NLN Medical Advisory comments
We are at an exciting time in the world of lymphedema as more research is being focused on evidence for best practice. One recently published study in the JOURNAL OF CLINICAL ONCOLOGY sought to answer some questions related to the treatment of lymphedema. (See article: “Randomized Trial of Decongestive Lymphatic Therapy for the Treatment of Lymphedema in Women With Breast Cancer”Ian S. Dayes, Tim J. Whelan, Jim A. Julian, Sameer Parpia, Kathleen I. Pritchard, David Paul D’Souza, Lyn Kligman, Donna Reise, Linda LeBlanc, Margaret L. McNeely, LeeManchul, Jennifer Wiernikowski, and Mark N. Levine J Clin Oncol 31. © 2013)
We understand that as new research is published, questions will arise for patients and clinicians regarding the recommended course for evaluation and treatment. We thought it might be helpful to summarize some comments on our website, as the NLN office has received numerous calls about this study.
This study investigated the treatment of breast cancer related lymphedema of the arm (BCRL). Half of the subjects received manual lymphatic drainage (MLD) with compression bandaging, followed by compression garments at four weeks, while the other half wore compression garments (sleeve and glove) without bandaging, and did not receive MLD. All received advice regarding skin care, exercise, and healthy body weight. While there was more of a reduction in limb volume in the group receiving MLD and compression bandaging, the amount of reduction was less than anticipated. Based on the results of this study, the authors suggest that MLD and compression bandaging may be more beneficial for lymphedema (LE) of longer duration. As the authors note, more research is needed.
When LE is caught early, it may respond to less treatment and that is good. When lymphedema progresses to a later stage, it generally requires more intensive treatment. This study suggests that patients who develop BCRL within the first year after surgery may need less therapy than previously thought. However, it is important to receive an evaluation by a professional with specialized training in lymphedema management regarding risk reduction. When any swelling is present, it is important to receive individualized treatment recommendations by a lymphedema-trained professional. Patients with swelling should be routinely followed so treatment can be promptly initiated in the event the lymphedema progresses.
The JCO study by Dayes et al. should be welcomed by the LE treatment community as a useful addition to the science of treatment for BCRL. We thank the authors for this work and encourage additional studies related to lymphedema treatment. As more research is completed, with larger numbers of participants involved, we will have a better understanding of the optimal patient care options for improved and sustained outcomes.
NLN Medical Advisory Committee