, the primary outcomes) were comparable between the experimental group (receiving guidelines, exercise therapy and MLD) and the control group (receiving guidelines and exercise therapy).
  • Despite follow-up for 5 years, it remains uncertain whether manual lymph drainage for 6 months after treatment for breast cancer has a preventive effect on lymphoedema. Until the long-term preventive effect of manual lymph drainage is clear, patients without lymphoedema may consider spending their available therapy time on interventions with more robust evidence of preventive benefits, such as exercise.