Present statistics indicate that women with breast cancer have a 77%
chances of survival for at least 10 years; therefore it is important to
effectively prevent and manage complications after treatment of the cancer.
excision can lead to stasis of lymph in the area and it is no different when it
comes to breast cancer surgical treatment. The axillary lymph nodes drain from
breast tissue and are responsible for spread of the cancer to other parts of
the body, hence their removal is indicated when doing curative surgery in
breast cancer. A randomized, single- blinded, clinical trial of women after unilateral
breast cancer surgery with axillary lymph node dissection was carried out at
the Príncipe de Asturias Hospital in Madrid between May 2005 and June 2007 by
Maria Torres et al and their findings were published recently in British
strived to analyze the unaddressed needs of women, in whom symptoms and signs
indicate the presence of lymphoedema, post breast cancer treatment.
The study tried
to determine the efficacy of an early physiotherapy programme in reducing the
risk of lymphoedema in women after breast cancer surgery involving dissection
of axillary lymph nodes.
women with signs and symptoms of lymphoedema formed the subject
axillary lymph node dissection or with bilateral breast cancer, systemic
disease, loco-regional recurrence, or any contraindication to physiotherapy
from the study.
interruption or damage to the axillary lymphatic system after breast cancer
surgery, or after radiotherapy for breast cancer, may result in generalized or
regional accumulation of lymph fluid in the interstitial space. This condition,
known as secondary lymphoedema,
the most important chronic complication after axillary lymph node dissection.
It has a tendency to progress.
lymphoedema can cause physical discomfort,
disfigurement, and functional
impairment. Other factors seen in patients with secondary lymphoedema include anxiety,
and emotional distress.
can badly undermine self esteem and can affect social relationships. It can
aggravate cellulitis, erysipelas, lymphangitis, and can occasionally cause
lymphangiosarcoma ( a form of cancer).
The factors that influence
secondary lymphoedema development after surgery:
• Number of lymph nodes removed
• Radiotherapy to the axilla
• Post -surgery wound infection,
• Post-surgical drainage time
• Lack of mobility,
The incidence rates
for secondary lymphoedema, ranges from 5% to 56%, two years post- surgery.
Each subject was evaluated pre-operatively and also between days 3 and 5
after hospital discharge. Equal numbers of participants were then randomly
assigned to either:
• The early physiotherapy and an educational strategy (early physiotherapy
• The educational strategy only (control group).
The incidence of secondary
lymphedema was the main outcome.
Management/ Interventions -
Early physiotherapy group and control
group would receive the same educational intervention.
a) Early physiotherapy group -
In this group, manual lymph drainage technique was
used to treat post-operative oedema. This group also did shoulder exercises and
stretching in their homes, once daily during the three -week intervention
b) Educational strategy (both groups)-
materials with instructions about the lymphatic system, concepts of normal load
versus overload, the factors leading to secondary lymphoedema, identification
of potential precipitating factors, and the four categories of interventions to
prevent secondary lymphoedema were given to the patients.
Four follow-up visits were to be carried out. They were four weeks three
months, six months, and 12 months after surgery. These dates were flexible,
depending on the availability of the participant. If patients experienced pain,
discomfort, or any other symptoms a physiotherapist was asked to visit them.
lymphoedema developed, complex decongestive physiotherapy was carried out on
Results and Conclusion -
Of 120 women
studied, 60 were slotted in the early physiotherapy and an educational strategy
group and 60 to the educational strategy only group.
discovered through the study that early physiotherapy along with an educational
strategy helped to lower the risk of
secondary lymph edema in women post breast cancer surgery involving dissection
of axillary lymph nodes, in comparison to the educational strategy only
lymphoedema developed from six to 12 months post surgery. The authors suggest
that the manual lymph drainage
breast cancer surgery in the early physiotherapy group could be one of the
contributing factor towards better results in that group.
concludes that early physiotherapy could
play a role in preventing and reducing secondary lymphoedema in post- breast
cancer surgery patients involving dissection of axillary lymph nodes, at least
for one year following surgery.As
for understanding its role long-term, more work is required.
also stress upon the positive role of
in creating awareness, prevention, early diagnosis, and
management of secondary lymphoedema.
Priorities for women with lymphoedema after
treatment for breast cancer: population based cohort study; Maria Torres et al; BMJ 2010; 340:b5396