From the Guidelines
Lymphedema should be treated with a comprehensive approach called Complete Decongestive Therapy (CDT), which includes manual lymphatic drainage, compression therapy, exercise, and meticulous skin care to prevent infections, as recommended by the most recent and highest quality study 1.
Overview of Lymphedema
Lymphedema is a chronic condition characterized by swelling in the arms or legs due to a blockage in the lymphatic system. It can occur after cancer treatment, such as breast cancer surgery and/or radiation, and can also be congenitally malformed. The incidence of lymphedema among breast cancer survivors varies widely, with over 40% of survivors experiencing lymphedema to some degree 1.
Risk Factors and Prevention
The risk of lymphedema is much lower with sentinel lymph node dissections than with full axillary lymph node dissection 1. Obesity is also a risk factor for lymphedema, and physicians should recommend weight loss for those who are overweight or obese 1. Regular physical activity, such as aerobic training and weight lifting, does not negatively affect the development of lymphedema and can actually help reduce the risk 1.
Treatment and Management
Treatment of lymphedema focuses on reducing swelling and preventing complications. Complete Decongestive Therapy (CDT) is the recommended treatment approach, which includes manual lymphatic drainage, compression therapy, exercise, and meticulous skin care to prevent infections 1. For mild cases, compression garments worn daily and regular exercise may suffice. Severe cases require intensive CDT with daily manual drainage and bandaging for 2-4 weeks, followed by maintenance therapy. Medications, such as diuretics, may occasionally help with acute symptoms, but are not primary treatments. Surgical options, such as lymphovenous anastomosis or lymph node transfer, are considered for cases resistant to conservative management.
Lifestyle Modifications
Patients with lymphedema should maintain a healthy weight, avoid limb injuries, prevent infections, and elevate affected limbs when possible. Regular physical activity, such as aerobic exercise and strength training, can help reduce the risk of lymphedema and improve symptoms 1. A healthy diet, high in vegetables, fruits, whole grains, and legumes, and low in saturated fats, can also help manage lymphedema.
Referral to Specialists
Patients who develop clinical symptoms or swelling suggestive of lymphedema should be referred to a therapist knowledgeable about the diagnosis and treatment of lymphedema, such as a physical or occupational therapist or a specialist therapist trained in lymphedema management 1. Early identification and management of lymphedema are crucial to preventing long-term complications and improving quality of life.
From the Research
Lymphedema Management
- Lymphedema is a chronic condition that can be managed with complete decongestive therapy (CDT) 2, 3, 4, 5, 6
- CDT is a combination of methods including manual lymphatic drainage, lymphedema rehabilitation exercises, compression therapy, and skin care 2, 5, 6
- The essential components of CDT are examination, compression, manual techniques, exercise, skin care, education, and self-management 2
- Adjunctive interventions and alternatives may complement CDT, and the individual's lymphedema etiology and presentation will determine the components of CDT applied and the frequency and duration of care 2
Treatment Outcomes
- CDT has been shown to be effective in reducing lymphedema volume, with a reduction of 45-70% reported in some studies 5
- A decrease in limb volume, edema volume, and limb-related volume change has been observed in patients undergoing CDT 3
- Health-related quality of life has also been shown to improve with CDT, with a high level of treatment satisfaction reported by patients 3
Healthcare Practitioners
- CDT should be provided by specifically trained healthcare practitioners in lymphedema management, preferably a certified lymphedema therapist 2
- Prerequisites for successful physiotherapy include the availability of physicians, nurses, and therapists who are specifically trained, educated, and experienced in each method 5
- Oncology nurses and healthcare providers play key roles in assessing needs and prescribing interventions to support patients with lymphedema 6