Interventions for Breast Cancer–Related Lymphedema: Clinical Practice Guideline From the Academy of Oncologic Physical Therapy of APTA

Abstract

A work group from the American Physical Therapy Association (APTA) Academy of Oncologic Physical Therapy developed a clinical practice guideline to aid clinicians in identifying interventions for people with breast cancer–related lymphedema, targeting volume reduction, beginning at breast cancer diagnosis and continuing through cancer treatments and survivorship. Following a systematic review of published studies and a structured appraisal process, recommendations were developed to guide physical therapists and other health care clinicians in their intervention selection. Overall, clinical practice recommendations were formulated based on the evidence for each intervention and were assigned a grade based on the strength of the evidence. The evidence for each specific intervention was synthesized and appraised by lymphedema stage, when the information was available. In an effort to make recommendations clinically applicable, they were presented by modality throughout the care trajectory. Methodology and research populations varied significantly across studies, and it will be important for future research to use standardized definitions for participant characteristics, diagnostic criteria, and interventions.

Combıned-Complex Decongestıve Therapy Reduces Volume And Improves Quality Of Lıfe And Functıonal Status In Patıents Wıth Breast Cancer-Related Lymphedema

“…Lymphedema is one of the most common complications of breast cancer causing disruption of lymphatic vessels due to axillar node dissection and/or radiation therapy (34). CDT causes a reduction of edema by facilitating lymphatic circulation and de ned as the gold standard for treatment of this multifactorial morbidity (6)(7)(8)10). There is not a standard protocol for CDT.…”

“…MLD and compression bandaging in the intensive phase may be applied alone, together or combined with pressure pumps or compression garments. The intervals of different procedures can be changed from two times a week to everyday for four weeks (4)(5)(6)(7)(8)(9)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). The most effective combination of treatment elements and the optimal duration of the treatments are still undetermined in CDT (7,28).…”

“…Phase 1 therapy includes education and meticulous skin care, manual lymphatic drainage (MLD), multilayer non-elastic compression bandaging and exercises while phase 2 comprises the continuation of skin care and exercise in addition to self -massage and pressure garments. In the second phase patients may need compression bandaging at night, according to the clinical condition of the patients (7)(8)(9)(10)(11)(12).…”

“…These treatments range from simple exercises to different types of microsurgical techniques (7-9). A variety of physiotherapeutic interventions have been proposed for the control of symptoms and to minimize complication, by reducing upper limb swelling (6,7). Complete decongestive therapy (CDT) is the most popular and gold standard of treatment for patients with lymphedema and comprises two phases.…”

“…There are several studies that address the bene ts of individual CDT variables with different protocols as phase 1 or phase 2 therapies (7,(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). Compression has been shown to be effective in the treatment of BCRL (10,28).…”