Journal of Clinical Oncology
Physiotherapy Lowers Risk of Lymphedema
January 4, 2010
By Kristina Fiore, Staff Writer, MedPage Today
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
Explain that after surgery or radiotherapy for breast cancer, significantly fewer women developed lymphedema when they were given early physiotherapy, compared with women who only received education on preventing the condition.
Physiotherapy may prevent lymphedema after breast cancer surgery that involves dissection of axillary lymph nodes, researchers say.
Significantly fewer women developed the condition when they were given physiotherapy, compared with women who only received education on preventing the condition, Maria Torres Lacomba, MD, of Alcala de Henares University in Madrid, and colleagues reported online in BMJ.
Lymphedema results from surgery or radiotherapy for breast cancer and is the most important chronic complication after dissection of the axillary lymph nodes, the researchers said. It impairs lymph drainage from the arm, resulting from an imbalance between filtration and resorption.
To determine the effectiveness of early physiotherapy in reducing the risk of lymphedema, the researchers assessed 120 women who'd had breast surgery involving dissection of axillary lymph nodes between May 2005 and June 2007 at Asturias Hospital in Madrid.
The early physiotherapy group was treated by a physiotherapist with a program that included manual lymph drainage, massage of scar tissue, and shoulder exercises, as well as an educational component.
The control group received only the educational material, which discussed the condition and how to prevent it through shoulder exercises.
All patients were followed for a year.
A total of 16% of the women developed secondary lymphedema: 25% of those in the control group versus 7% in the intervention group (P=0.01).
That translated to a 72% decreased risk of lymphedema (HR 0.28, 95% CI 0.10 to 0.79).
By the 12-month follow-up visit, the volume ratio between arms had increased in both groups.
In the control group, the affected arm was on average 5.1% greater in volume than the unaffected arm, whereas in the intervention group the affected arm was on average 1.6% greater than the unaffected arm (P=0.0065).
In a survival analysis, secondary lymphedema was diagnosed four times earlier in the control group than in the intervention group (HR 0.26, 95% CI 0.09 to 0.79, P=0.01).
The manual lymph drainage in this study involved gently massaging the area to improve lymph circulation, which improves the removal of interstitial fluid.
"We think that the implementation of manual lymph drainage after surgery for breast cancer in the early physiotherapy group could have contributed to the better results in that group," the researchers wrote.
They noted that the study was limited by a short duration of follow-up, by the fact that it was limited to one hospital, and by a definition of lymphedema in which measurement errors could have been significant.
The study also was not powered to examine subgroups of patients. Patients who developed lymphedema were more likely to be overweight, to have had more lymph nodes removed, and to have developed postoperative complications regardless of assignment to physiotherapy or control.
Even so, the researchers concluded that early physiotherapy "could help prevent and reduce secondary lymphedema in patients after breast cancer surgery involving dissection of axillary lymph nodes, at least for one year after surgery."
Further studies are needed, they wrote, "to clarify whether early physiotherapy after breast cancer surgery can remain effective in preventing secondary lymphedema in the longer term."
In an accompanying editorial, Andrea Cheville, MD, of the Mayo Clinic in Rochester, Minn., wrote that "several factors should be considered when generalizing the results to clinical practice."
Cheville noted that physiotherapy can vary depending on therapists' training, and the study couldn't determine which component of the intervention -- manual lymph drainage, massage of the scar, shoulder exercises, and education -- had the most significant effect on outcomes.
She also noted that the study was limited to one year, so "we do not know if the intervention prevented or simply delayed lymphedema."
Still, Cheville wrote that the "limited but compelling evidence supports the usefulness of physiotherapy after surgical clearance of the axillary lymph nodes to control pain, enhance shoulder functionality and range of motion, and reduce a woman's risk of developing lymphedema."
The study was supported by the Health Institute Carlos III of the Spanish Health Ministry.
The researchers reported no disclosures.
Primary source: BMJ
Source reference:
Torres Lacomba M, et al "Effectiveness of early physiotherapy to prevent lymphedema after surgery for breast cancer: Randomized, single blinded clinical trial" BMJ 2010; DOI: 10.1136/bmj.b5396.
Additional source: BMJ
Source reference:
Cheville A "Prevention of lymphedema after axillary surgery for breast cancer" BMJ 2010; DOI: 10.1136/bmj.b5235.
Lifestyle Factors Increase Risk of Second Breast Cancer?
Journal of Clinical Oncology, 8 Sepember 2009
Obesity, alcohol consumption, and smoking significantly increase the risk of second breast cancers among breast cancer survivors, according to the results of a study published in the Journal of Clinical Oncology.[1]
Approximately 200,000 women are diagnosed with breast cancer every year in the United States alone. Treatment for the disease has improved, and five-year survival rates are now greater than 90%; however, survivors have a significantly increased risk of developing a second breast cancer in the opposite breast.[2]
Researchers from the Fred Hutchinson Cancer Research Center in Seattle conducted a study that involved 365 women who were diagnosed with an estrogen-receptor (ER) positive first primary breast cancer and then were later diagnosed with a second primary breast cancer. These women were compared to 726 matched controls who were diagnosed with only an ER-positive primary breast cancer.
The researchers reviewed medical records and conducted patient interviews to ascertain data on obesity, alcohol consumption, and smoking. The results indicated that women who were considered obese (body mass index [BMI] over 30 kg/m2) were 50% more likely to develop a second breast cancer than women who had a BMI lower than 25 kg/m2. Furthermore, women who consumed more than seven drinks per week after their first breast cancer diagnosis had a 70% higher risk of developing a second breast cancer compared with non-drinkers. Finally, women who smoked were more than twice as likely to develop a second breast cancer compared with nonsmokers.
The researchers concluded that lifestyle factors such as obesity, smoking, and drinking could significantly increase the risk of developing a second cancer. Modifying these factors might provide breast cancer survivors with a way to reduce their risk of developing a second cancer.
Reference:
[1] Li CI, Daling JR, Porter PL, et al. Relationship between potentially modifiable lifestyle factors and risk of second primary contralateral breast cancer among women diagnosed with estrogen receptor-positive invasive breast cancer. Journal of Clinical Oncology [early online publication]. September 8, 2009.
[2] Chen Y, Thompson W, Semenciw R, et al. Epidemiology of contralateral breast cancer. Cancer Epidemiology, Biomarkers, & Prevention. 1999; 8: 855-861.