Skip to main content
SpringerLink
Log in

Physiotherapy After Breast Cancer Surgery: Results of a Randomised Controlled Study to Minimise Lymphoedema

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

Abstract

The development of secondary arm lymphoedema after the removal of axillary lymph nodes remains a potential problem for women with breast cancer. This study investigated the incidence of arm lymphoedema following axillary dissection to determine the effect of prospective monitoring and early physiotherapy intervention. Sixty-five women were randomly assigned to either the treatment (TG) or control group (CG) and assessments were made preoperatively, at day 5 and at 1, 3, 6, 12 and 24 months postoperatively. Three measurements were used for the detection of arm lymphoedema: arm circumferences (CIRC), arm volume (VOL) and multi-frequency bioimpedance (MFBIA). Clinically significant lymphoedema was confirmed by an increase of at least 200 ml from the preoperative difference between the two arms. Using this definition, the incidence of lymphoedema at 24 mo. was 21%, with a rate of 11% in the TG compared to 30% in the CG. The CIRC or MFBIA methods failed to detect lymphoedema in up to 50% of women who demonstrated an increase of at least 200 ml in the VOL of the operated arm compared to the unoperated arm. The physiotherapy intervention programme for the TG women included principles for lymphoedema risk minimisation and early management of this condition when it was identified. These strategies appear to reduce the development of secondary lymphoedema and alter its progression in comparison to the CG women. Monitoring of these women is continuing and will determine if these benefits are maintained over a longer period for women with early lymphoedema after breast cancer surgery.

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.

Institutional subscriptions

Similar content being viewed by others

References

  1. Brennan MJ: Lymphoedema following the surgical treatment of breast cancer: a review of pathophysiology and treatment. J Pain Symp Manag 7: 110–116, 1992

    Google Scholar 

  2. Kissin MW, Querci della Rovere G, Easton D, Westbury G: Risk of lymphoedema following the treatment of breast cancer. Brit J Surg 73: 580–584, 1986

    Google Scholar 

  3. Yeoh E, Denham J, Davies S, Spittle M: Primary breast cancer: complications of axillary management. Acta Radiol Oncol 25: 105–108, 1986

    Google Scholar 

  4. Hoe AL, Iven D, Royle GT, Taylor I: Incidence of arm swelling following axillary clearance for breast cancer. Brit J Surg 79: 261–262, 1992

    Google Scholar 

  5. Segerstrom K, Berle P, Graffman S, Nystrom A: Factors that influence the incidence of brachial oedema after treatment of breast cancer. Scand J Plast Recon Surg Hand Surg 26: 223–227, 1992

    Google Scholar 

  6. Spratt JS, Donegan WL: Surgical management. In: Donegan WL, Spratt JS (eds) Cancer of the Breast. 4th edn, WB Saunders, Philadelphia, 1995, pp 443–504

    Google Scholar 

  7. National Health and Medical Research Council (NHMRC): Clinical Practice Guidelines: The Management of Early Breast Cancer. NHMRC National Breast Cancer Centre Publications, Sydney, 1995

    Google Scholar 

  8. Mortimer PS, Bates DO, Brassington HD, Stanton SWB, Strachan, Levick JR: The prevalence of arm oedema following treatment for breast cancer. Quart J Med 89: 377–380, 1996

    Google Scholar 

  9. National Health and Medical Research Council National Breast Cancer Centre (NBCC): Lymphoedema: Prevalence, Risk Factors and Management: A Review of Research. NHMRC National Breast Cancer Centre Publications, Sydney, 1997

    Google Scholar 

  10. Kissane DW, Clarke M, Ikin J, Blocah S, Smith GC, Vitetta L, McKenzie DP: Psychological morbidity and quality of life in Australian women with early-stage breast cancer: a cross-sectional study. Med J Aus 169: 192–196, 1998

    Google Scholar 

  11. Ryttov N, Holm N, Qvist N, Blichert-Toft M: Influence of adjuvant irradiation on the development of late arm lymphoedema and impaired shoulder mobility after mastectomy for carcinoma of the breast. Acta Oncol 27: 667–670, 1988

    Google Scholar 

  12. Földi E, Földi M, Clodius L: The lymphoedema chaos: a lancet. Ann Plast Surg 22: 505–515, 1989

    Google Scholar 

  13. Wingate L, Croghan I, Natarjan N, Michalek A, Jordan C: Rehabilitation of the mastectomy patient: a randomised, blind prospective study. Arch Phys Med Rehab 70: 21–24, 1989

    Google Scholar 

  14. Gerber L, Lampert M, Wood C, Duncan M, D'Angelo T, Schain W, McDonald H, Danforth D, Findlay P, Glatstein E, Lippman M, Steinberg S, Gorrell C, Lichter A, Demoss E: Comparison of pain, motion and edema after modified radical mastectomy vs local excision with axillary dissection and radiotherapy. Breast Cancer Res Treat 21: 139–145, 1992

    Google Scholar 

  15. Hladiuk M, Huchcroft S, Temple W, Schurr BE: Arm func-tion after axillary dissection for breast cancer: a pilot study to provide parameter estimates. J Surg Oncol 50: 47–52, 1992

    Google Scholar 

  16. Mortimer PS (1995) Managing lymphoedema. Clin Exp Dematol 20: 98–106

    Google Scholar 

  17. Casley-Smith JR: Modern treatment of lymphoedema. Modern Med Aust, May, 70–83, 1992

  18. Tobin M, Lacey H, Meyer L, Mortimer P: The psychological morbidity of breast cancer-related arm swelling. Cancer 72: 3248–3252, 1993

    Google Scholar 

  19. Maunsell E, Brisson J, Deschenes L: Arm problems and psychological distress after surgery for breast cancer. Can J Surg 36: 315–320, 1993

    Google Scholar 

  20. Box R, Reul-Hirche H: Results of a quality improvement project evaluating a physiotherapy programme for women after breast cancer surgery (abstract). Proc Nat Congress of the Australian Physiotherapy Association, 1996

  21. Box RC: Rehabilitation after breast cancer. In: Sapsford R, Bullock-Saxton J, Markwell S (eds) Women's Health: A Text-book for Physiotherapists. WB Saunders, London, 1998, pp 454–465

    Google Scholar 

  22. Box RC, Reul-Hirche HM, Bullock-Saxton JE, Furnival CM: Shoulder movement after breast cancer surgery: results of a randomised controlled study of postoperative physiotherapy. Breast Canc Res Treat 75: 35–50

  23. Box RC: The evaluation of a physiotherapy management care plan for women undergoing breast cancer surgery. PhD Thesis, Physiotherapy Department, University of Queensland, Australia, 2000

    Google Scholar 

  24. Box RC, Reul-Hirche HM, Bullock-Saxton JE: The intra-and inter-tester reliability of three measurement methods for the early detection of lymphoedema after axillary dissection. Eur J Lymph 27: 74–79, 1999.

    Google Scholar 

  25. Ward LC, Bunce IH, Cornish BH, Mirolo BR, Thomas BJ, Jones LC: Multi-frequency bioelectrical impedance augments the diagnosis and management of lymphoedema in post-mastectomy patients. Eur J Clin Invest 22: 51–754, 1992

    Google Scholar 

  26. Christensen SB, Lundgren G: Sequelae of axillary dissection vs axillary sampling with or without irradiation for breast cancer. Acta Chir Scand 155: 515–520, 1989

    Google Scholar 

  27. Cornish BH, Bunce IH, Ward LC, Jones LC, Thomas BJ: Bioelectrical impedance for monitoring the efficacy of lymphoedema treatment programmes. Breast Cancer Res Treat 38: 169–176, 1996

    Google Scholar 

  28. Megens A, Harris S: Physical therapist management of lymphoedema following treatment for breast cancer: a critical review of its effectiveness. Phys Ther 78: 1302–1311, 1998

    Google Scholar 

  29. Petrek JA, Pressman PI, Smith RA: Lymphedema: Current issues in research and management. CA-A Cancer J Clin 50: 292–307, 2000

    Google Scholar 

  30. National Breast Cancer Centre (NBCC): Lymphoedema following treatment for breast cancer: some potential approaches to answering priority research questions. Draft document for the NHMRC National Breast Cancer Centre Summit, Adelaide, 2000

    Google Scholar 

  31. Tengrup I, Tennvall-Nittby L, Christiansson I, Laurin M: Arm morbidity after breast-conserving therapy for breast cancer. Acta Oncol 39: 393–397, 2000

    Google Scholar 

  32. Keramopoulos A, Tsionou C, Minaretzis D, Michalas S, Aravantinos D: Arm morbidity following treatment of breast cancer with total axillary dissection: a multivariate approach. Oncology 50: 445–449, 1993

    Google Scholar 

  33. Carroll D, Rose K: Treatment leads to significant improvement: effect of conservative treatment on pain in lymphoedema. Prof Nurse 8: 32–33, 1992

    Google Scholar 

  34. Boris M, Weindorf S, Lasinski B, Boris G: Lymphoedema reduction by noninvasive complex lymphoedema therapy. Oncology 8: 95–106, 1994

    Google Scholar 

  35. Edwards T: Prevalence and aetiology of lymphoedema after breast cancer treatment in Southern Tasmania. Aust NZJ Surg 70: 412–418, 2000

    Google Scholar 

  36. Kosir M, Rymal C, Koppolu P, Hryniuk L, Darga L, Du W, Rice V, Mood D, Shakoor S, Wang W, Bedoyan J, Aref A, Biernat L, Northouse L: Surgical outcomes after breast cancer surgery: measuring acute lymphoedema. J Surg Res 95: 147–151, 2000

    Google Scholar 

  37. Ramos S, O'Donnell L, Knight G: Edema volume, Not timing, is the key to success in lymphoedema treatment. Am J Surg 178: 311–315, 1999

    Google Scholar 

  38. International Society of Lymphology Executive Committee: The diagnosis and treatment of peripheral lymphoedema. Lymphology 28: 113–117, 1995

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Physiotherapy, University of Queensland, Brisbane, Australia

    Robyn C. Box & Joanne E. Bullock-Saxton

  2. School of Physiotherapy, La Trobe University, Melbourne, Australia

    Robyn C. Box

  3. Department of Physiotherapy, Royal Brisbane and Women's Hospital, Brisbane, Australia

    Hildegard M. Reul-Hirche

  4. Royal Brisbane and Wesley Hospitals, Brisbane, Australia

    Colin M. Furnival

Authors
  1. Robyn C. Box
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hildegard M. Reul-Hirche
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joanne E. Bullock-Saxton
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Colin M. Furnival
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Box, R.C., Reul-Hirche, H.M., Bullock-Saxton, J.E. et al. Physiotherapy After Breast Cancer Surgery: Results of a Randomised Controlled Study to Minimise Lymphoedema. Breast Cancer Res Treat 75, 51–64 (2002). https://doi.org/10.1023/A:1016591121762

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1016591121762

Search

Navigation