Medline ® Abstract for Reference 52
of 'Clinical staging and conservative management of peripheral lymphedema'
Randomized trial of decongestive lymphatic therapy for the treatment of lymphedema in women with breast cancer.
Dayes IS, Whelan TJ, Julian JA, Parpia S, Pritchard KI, D'Souza DP, Kligman L, Reise D, Leblanc L, McNeely ML, Manchul L, Wiernikowski J, Levine MN
J Clin Oncol. 2013 Oct;31(30):3758-63. Epub 2013 Sep 16.
PURPOSE: Because of its morbidity and chronicity, arm lymphedema remains a concerning complication of breast cancer treatment. Although massage-based decongestive therapy is often recommended, randomized trials have not consistently demonstrated benefit over more conservative measures.
PATIENTS AND METHODS: Women previously treated for breast cancer with lymphedema were enrolled from six institutions. Volumes were calculated from circumference measurements. Patients with a minimum of 10% volume difference between their arms were randomly assigned to either compression garments (control) or daily manual lymphatic drainage and bandaging followed by compression garments (experimental). The primary outcome was percent reduction in excess arm volume from baseline to 6 weeks.
RESULTS: A total of 103 women were randomly assigned, and 95 were evaluable. Mean reduction of excess arm volume was 29.0% in the experimental group and 22.6% in the control group (difference, 6.4%; 95% CI, -6.8% to 20.5%; P = .34). Absolute volume loss was 250 mL and 143 mL in the experimental and control groups, respectively (difference, 107 mL; 95% CI, 13 to 203 mL; P = .03). There was no difference between groups in the proportion of patients losing 50% or greater excess arm volume. Quality of life (Short Form-36 Health Survey) and arm function were not different between groups.
CONCLUSION: This trial was unable to demonstrate a significant improvement in lymphedema with decongestive therapy compared with a more conservative approach. The failure to detect a difference may have been a result of the relatively small size of our trial.
Ian S. Dayes, Tim J. Whelan, Jim A. Julian, Sameer Parpia, and Mark N. Levine, McMaster University; Tim J. Whelan, Jim A. Julian, Sameer Parpia, Kathleen I. Pritchard, and Mark N. Levine, Ontario Clinical Oncology Group; Ian S. Dayes, Tim J. Whelan, and Mark N. Levine, Juravinski Cancer Centre; Donna Reise, Talspar Nursing Services; Jennifer Wiernikowski, Hamilton Health Sciences, Hamilton; Kathleen I. Pritchard and Lee Manchul, University of Toronto; Kathleen I. Pritchard, Odette Sunnybrook Cancer Centre; Lee Manchul, University Health Network, Toronto; David Paul D'Souza and Lyn Kligman, London Regional Cancer Program, London; David Paul D'Souza, University of Western Ontario, London, Ontario; Linda LeBlanc, Dr Leon Richard Oncology Centre, Moncton, New Brunswick; Margaret L. McNeely, University of Alberta; and Margaret L. McNeely, Cross Cancer Institute, Edmonton, Alberta, Canada.