Skip to main content

Advertisement

SpringerLink
Log in

Therapy modalities to reduce lymphoedema in female breast cancer patients: a systematic review and meta-analysis

  • Review
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

The aim of the present study was to evaluate the effects of compression bandages, sleeves, intermittent pneumatic compression (IPC) and active exercise on the reduction of breast cancer-related lymphoedema (BCRL). A systematic literature search up to the year January 2016 was performed in CINAHL, Cochrane Register of Controlled Trials, Embase, International Clinical Trials Registry Platform (WHO), PEDro and PubMed. Inclusion criteria were (1) RCTs, (2) reported adequate statistics for meta-analysis, (3) English or German language. Exclusion criteria were (1) effects of drugs, hormonal, radiation and surgical procedures, (2) studies with children, (3) non-breast cancers, lower extremity oedema, (4) impact on fatigue only, diets or sexually transmitted diseases, (5) cost-analysis only and (6) non-carcinogenic syndromes or (7) prevention of breast cancer. After scoring the methodological quality of the selected studies, data concerning volume reduction of the oedema swelling were extracted. Thirty-two studies were included in this systematic review. Nine studies were selected for the RCT-based studies and 19 studies were included in the pre–post studies-based random-effects meta-analyses. All conclusions should be taken with precautions because of the insufficient quality of the selected papers. Exercise seems beneficial in reducing oedema volume in BCRL. IPC seems beneficial in helping to reduce the oedema volume in the acute phase of treatment. Compression sleeves do not aid in the volume reduction in the acute phase; however, they do prevent additional swelling.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Tsai RJ, Dennis LK, Lynch CF, Snetselaar LG, Zamba GK, Scott-Conner C (2009) The risk of developing arm lymphedema among breast cancer survivors: a meta-analysis of treatment factors. Ann Surg Oncol 16(7):1959–1972

    Article  PubMed  Google Scholar 

  2. Zhu YQ, Xie YH, Liu FH, Guo Q, Shen PP, Tian Y (2014) Systemic analysis on risk factors for breast cancer related lymphedema. Asian Pac J Cancer Prev APJCP 15(16):6535–6541

    Article  PubMed  Google Scholar 

  3. DiSipio T, Rye S, Newman B, Hayes S (2013) Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol 14(6):500–515

    Article  PubMed  Google Scholar 

  4. Petrek JA, Senie RT, Peters M, Rosen PP (2001) Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis. Cancer 92(6):1368–1377

    Article  CAS  PubMed  Google Scholar 

  5. Verbelen H, Gebruers N, Beyers T, De Monie AC, Tjalma W (2014) Breast edema in breast cancer patients following breast-conserving surgery and radiotherapy: a systematic review. Breast Cancer Res Treat 147(3):463–471. doi:10.1007/s10549-014-3110-8

    Article  PubMed  Google Scholar 

  6. Gebruers N, Verbelen H, De Vrieze T, Coeck D, Tjalma W (2015) Incidence and time path of lymphedema in sentinel node negative breast cancer patients: a systematic review. Arch Phys Med Rehabil 96(6):1131–1139

    Article  PubMed  Google Scholar 

  7. Netopil BC (2010) Häufigkeit sekundärer Arm-, Mamma-und Thoraxwandödeme nach Mammakarzinomtherapie heutzutage: eine retrospektive Studiemit 1000 einseitig am Mammakarzinom operierten Patientinnen (mit Erstdiagnose von 2000–2007). Universitätsbibliothek Giessen

  8. Chachaj A, Malyszczak K, Pyszel K, Lukas J, Tarkowski R, Pudelko M, Andrzejak R, Szuba A (2010) Physical and psychological impairments of women with upper limb lymphedema following breast cancer treatment. Psychooncology 19(3):299–305. doi:10.1002/pon.1573

    Article  PubMed  Google Scholar 

  9. Vassard D, Olsen MH, Zinckernagel L, Vibe-Petersen J, Dalton SO, Johansen C (2010) Psychological consequences of lymphoedema associated with breast cancer: a prospective cohort study. Eur J Cancer 46(18):3211–3218. doi:10.1016/j.ejca.2010.07.041

    Article  PubMed  Google Scholar 

  10. Kwan W, Jackson J, Weir LM, Dingee C, McGregor G, Olivotto IA (2002) Chronic arm morbidity after curative breast cancer treatment: prevalence and impact on quality of life. J Clin Oncol 20(20):4242–4248

    Article  PubMed  Google Scholar 

  11. Verbelen H, Gebruers N, Eeckhout FM, Verlinden K, Tjalma W (2014) Shoulder and arm morbidity in sentinel node-negative breast cancer patients: a systematic review. Breast Cancer Res Treat 144(1):21–31

    Article  PubMed  Google Scholar 

  12. Fantoni SQ, Peugniez C, Duhamel A, Skrzypczak J, Frimat P, Leroyer A (2010) Factors related to return to work by women with breast cancer in northern France. J Occup Rehabil 20(1):49–58. doi:10.1007/s10926-009-9215-y

    Article  PubMed  Google Scholar 

  13. ISL (2013) The diagnosis and treatment of peripheral lymphedema: 2013 Consensus Document of the International Society of Lymphology. Lymphology 46(1):1–11

    Google Scholar 

  14. Ezzo J, Manheimer E, McNeely ML, Howell DM, Weiss R, Johansson KI, Bao T, Bily L, Tuppo CM, Williams AF, Karadibak D (2015) Manual lymphatic drainage for lymphedema following breast cancer treatment. The Cochrane database of systematic reviews 5:CD003475. doi:10.1002/14651858.CD003475.pub2

    PubMed  Google Scholar 

  15. Stuiver MM, ten Tusscher MR, Agasi-Idenburg CS, Lucas C, Aaronson NK, Bossuyt PM (2015) Conservative interventions for preventing clinically detectable upper-limb lymphoedema in patients who are at risk of developing lymphoedema after breast cancer therapy. The Cochrane database of systematic reviews 2:CD009765. doi:10.1002/14651858.CD009765.pub2

    PubMed  Google Scholar 

  16. Huang TW, Tseng SH, Lin CC, Bai CH, Chen CS, Hung CS, Wu CH, Tam KW (2013) Effects of manual lymphatic drainage on breast cancer-related lymphedema: a systematic review and meta-analysis of randomized controlled trials. World J Surg Oncol 11:15. doi:10.1186/1477-7819-11-15

    Article  PubMed  PubMed Central  Google Scholar 

  17. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62(10):e1–e34. doi:10.1016/j.jclinepi.2009.06.006

    Article  PubMed  Google Scholar 

  18. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. doi:10.1371/journal.pmed.1000097

    Article  Google Scholar 

  19. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, Cochrane Bias Methods G, Cochrane Statistical Methods G (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928. doi:10.1136/bmj.d5928

    Article  PubMed  PubMed Central  Google Scholar 

  20. Tschopp M, Sattelmayer MK, Hilfiker R (2011) Is power training or conventional resistance training better for function in elderly persons? A meta-analysis. Age Ageing 40(5):549–556. doi:10.1093/ageing/afr005

    Article  PubMed  Google Scholar 

  21. Higgins J, Green S (2010) Cochrane handbook for systematic reviews of intervention version 5.0. 2, 2009

  22. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560. doi:10.1136/bmj.327.7414.557

    Article  PubMed  PubMed Central  Google Scholar 

  23. Haghighat S, Lotfi-Tokaldany M, Yunesian M, Akbari ME, Nazemi F, Weiss J (2010) Comparing two treatment methods for post mastectomy lymphedema: complex decongestive therapy alone and in combination with intermittent pneumatic compression. Lymphology 43(1):25–33

    CAS  PubMed  Google Scholar 

  24. Schmitz KH, Ahmed RL, Troxel A, Cheville A, Smith R, Lewis-Grant L, Bryan CJ, Williams-Smith CT, Greene QP (2009) Weight lifting in women with breast-cancer-related lymphedema. N Engl J Med 361(7):664–673. doi:10.1056/NEJMoa0810118

    Article  CAS  PubMed  Google Scholar 

  25. Kim DS, Sim Y, Jeong HJ, Kim GC (2010) Effect of Active Resistive Exercise on Breast Cancer-Related Lymphedema: a Randomized Controlled Trial. Arch Phys Med Rehabil 91(12):1844–1848. doi:10.1016/j.apmr.2010.09.008

    Article  PubMed  Google Scholar 

  26. Loudon A, Barnett T, Piller N, Immink MA, Visentin D, Williams AD (2012) The effect of yoga on women with secondary arm lymphoedema from breast cancer treatment. BMC Complement Altern Med 12:66. doi:10.1186/1472-6882-12-66

    Article  PubMed  PubMed Central  Google Scholar 

  27. Malicka I, Stefanska M, Rudziak M, Jarmoluk P, Pawlowska K, Szczepanska-Gieracha J (2011) Wozniewski M (2011) The influence of Nordic walking exercise on upper extremity strength and the volume of lymphoedema in women following breast cancer treatment. Isokinet Exerc Sci 19(4):295–304

    Google Scholar 

  28. McKenzie DC, Kalda AL (2003) Effect of upper extremity exercise on secondary lymphedema in breast cancer patients: a pilot study. J Clin Oncol 21(3):463–466

    Article  PubMed  Google Scholar 

  29. Kwan ML, Cohn JC, Armer JM, Stewart BR, Cormier JN (2011) Exercise in patients with lymphedema: a systematic review of the contemporary literature. J Cancer Surviv 5(4):320–336

    Article  PubMed  Google Scholar 

  30. Paramanandam VS, Roberts D (2014) Weight training is not harmful for women with breast cancer-related lymphoedema: a systematic review. J Physiother 60(3):136–143. doi:10.1016/j.jphys.2014.07.001

    Article  PubMed  Google Scholar 

  31. Szuba A, Achalu R, Rockson SG (2002) Decongestive lymphatic therapy for patients with breast carcinoma-associated lymphedema. A randomized, prospective study of a role for adjunctive intermittent pneumatic compression. Cancer 95(11):2260–2267

    Article  PubMed  Google Scholar 

  32. Shao Y, Qi K, Zhou QH, Zhong DS (2014) Intermittent Pneumatic Compression Pump for Breast Cancer-Related Lymphedema: a Systematic Review and Meta-Analysis of Randomized Controlled Trials. Oncol Res Treat 37(4):170–174. doi:10.1159/000360786

    Article  PubMed  Google Scholar 

  33. Stout Gergich NL, Pfalzer LA, McGarvey C, Springer B, Gerber LH, Soballe P (2008) Preoperative assessment enables the early diagnosis and successful treatment of lymphedema. Cancer 112(12):2809–2819. doi:10.1002/cncr.23494

    Article  Google Scholar 

  34. Vale TCP, Guimaraes TD, Libanori D (2011) Baruffi SM (2011) Synergistic effect of low elastic compression sleeves in the treatment of lymphedema after breast cancer treatment. J Phlebol Lymphol 4(1):5–9

    Google Scholar 

  35. Johansson K, Tibe K, Weibull A, Newton RC (2005) Low intensity resistance exercise for breast cancer patients with arm lymphedema with or without compression sleeve. Lymphology 38(4):167–180

    CAS  PubMed  Google Scholar 

  36. Vignes S, Porcher R, Arrault M, Dupuy A (2007) Long-term management of breast cancer-related lymphedema after intensive decongestive physiotherapy. Breast Cancer Res Treat 101(3):285–290. doi:10.1007/s10549-006-9297-6

    Article  PubMed  Google Scholar 

  37. Damstra RJ, Partsch H (2009) Compression therapy in breast cancer-related lymphedema: a randomized, controlled comparative study of relation between volume and interface pressure changes. J Vasc Surg 49(5):1256–1263. doi:10.1016/j.jvs.2008.12.018

    Article  PubMed  Google Scholar 

  38. Partsch H, Damstra RJ, Mosti G (2011) Dose finding for an optimal compression pressure to reduce chronic edema of the extremities. Int Angiol 30(6):527–533

    CAS  PubMed  Google Scholar 

  39. Johansson K, Albertsson M, Ingvar C, Ekdahl C (1999) Effects of compression bandaging with or without manual lymph drainage treatment in patients with postoperative arm lymphedema. Lymphology 32(3):103–110

    CAS  PubMed  Google Scholar 

  40. Kasseroller RG, Brenner E (2010) A prospective randomised study of alginate-drenched low stretch bandages as an alternative to conventional lymphologic compression bandaging. Support Care Cancer 18(3):343–350. doi:10.1007/s00520-009-0658-7

    Article  PubMed  Google Scholar 

  41. King M, Deveaux A, White H, Rayson D (2012) Compression garments versus compression bandaging in decongestive lymphatic therapy for breast cancer-related lymphedema: a randomized controlled trial. Support Care Cancer 20(5):1031–1036. doi:10.1007/s00520-011-1178-9

    Article  PubMed  Google Scholar 

  42. Maldonado GE, Perez CA, Covarrubias EE, Cabriales SA, Leyva LA, Perez JC, Almaguer DG (2011) Autologous stem cells for the treatment of post-mastectomy lymphedema: a pilot study. Cytotherapy 13(10):1249–1255. doi:10.3109/14653249.2011.594791

    Article  PubMed  Google Scholar 

  43. Dayes IS, Whelan TJ, Julian JA, Parpia S, Pritchard KI, D’Souza DP, Kligman L, Reise D, LeBlanc L, McNeely ML, Manchul L, Wiernikowski J, Levine MN (2013) Randomized trial of decongestive lymphatic therapy for the treatment of lymphedema in women with breast cancer. J Clin Oncol 31(30):3758–3763. doi:10.1200/jco.2012.45.7192

    Article  CAS  PubMed  Google Scholar 

  44. Ridner SH, Murphy B, Deng J, Kidd N, Galford E, Bonner C, Bond SM, Dietrich MS (2012) A randomized clinical trial comparing advanced pneumatic truncal, chest, and arm treatment to arm treatment only in self-care of arm lymphedema. Breast Cancer Res Treat 131(1):147–158. doi:10.1007/s10549-011-1795-5

    Article  CAS  PubMed  Google Scholar 

  45. Johansson K, Lie E, Ekdahl C, Lindfeldt J (1998) A randomized study comparing manual lymph drainage with sequential pneumatic compression for treatment of postoperative arm lymphedema. Lymphology 31(2):56–64

    CAS  PubMed  Google Scholar 

  46. Letellier M, Towers A, Cohen R (2008) Aqualymphatic exercise as an alternative therapy for lympedema management following breast cancer: a randomized controlled pilot study… 17th International Congress on Palliative Care, September 23-26, 2008/Palais Des Congres, Montreal, Canada. J Palliat Care 24(3):215

    Google Scholar 

  47. Gautam AP, Maiya AG, Vidyasagar MS (2011) Effect of home-based exercise program on lymphedema and quality of life in female postmastectomy patients: pre-post intervention study. J Rehabil Res Dev 48(10):1261–1268. doi:10.1682/JRRD.2010.05.0089

    Article  PubMed  Google Scholar 

  48. Johansson K, Klernas P, Weibull A, Mattsson S (2014) A home-based weight lifting program for patients with arm lymphedema following breast cancer treatment: a pilot and feasibility study. Lymphology 47(2):51–64

    CAS  PubMed  Google Scholar 

  49. Godoy Mde F, Pereira MR, Oliani AH, Godoy JM (2012) Synergic effect of compression therapy and controlled active exercises using a facilitating device in the treatment of arm lymphedema. Int J Med Sci 9(4):280–284. doi:10.7150/ijms.3272

    Article  PubMed  Google Scholar 

  50. Kim do S, Sim YJ, Jeong HJ, Kim GC (2010) Effect of active resistive exercise on breast cancer-related lymphedema: a randomized controlled trial. Arch Phys Med Rehabil 91(12):1844–1848. doi:10.1016/j.apmr.2010.09.008

    Article  PubMed  Google Scholar 

  51. Kozanoglu E, Basaran S, Paydas S, Sarpel T (2009) Efficacy of pneumatic compression and low-level laser therapy in the treatment of postmastectomy lymphoedema: a randomized controlled trial. Clin Rehabil 23(2):117–124. doi:10.1177/0269215508096173

    Article  PubMed  Google Scholar 

  52. Letellier ME, Towers A, Shimony A, Tidhar D (2014) Breast cancer-related lymphedema: a randomized controlled pilot and feasibility study. Am J Phys Med Rehabil/Assoc Acad Physiatr 93(9):751–759. doi:10.1097/phm.0000000000000089 quiz 760-751

    Article  Google Scholar 

  53. Loudon A, Barnett T, Piller N, Immink MA, Williams AD (2014) Yoga management of breast cancer-related lymphoedema: a randomised controlled pilot-trial. BMC Complement Altern Med 14:214. doi:10.1186/1472-6882-14-214

    Article  PubMed  PubMed Central  Google Scholar 

  54. Maher J, Refshauge K, Ward L, Paterson R, Kilbreath S (2012) Change in extracellular fluid and arm volumes as a consequence of a single session of lymphatic massage followed by rest with or without compression. Support Care Cancer 20(12):3079–3086. doi:10.1007/s00520-012-1433-8

    Article  CAS  PubMed  Google Scholar 

  55. Malicka I, Rosseger A, Hanuszkiewicz J, Wozniewski M (2014) Kinesiology Taping reduces lymphedema of the upper extremity in women after breast cancer treatment: a pilot study. Prz Menopauzalny 13(4):221–226. doi:10.5114/pm.2014.44997

    PubMed  PubMed Central  Google Scholar 

  56. Pilch U, Wozniewski M, Szuba A (2009) Influence of compression cycle time and number of sleeve chambers on upper extremity lymphedema volume reduction during intermittent pneumatic compression. Lymphology 42(1):26–35

    CAS  PubMed  Google Scholar 

  57. Randheer S, Kadambari D, Srinivasan K, Bhuvaneswari V, Bhanumathy M, Salaja R (2011) Comprehensive decongestive therapy in postmastectomy lymphedema: an Indian perspective. Indian J Cancer 48(4):397–402. doi:10.4103/0019-509x.92250

    Article  CAS  PubMed  Google Scholar 

  58. Ridner SH, Poage-Hooper E, Kanar C, Doersam JK, Bond SM, Dietrich MS (2013) A pilot randomized trial evaluating low-level laser therapy as an alternative treatment to manual lymphatic drainage for breast cancer-related lymphedema. Oncol Nurs Forum 40(4):383–393. doi:10.1188/13.onf.383-393

    Article  PubMed  Google Scholar 

  59. Schmitz KH, Troxel AB, Cheville A, Grant LL, Bryan CJ, Gross CR, Lytle LA, Ahmed RL (2009) Physical Activity and Lymphedema (the PAL trial): assessing the safety of progressive strength training in breast cancer survivors. Contemp Clin Trials 30(3):233–245. doi:10.1016/j.cct.2009.01.001

    Article  PubMed  PubMed Central  Google Scholar 

  60. Sitzia J, Sobrido L, Harlow W (2002) Manual lymphatic drainage compared with simple lymphatic drainage in the treatment of post-mastectomy lymphoedema. Physiotherapy 88(2):99–107

    Article  Google Scholar 

  61. Szuba A, Achalu R (2002) Rockson SG (2002), Decongestive lymphatic therapy for patients with breast carcinoma-associated lymphedema. A randomized, prospective study of a role for adjunctive intermittent pneumatic compression. Cancer 95(11):2260–2267

    Article  Google Scholar 

  62. Tsai HJ, Hung HC, Yang JL, Huang CS, Tsauo JY (2009) Could Kinesio tape replace the bandage in decongestive lymphatic therapy for breast-cancer-related lymphedema? A pilot study. Support Care Cancer 17(11):1353–1360. doi:10.1007/s00520-009-0592-8

    Article  PubMed  Google Scholar 

  63. Uzkeser H, Karatay S, Erdemci B, Koc M, Senel K (2013) Efficacy of manual lymphatic drainage and intermittent pneumatic compression pump use in the treatment of lymphedema after mastectomy: a randomized controlled trial. Breast Cancer. doi:10.1007/s12282-013-0481-3

    PubMed  Google Scholar 

  64. Miller L (1998) Exercise in the management of breast cancer-related lymphoedema. Innovatios Breast Cancer Care 3:101–106

    Google Scholar 

  65. Hanson E (2004) MotionVExercises for Lymphoedema. Yukin

Download references

Author information

Authors and Affiliations

  1. Discipline of Physiotherapy, Bern University of Applied Sciences, Bern, Switzerland

    Slavko Rogan, Jan Taeymans, Helena Luginbuehl, Martina Aebi & Sara Mahnig

  2. Academy of integrative Physiotherapy and Training Education, Grenzach-Wyhlen, Germany

    Slavko Rogan

  3. Faculty for Sports and Rehabilitation Science, Vrije Universiteit Brussel, Brussels, Belgium

    Jan Taeymans

  4. Rehabilitation Sciences & Physiotherapy, University of Antwerp, Antwerp, Belgium

    Nick Gebruers

Authors
  1. Slavko Rogan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jan Taeymans
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Helena Luginbuehl
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Martina Aebi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sara Mahnig
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nick Gebruers
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Slavko Rogan.

Ethics declarations

Conflict of interests

The authors report no conflicts of interest.

Additional information

Trial registration: PROSPERO 2014:CRD42014010700.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rogan, S., Taeymans, J., Luginbuehl, H. et al. Therapy modalities to reduce lymphoedema in female breast cancer patients: a systematic review and meta-analysis. Breast Cancer Res Treat 159, 1–14 (2016). https://doi.org/10.1007/s10549-016-3919-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-016-3919-4

Keywords

Search

Navigation