For many many years, one of the sacred myths of the lymphedema world was that you should never do complete decongestive therapy (or) manual decongestive therapy on a patient with active cancer. The general belief was that the CDT/MLD would promote the spread (metastasis) of the cancer.
As time has passed, there is now emerging a growing body of clinical evidence that this is false.
Specifically, research is indicating that it does NOT promote metastasis and infact can be a valuable tool in early lymphedema intervention and can significantly improve the quality of life for cancer patients.
Below are a couple of abstracts involved in these studies and some related articles on the efficacy of lymphedema treatment for cancer related lymphedema.
J Soc Integr Oncol. 2006 Winter
Godette K, Mondry TE, Johnstone PA. Radiation Oncology Department, Emory University School of Medicine, Atlanta, GA 30322, USA. Complete decongestive therapy (CDT; alternatively known as complete decongestive physiotherapy) is a treatment program for patients diagnosed with primary or secondary lymphedema. CDT incorporates manual lymphatic drainage (MLD), a technique involving therapeutic manipulation of the affected limb. There are several contraindications to performing CDT. Relative contraindications include hypertension, paralysis, diabetes, and bronchial asthma. General contraindications include acute infections of any kind and congestive heart failure. Malignant disease is also widely considered a general contraindication; a current vogue concept is that MLD will lead to dissemination and acceleration of cancer. However, cancer research supports the contention that this therapy does not contribute to spread of disease and should not be withheld from patients with metastasis. The intent of this article is to review these data.
PMID: 16737666 [PubMed - indexed for MEDLINE]
Cancer. 2007 Dec 17
Pinell XA, Kirkpatrick SH, Hawkins K, Mondry TE, Johnstone PA. Radiation Oncology Department, Emory University School of Medicine, Atlanta, Georgia.
BACKGROUND: Complete decongestive therapy (CDT), including manual lymphatic drainage (MLD) is a manipulative intervention of documented benefit to patients with lymphedema (LE). Although the role of CDT for LE is well described, to the authors' knowledge there are no data regarding its efficacy for patients with LE due to tumor masses in the draining anatomic bed. Traditionally, LE therapists are wary of providing therapy to such patients with 'malignant' LE for fear of exacerbating the underlying cancer, and that the obstruction will render therapy less effective. In the current study, the authors' experience providing CDT for such patients is discussed.
METHODS: Cancer survivors with LE were referred to therapists at 2 Atlanta-area clinics. CDT consists of treatment (Phase 1) and maintenance phases (Phase 2). During Phase 1, the patient undergoes manipulative therapy and bandaging daily until the LE reduction plateaus; at that point, Phase 2 (self-care) begins. At the beginning and end of
Phase 1, LE is quantified and differences in girth volume calculated. The results for patients completing Phase 1 therapy for LE in the presence of locoregional masses were compared with results for patients with LE in the absence of such disease. Both volume reduction of the affected limb and number of treatments to plateau were analyzed.
RESULTS: Between January 2004, and March 2007, LE of 82 limbs in 72 patients was treated with CDT and Phase 1 was completed. The median number of treatments to plateau was 12 (range, 4-23 treatments); the median limb volume reduction was 22% (range, -23 to 164%). Nineteen limbs (16 patients) with associated chest wall/axillary or pelvic/inguinal tumors had nonsignificant difference in LE reduction (P = .75) in the presence of significantly more sessions to attain plateau (P = .0016) compared with 63 limbs in 56 patients without such masses.
CONCLUSIONS: Patients with LE may obtain relief with CDT regardless of whether they have locoregional disease contributing to their symptoms. However, it will likely take longer to achieve that effect. Manipulative therapy of LE should not be withheld because of persistent or recurrent disease in the draining anatomic bed. Cancer 2008.
Int J Radiat Oncol Biol Phys. 2007 Mar
Koul R, Dufan T, Russell C, Guenther W, Nugent Z, Sun X, Cooke AL. Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, MB, Canada. email@example.com
Keywords: Lymphedema, Breast cancer, Combined decongestive therapy, Manual lymphatic drainage
OBJECTIVE: To evaluate the results of combined decongestive therapy and manual lymphatic drainage in patients with breast cancer-related lymphedema.
METHODS AND MATERIALS: The data from 250 patients were reviewed. The pre- and posttreatment volumetric measurements were compared, and the correlation with age, body mass index, and type of surgery, chemotherapy, and radiotherapy was determined. The Spearman correlation coefficients and Wilcoxon two-sample test were used for statistical analysis.
RESULTS: Of the 250 patients, 138 were included in the final analysis. The mean age at presentation was 54.3 years. Patients were stratified on the basis of the treatment modality used for breast cancer management. Lymphedema was managed with combined decongestive therapy in 55%, manual lymphatic drainage alone in 32%, and the home program in 13%. The mean pretreatment volume of the affected and normal arms was 2929 and 2531 mL. At the end of 1 year, the posttreatment volume of the affected arm was 2741 mL. The absolute volume of the affected arm was reduced by a mean of 188 mL (p < 0.0001). The type of surgery (p = 0.0142), age (p = 0.0354), and body mass index (p < 0.0001) were related to the severity of lymphedema.
CONCLUSION: Combined decongestive therapy and manual lymphatic drainage with exercises were associated with a significant reduction in the lymphedema volume.
Vignes S, Porcher R, Arrault M, Dupuy A. Department of Lymphology, Hôpital Cognacq-Jay, Site Broussais, 102 rue Didot, 75014 Paris, France. firstname.lastname@example.org
Keywords: Breast cancer - Lymphedema - Physiotherapy - Compliance - Elastic garment - Low stretch bandage
BACKGROUND: Treatment of lymphedema is based on intensive decongestive physiotherapy followed by a long-term maintenance treatment. We analyzed the factors influencing lymphedema volume during maintenance treatment.
METHOD: Prospective cohort of 537 patients with secondary arm lymphedema were recruited in a single lymphology unit and followed for 12 months. Lymphedema volume was recorded prior to and at the end of intensive treatment, and at month 6 and month 12 follow-up visits. Multivariate models were fitted to analyze the respective role of the three components of complete decongestive therapy, i.e. manual lymph drainage, low stretch bandage, and elastic sleeve, on lymphedema volume during the 1-year maintenance phase therapy.
RESULTS: Mean volume of lymphedema was 1,054 +/- 633 ml prior and 647 +/- 351 ml after intensive decongestive physiotherapy. During the 1-year maintenance phase therapy, the mean lymphedema volume slightly increased (84 ml-95% confidence interval [CI]: 56-113). Fifty-two percent of patients had their lymphedema volume increased above 10% from their value at the end of the intensive decongestive physiotherapy treatment phase. Non-compliance to low stretch bandage and elastic sleeve were risk factors for an increased lymphedema after 1-year of maintenance treatment (RR: 1.55 [95% CI: 1.3-1.76]; P < 0.0001 and RR: 1.61 (95% CI: 1.25-1.82); P = 0.002, respectively). Non-compliance to MLD was not a risk factor (RR: 0.99 [95% CI: 0.77-1.2]; P = 0.91).
CONCLUSION: During maintenance phase after intensive decongestive physiotherapy, compliance to the use of elastic sleeve and low stretch bandage should be required to stabilize lymphedema volume.