How well will lymphedema therapy work for me? New research suggests that CDT actually works better for milder cases of breast cancer related lymphedema.By: Lindsay Davey, MScPT, MSc, CDT
January 29, 2013
Editors: Ryan Davey, PhD and Lindsay Davey, MScPT, MSc, CDT
There are two major factors that determine how well a patient will respond to lymphedema treatment: the type and frequency of treatment, and patient compliance. But let’s assume that you are receiving an appropriate course of therapy, and that you’re also compliant with your therapist’s instructions regarding bandaging, self-massage, and other directives. Unfortunately this will not be the case for many people, but assuming it is, is there any way of predicting how well you will respond to Combined Decongestive Therapy (CDT)?
A new study currently in press examines the factors that influence how well patients with breast cancer related lymphedema respond to CDT, otherwise known as “treatment efficacy” (Su-Fen Liao et al. The efficacy of complex decongestive physiotherapy (CDP) and predictive factors of lymphedema severity and response to CDP in breast cancer-related lymphedema (BCRL). The Breast. 2013, in press). Although the study was limited by the fact that it was a relatively small retrospective cohort, the conclusions they drew were both sound and interesting. They found that the best way to predict the success of lymphedema treatment was to determine the initial percentage excess volume of the affected limb. In other words, the initial size of the swollen limb relative to the unaffected limb was the best predictor of treatment outcome.
The study examined 108 patients. CDT was found to decrease excess limb volume (swelling) in all patients, with an average reduction of 50.5% (over an average of 12 treatments). The majority of this improvement occurred within the first 10 days of treatment initiation. Interestingly, although absolute limb volume was reduced by a greater amount in limbs that were more swollen (as you might expect), CDT actually worked better for milder cases. The percentage reduction in swelling relative to the unaffected arm was found to be greater for patients with mild swelling than for those with moderate swelling: so mildly affected patients responded better to CDT than their more severely affected peers. CDT efficacy was also found to be reduced in patients who had been experiencing lymphedema for a longer time (which would in turn correlate with more severe swelling) and for those who were older. The authors speculated that reduced treatment efficacy in older patients may be a result of reduced patient compliance, in particular with respect to bandaging.
These results suggest that patients should receive lymphedema therapy as early as possible once lymphedema is identified. Although mild cases may not seem as urgent, these patients are more likely to see the greatest benefit from treatment, and receive fewer treatments overall. Importantly, in an earlier study it was also reported that early intervention could maintain mild cases of lymphedema to low levels for at least 10 years (Johansson K, Branje E. Arm lymphoedema in a cohort of breast cancer survivors10 years after diagnosis. Acta Oncol 2010;49(2):166e73.). Good incentive to get on top of lymphedema early!
If you know you have it. I was diagnosed with chronic insufficiency and am now just going through lymphedema tests. They still are not sure but my legs and stomach are swelling up.
You’re bang-on correct Lynn. Quick identification and symptom management is vital for decreasing lymphedema severity, and the associated impact on quality of life. Greater education and awareness is needed for those at risk, and for their physicians. Keep up with your investigations, and best wishes to you and your health. Ryan