Long term effects of manual lymphatic drainage and active exercises on physical morbidities, lymphoscintigraphy parameters and lymphedema formation in patients operated due to breast cancer: A clinical trial
Mariana Maia Freire de Oliveira1, Maria Salete Costa Gurgel, Ba´rbara Juarez Amorim, Celso Dario Ramos, Sophie Derchain, Natachie Furlan-Santos, Ce ´sar Cabello dos Santos, Luı ´s Ota ´vio Sarian
https://doi.org/10.1371/journal.pone.0189176
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Long term effects of manual lymphatic drainage and active exercises on physical morbidities, lymphoscintigraphy parameters and lymphedema formation in patients operated due to breast cancer: A clinical trial
Mariana Maia Freire de Oliveira1, Maria Salete Costa Gurgel, Ba´rbara Juarez Amorim, Celso Dario Ramos, Sophie Derchain, Natachie Furlan-Santos, Ce ´sar Cabello dos Santos, Luı ´s Ota ´vio Sarian
Purpose Approximately 20% of breast cancer survivors develop breast cancer-related lymphedema (BCRL), and current therapies are limited. We compared acupuncture (AC) to usual care wait-list control (WL) for treatment of persistent BCRL.
Methods Women with moderate BCRL lasting greater than six months were randomized to AC or WL. AC included twice weekly manual acupuncture over six weeks. We evaluated the difference in circumference and bioimpedance between affected and unaffected arms. Responders were defined as having a decrease in arm circumference difference greater than 30% from baseline. We used analysis of covariance for circumference and bioimpedance measurements and Fisher’s exact to determine the proportion of responders.
Results Among 82 patients, 73 (89%) were evaluable for the primary endpoint (36 in AC, 37 in WL). 79 (96%) patients received lymphedema treatment before enrolling in our study; 67 (82%) underwent ongoing treatment during the trial. We found no significant difference between groups for arm circumference difference (0.38 cm greater reduction in AC vs. WL, 95% CI − 0.12 to 0.89, p = 0.14) or bioimpedance difference (1.06 greater reduction in AC vs. WL, 95% CI − 5.72 to 7.85, p = 0.8). There was also no difference in the proportion of responders: 17% AC versus 11% WL (6% difference, 95% CI – 10 to 22%, p = 0.5). No severe adverse events were reported.
Conclusions Our acupuncture protocol appeared to be safe and well tolerated. However, it did not significantly reduce BCRL in pretreated patients receiving concurrent lymphedema treatment. This regimen does not improve upon conventional lymphedema treatment for breast cancer survivors with persistent BCRL.
Main findings
- There were 2 groups, manual lymphatic drainage (MLD) or active exercise (AE). Forty-eight hours after surgery, women started the intervention (MLD or AE). Women assigned to MLD group began 40-min individual MLD sessions, twice a week, for 30 days, and those women assigned to the exercise group began 40-min group sessions (5–20 women), twice a week, for 30 days.
- MLD and AE for UL rehabilitation after breast cancer surgery produced similar effects on wound complications, ROM, and lymphoscintigraphy parameters in the short and long run. In addition, our study suggests that AE may be more effective than MLD for the prevention of lymphedema in women older than 39 years.
- This study shows that shoulder flexion and abduction ROM decreased significantly in both groups during the first 60 days. For the MLD group this could be due to positioning of the shoulder in various positions to perform the MLD.
- This study shows that manual lymphatic drainage is as safe and effective as exercise in rehabilitation after breast cancer surgery. Also of note, the data clearly shows that lymphatic abnormalities precede lymphedema formation in BC patients. In younger women, obesity seems to be the major player in lymphedema development, and actions devoted to reduce body weight may be of great benefit to women undergoing surgery for BC. On the other hand, the study shows that in older women, interventions focused on improving muscle strength are pivotal in preventing lymphedema formation.
- This study wasn’t a randomised control trial.
- MLD twice per week for 30 days is a huge commitment for the client as well as costly. It is also labour intensive.
