Early physiotherapy, including massage and shoulder exercises, could help to prevent and reduce one of the most common complications of breast cancer surgery, finds a study published on bmj.com today.
Secondary lymphoedema is the most significant chronic complication after breast cancer surgery or radiation therapy. It is caused by damage to the lymphatic system during treatment, leading to fluid retention and arm swelling. It affects 71% of women within 12 months of surgery and can also cause cosmetic disfigurement, anxiety, depression and emotional distress.
Currently, women with breast cancer have a 77% probability of surviving at least 10 years, so effective prevention and management of complications that can impair function and affect quality of life after treatment are important.
So a research team in Madrid set out to investigate the effectiveness of early physiotherapy in reducing the risk of secondary lymphedema after breast cancer surgery.
They identified 120 women who had undergone breast cancer surgery involving removal of lymph nodes between May 2005 and June 2007.
Sixty patients were assigned to early physiotherapy and an educational strategy (intervention group) and 60 to the educational strategy only (control group). Both programmes lasted three weeks and patients were followed up four weeks after surgery, and again at three, six and 12 months after surgery.
Physiotherapy included manual lymph drainage, massage of scar tissue, and shoulder exercises by a physiotherapist. The educational strategy included materials about the lymphatic system and advice on how to avoid injury and prevent infection.
One year follow-up was completed by 116 women. Of these, 18 (16%) developed secondary lymphoedema: 14 in the control group (25%) and four in the intervention group (7%). This difference was statistically significant.
A survival analysis also showed a significant difference, with secondary lymphoedema being diagnosed four times earlier in the control group than in the intervention group.
Early physiotherapy could help to prevent and reduce secondary lymphoedema in women for at least one year after breast cancer surgery, conclude the authors. Further studies are needed to clarify whether early physiotherapy after breast cancer surgery can remain effective in preventing secondary lymphoedema in the longer term.
An accompanying editorial says that physiotherapy shows promise in a selected group of women and suggests that clinicians should consider referring patients to physiotherapists who are trained in treating lymphoedema.