Manual lymphatic drainage for breast cancer-related lymphoedema

Shao Y. & Zhong D.-S. (2017) European Journal of Cancer Care 26

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Manual lymphatic drainage for breast cancer-related lymphoedema

Shao Y. & Zhong D.-S. (2017) European Journal of Cancer Care 26

Breast cancer-related lymphoedema (BCRL) is a common sequela of surgical or radiation therapy of breast cancer. Although being an important part of conservative therapy, the role of manual lymphatic drainage (MLD) on BCRL is still debating. The objective of the current systematic review and meta-analysis was to determine whether the addition of MLD to the standard therapy (ST) could manage BCRL more effectively. We searched PubMed, EMBASE and Cochrane Library for related randomised clinical trials to compare the volume reduction, improvement of symptoms and arm function between groups with or without MLD. Four randomised controlled trials, with 234 patients, were included. Results showed there was a significant difference in volume reduction between MLD plus routine treatment and sole routine treatment. Current trials show that adding MLD to the ST could enhance the effectiveness of treating volume

Main findings

  • Four randomised controlled clinical trials (Andersen et al. 2000; McNeely et al. 2004; Didem et al. 2005; Dayes et al. 2013) with 234 patients, were included. Among them, three randomised controlled trials (Andersen et al. 2000; McNeely et al. 2004; Dayes et al. 2013) with 181 patients were available for a meta-analysis.
  • The results of this systematic review show that the addition of MLD to the standard conservative therapy for the management of BCRL leads to a significant relief of lymphoedema, but may not help to additionally alleviate the subjective symptoms and arm function. Other complications of breast cancer itself and treatment, such as neuropathy, shoulder mobility inconvenience, fatigue, etc. may all contribute to the function impairment.
  • MLD could not target all the aetiology. Maybe that is the reason why symptoms and function could not improve significantly.
  • The quality of the included studies was all category B, which might make the conclusion less convincing.
  • The clinical outcomes still need to be confirmed by large-sample, high quality randomised controlled trials.