Combined decongestive therapy and reduction of pain and heaviness in patients with breast cancer-related lymphedema

Zahra Sheikhi Mobarakeh1 & Parisa Mokhtari-Hesari1,2 & Masomeh Lotfi-Tokaldany3 & Ali Montazeri4 & Mahnaz Heidari5 & Fatemeh Zekri5. Supportive Cancer Care 2019

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Combined decongestive therapy and reduction of pain and heaviness in patients with breast cancer-related lymphedema

Zahra Sheikhi Mobarakeh1 & Parisa Mokhtari-Hesari1,2 & Masomeh Lotfi-Tokaldany3 & Ali Montazeri4 & Mahnaz Heidari5 & Fatemeh Zekri5. Supportive Cancer Care 2019

Purpose We aimed to determine the effectiveness of combined decongestive therapy (CDT)and the minimum sessions required to significantly reduce pain and heaviness in patients with breast cancer-related lymphedema.

Methods A sample of 169 patients with breast cancer-related lymphedema underwent CDT, 5 days/week for a total of 3 to 4 weeks. Self-reported pain and heaviness was quantified on a separate visual analog scale (VAS) prior to CDT and after 3,5, 7, 10, and 15 sessions. Scores derived from VASs were categorized into three categories: mild (score<4), moderate (score=4–6), and severe (score>6). Downward transition for at least one category in severity of each parameter was considered as an improvement. Repeated measure analysis of variance was conducted to test the effect of time on the severities of pain and heaviness while age, afflicted side with lymphedema, history of chemotherapy, and radiotherapy were considered as covariates.

Results The mean age of patients was 52.66 ±12.20 years. In all 132 patients, out of 169 patients (71.3%)  reported pain and 155 patients (83.7%) reported heaviness at baseline. However, after intervention, the cumulative percentage of patients with at least a one category reduction in pain and heaviness was 86.4% and 83%, respectively. At least seven sessions of CDT were shown to be sufficient in alleviating the severity of the symptoms in greater than 83% of patients.

Conclusions The combined decongestive therapy significantly reduced the intensities of pain and heaviness in patients with breast cancer-related lymphedema.

Main findings

  • They included female breast cancer patients and those who clinically were diagnosed with post mastectomy secondary lymphedema of the ipsilateral arm. Also, patients who had a sensation of pain and/ or heaviness in the affected side were included.
  • The first phase of CDT, known as the therapeutic phase, was performed on a daily basis (5days/week) for 3 to 4 weeks, giving a total of 15 to 20 sessions. However, if during the sessions, patients’ pain or heaviness severity was entirely relieved, the sessions were ceased. Each session consisted of 40min of Dr. Vodder’s method of manual lymph drainage] performed by a trained therapist followed by appropriate skin care procedures and moisturization. Multilayer short stretch bandaging was applied using Lohmann and Rauscher’s compression bandaging. All patients were instructed to practice remedial exercises of their upper extremities at least two times per day with their bandages on at home. Remedial exercises were given with diaphragmatic breathing exercises in between.
  • The following order was adopted for remedial exercises: protraction, depression, shoulder extension, elbow flexion and extension, wrist flexion and extension, and ball squeeze.
  • Measurements utilised a visual analog scale and limb volumes.
  • The median pain score was reduced from 5 to 4 after three treatments and decreased even further to a value of 1 after seven treatments and zero after ten treatments.
  • The frequency of patients reporting at least a one-grade reduction in pain increased continually from the first to the 15th session.
  • The percentages of patients with moderate or severe heaviness prior to CDT (78%) decreased to 69.7%, 54.8%, 33.6%, 17.4%, and 3.2% after 3, 5, 7, 10, and 15 treatments, respectively.
  • Majority of patients reported a noticeable reduction in heaviness as the number of CDT sessions progressedfromoneto15treatments.After5sessions,53.5% of patients had a reduction of one grade in heaviness, while after 7 and 15 treatments, 83% and 97.9% of subjects reported such reductions, respectively.
  • Pain intensity reduction during the early sessions can diminish patients’ distress and improve their compliance.