May 23, 2008 A recent study shows that pre-operative assessments of patients with breast cancer by physical therapists allow for early diagnosis and successful treatment of lymphedema.
The study, conducted by the National Naval Medical Center (NNMC) and the National Institutes of Health (NIH) and in collaboration with the University of Michigan-Flint and George Mason University, was published in the journal, Cancer (April 25, 2008). The authors demonstrated the effectiveness of a surveillance program that included pre-operative limb volume measurement and interval post-operative follow-up to successfully detect and treat lymphedema, a chronic and often irreversible condition that can cause significant swelling of the upper and lower extremities due to the build-up of excess lymph fluid.
"This study is significant for several reasons, but none more so than it showing that detection and management of lymphedema at early stages may prevent the condition from progressing to a chronic, disabling stage and may enable a more cost-effective, conservative intervention," said American Physical Therapy Association (APTA) spokesperson and the study's lead author, Nicole L Stout Gergich, PT, MPT, CLT-LANA, of the National Naval Medical Center (NNMC) Breast Care Center, in Bethesda, Maryland.
Breast cancer related lymphedema is associated with decreased arm function, disability and diminished quality of life. If the condition is not diagnosed early and managed, it can progress to a situation where the patient is at risk for infection and further shoulder complications. The swelling is disfiguring and many times prohibits patients from finding clothes that fit properly.
Stout noted that the baseline pre-operative assessment of 196 patients with breast cancer participating in the study - which was conducted from 2001 to 2005 - included basic strength, range of motion, limb volume, and physical activity level. "To measure limb volume, we employed infra-red technology that scans the limbs using beams and sensors, providing us with very accurate information," she said. All study participants were monitored one month post-surgery and at three-month intervals thereafter for one year even if they exhibited no swelling. "Using both the pre- and post-operative assessments enabled us to diagnose lymphedema before it became visible, which is an unprecedented accomplishment," Stout noted.
Once lymphedema was diagnosed in 43 of the patients participating in the study, the condition was managed using a conservative compression garment, atypical of lymphedema treatment, observed Stout. A light-grade compression sleeve and gauntlet, fitted by the physical therapist, were prescribed for daily wear. "Lymphedema is normally treated with more aggressive and often costly and time-consuming techniques, such as complete decongestive therapy, which requires the patient to attend daily therapy sessions for weeks and wear bulky compression bandages. This study clearly demonstrates that the condition can be managed with a more conservative treatment option when it is diagnosed at its earliest presentation, which will be good news to breast cancer patients," she added.
"What we hope to garner from publicizing this study is that it will encourage patients with breast cancer to ask the questions that need to be asked regarding their treatment, as well as galvanize physicians, surgeons, oncologists and other physical therapists to make early intervention and conservative treatment of lymphedema the standard of care in breast cancer care," Stout concluded.
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