Advertisement

Treatment of Breast Cancer–Related Lymphedema Using Negative Pressure Massage: A Pilot Randomized Controlled Trial

Published:April 16, 2021DOI:https://doi.org/10.1016/j.apmr.2021.03.022

      Abstract

      Objective

      To evaluate the efficacy of negative pressure massage treatment (NPMT) compared with manual lymphatic drainage (MLD) in women with chronic breast cancer–related lymphedema (LE). We hypothesized that NPMT would result in greater improvements in LE and upper limb function.

      Design

      Pilot single-blinded randomized controlled trial.

      Setting

      Health sciences university.

      Participants

      Of 64 women screened, 28 met eligibility requirements (ie, >18y of age; completed active treatment for breast cancer; had unilateral arm LE for ≥1y; were not receiving LE care; had stable LE) and were randomized to the NPMT (n=15) and control groups (n=13).

      Interventions

      The intervention group received NPMT and the control group received MLD; both received twelve 60-minute sessions over 4-6 weeks.

      Main Outcome Measures

      Bioimpedance (lymphedema index [L-Dex] units]), limb volume (mL) calculated from limb circumference, and Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) score.

      Results

      Outcomes were analyzed for 28 women. Compared to the MLD group, the NPMT group demonstrated greater improvement with a large effect size in L-Dex scores (P=.001; standardized mean difference [SMD]=−1.15; 95% confidence interval, −1.96 to −0.35) and interlimb volume differences (P=.038; SMD=−0.83; 95% confidence interval, −1.60 to −0.05). Differences in DASH scores were not statistically significant (P=.067).

      Conclusions

      Compared to MLD, treatment with NPMT resulted in greater improvement in L-Dex scores and interlimb volume differences in women with a duration of unilateral upper limb LE of >1 year. Our findings need to be confirmed in a larger randomized controlled trial.

      Keywords

      List of abbreviations:

      BC (breast cancer), BIS (bioelectrical impedance spectroscopy), DASH (Disabilities of the Arm, Shoulder, and Hand questionnaire), ECF (extracellular fluid), ES (effect size), L-Dex (lymphedema index), LE (lymphedema), MLD (manual lymphatic drainage), NPMT (negative pressure massage therapy), PI (principal investigator), RCT (randomized controlled trial), SMD (standardized mean difference)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • DiSipio T
        • Rye S
        • Newman B
        • Hayes S
        Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis.
        Lancet Oncol. 2013; 14: 500-515
        • Mortimer PS
        The pathophysiology of lymphedema.
        Cancer. 1998; 83: 2798-2802
        • Smoot B
        • Wong J
        • Cooper B
        • et al.
        Upper extremity impairments in women with or without lymphedema following breast cancer treatment.
        J Cancer Surviv. 2010; 4: 167-178
        • Ridner SH
        Quality of life and a symptom cluster associated with breast cancer treatment–related lymphedema.
        Support Care Cancer. 2005; 13: 904-911
        • Dawes DJ
        • Meterissian S
        • Goldberg M
        • Mayo NE
        Impact of lymphoedema on arm function and health-related quality of life in women following breast cancer surgery.
        J Rehabil Med. 2008; 40: 651-658
        • Kwan W
        • Jackson J
        • Weir LM
        • Dingee C
        • McGregor G
        • Olivotto IA
        Chronic arm morbidity after curative breast cancer treatment: prevalence and impact on quality of life.
        J Clin Oncol. 2002; 20: 4242-4248
        • Shih YC
        • Xu Y
        • Cormier JN
        • et al.
        Incidence, treatment costs, and complications of lymphedema after breast cancer among women of working age: a 2-year follow-up study.
        J Clin Oncol. 2009; 27: 2007-2014
        • Basta MN
        • Fox JP
        • Kanchwala SK
        • et al.
        Complicated breast cancer–related lymphedema: evaluating health care resource utilization and associated costs of management.
        Am J Surg. 2016; 211: 133-141
        • Cuzzone DA
        • Weitman ES
        • Albano NJ
        • et al.
        IL-6 regulates adipose deposition and homeostasis in lymphedema.
        Am J Physiol Heart Circ Physiol. 2014; 306: H1426-H1434
        • Haghighat S
        • Lotfi-Tokaldany M
        • Maboudi AA
        • Karami M
        • Bahadori A
        • Weiss J
        Predictive factors of response to phase I complete decongestive therapy in upper extremity lymphedema following breast carcinoma in Iran.
        Lymphology. 2013; 46: 97-104
        • Mayrovitz HN
        The standard of care for lymphedema: current concepts and physiological considerations.
        Lymphat Res Biol. 2009; 7: 101-108
        • Thompson B
        • Gaitatzis K
        • Janse de Jonge X
        • Blackwell R
        • Koelmeyer LA
        Manual lymphatic drainage treatment for lymphedema: a systematic review of the literature.
        J Cancer Surviv. 2021; 15: 244-258
        • Shao Y
        • Zhong DS
        Manual lymphatic drainage for breast cancer–related lymphoedema.
        Eur J Cancer Care (Engl). 2017; 26https://doi.org/10.1111/ecc.12517
        • Ezzo J
        • Manheimer E
        • McNeely ML
        • et al.
        Manual lymphatic drainage for lymphedema following breast cancer treatment.
        Cochrane Database Syst Rev. 2015; 5CD003475
        • Gradalski T
        • Ochalek K
        • Kurpiewska J
        Complex decongestive lymphatic therapy with or without Vodder II manual lymph drainage in more severe chronic postmastectomy upper limb lymphedema: a randomized noninferiority prospective study.
        J Pain Symptom Manage. 2015; 50: 750-757
        • Huang TW
        • Tseng SH
        • Lin CC
        • et al.
        Effects of manual lymphatic drainage on breast cancer–related lymphedema: a systematic review and meta-analysis of randomized controlled trials.
        World J Surg Oncol. 2013; 11: 15
        • Lasinski BB
        • McKillip Thrift K
        • Squire D
        • et al.
        A systematic review of the evidence for complete decongestive therapy in the treatment of lymphedema from 2004 to 2011.
        PM R. 2012; 4: 580-601
        • Moseley AL
        • Carati CJ
        • Piller NB
        A systematic review of common conservative therapies for arm lymphoedema secondary to breast cancer treatment.
        Ann Oncol. 2007; 18: 639-646
        • Brorson H
        • Ohlin K
        • Olsson G
        • Karlsson MK
        Breast cancer–related chronic arm lymphedema is associated with excess adipose and muscle tissue.
        Lymphat Res Biol. 2009; 7: 3-10
        • Dylke ES
        • Ward LC
        • Meerkin JD
        • Nery L
        • Kilbreath SL
        Tissue composition changes and secondary lymphedema.
        Lymphat Res Biol. 2013; 11: 211-218
        • Gott FH
        • Ly K
        • Piller N
        • Mangio A
        Negative pressure therapy in the management of lymphoedema.
        J Lymphoedema. 2018; 13: 43-48
        • Vuorinen V-P
        • Iivarinen J
        • Jurvelin J
        • Airaksinen O
        Lymphatic therapy using negative pressure, a clinical study with the LymphaTouch device.
        Finnish Funding Agency for Technology and Innovation, August 2013 (Research Report #5320003/221.https://www.bodyanalyse.no/gammel/studier/lymphatic_therapy.pdf. Accessed May 18, 2021)
        • Iivarinen JT
        • Korhonen RK
        • Jurvelin JS
        Modeling of interstitial fluid movement in soft tissue under negative pressure—relevance to treatment of tissue swelling.
        Comput Methods Biomech Biomed Engin. 2016; 19: 1089-1098
        • Glass GE
        • Murphy GF
        • Esmaeili A
        • Lai LM
        • Nanchahal J
        Systematic review of molecular mechanism of action of negative-pressure wound therapy.
        Br J Surg. 2014; 101: 1627-1636
        • Gage MJ
        • Yoon RS
        • Egol KA
        • Liporace FA
        Uses of negative pressure wound therapy in orthopedic trauma.
        Orthop Clin North Am. 2015; 46: 227-234
        • Saul D
        • Fischer AC
        • Lehmann W
        • Dresing K
        Reduction of postoperative swelling with a negative pressure treatment—a prospective study.
        J Orthop Surg (Hong Kong). 2020; 282309499020929166
        • Levenhagen K
        • Davies C
        • Perdomo M
        • Ryans K
        • Gilchrist L.
        Diagnosis of upper quadrant lymphedema secondary to cancer: clinical practice guideline from the Oncology Section of the American Physical Therapy Association.
        Phys Ther. 2017; 97: 729-745
        • Fu MR
        • Cleland CM
        • Guth AA
        • et al.
        L-Dex ratio in detecting breast cancer–related lymphedema: reliability, sensitivity, and specificity.
        Lymphology. 2013; 46: 85-96
        • Gummesson C
        • Atroshi I
        • Ekdahl C
        The Disabilities of the Arm, Shoulder and Hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery.
        BMC Musculoskelet Disord. 2003; 4: 11
        • Angst F
        • Schwyzer HK
        • Aeschlimann A
        • Simmen BR
        • Goldhahn J
        Measures of adult shoulder function: Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and its short version (QuickDASH), Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) Society standardized shoulder assessment form, Constant (Murley) Score (CS), Simple Shoulder Test (SST), Oxford Shoulder Score (OSS), Shoulder Disability Questionnaire (SDQ), and Western Ontario Shoulder Instability Index (WOSI).
        Arthritis Care Res (Hoboken). 2011; 63: S174-S178
        • Davies C
        • Ryans K
        • Levenhagen K
        • Perdomo M
        Breast Cancer EDGE Task Force outcomes: quality of life and functional outcome measures for secondary lymphedema in breast cancer survivors.
        Rehabil Oncol. 2014; 32: 7-12
        • Schmitt JS
        • Di Fabio RP
        Reliable change and minimum important difference (MID) proportions facilitated group responsiveness comparisons using individual threshold criteria.
        J Clin Epidemiol. 2004; 57: 1008-1018
        • Taylor R
        • Jayasinghe UW
        • Koelmeyer L
        • Ung O
        • Boyages J.
        Reliability and validity of arm volume measurements for assessment of lymphedema.
        Phys Ther. 2006; 86: 205-214
        • Cornish BH
        • Chapman M
        • Hirst C
        • et al.
        Early diagnosis of lymphedema using multiple frequency bioimpedance.
        Lymphology. 2001; 34: 2-11
        • Sander AP
        • Hajer NM
        • Hemenway K
        • Miller AC
        Upper-extremity volume measurements in women with lymphedema: a comparison of measurements obtained via water displacement with geometrically determined volume.
        Phys Ther. 2002; 82: 1201-1212
        • Warren AG
        • Janz BA
        • Slavin SA
        • Borud LJ
        The use of bioimpedance analysis to evaluate lymphedema.
        Ann Plast Surg. 2007; 58: 541-543
        • Jain MS
        • Danoff JV
        • Paul SM
        Correlation between bioelectrical spectroscopy and perometry in assessment of upper extremity swelling.
        Lymphology. 2010; 43: 85-94
        • Cornish BH
        • Chapman M
        • Thomas BJ
        • Ward LC
        • Bunce IH
        • Hirst C
        Early diagnosis of lymphedema in postsurgery breast cancer patients.
        Ann N Y Acad Sci. 2000; 904: 571-575
        • Hayes S
        • Cornish B
        • Newman B.
        Comparison of methods to diagnose lymphoedema among breast cancer survivors: 6-month follow-up.
        Breast Cancer Res Treat. 2005; 89: 221-226
        • Strossenreuther RHK
        Practical instructions for therapists—manual lymph drainage according to Dr. E. Vodder.
        in: Foldi M Foldi E Strossenreuther RHK Kubik S Foldi’s textbook of lymphology. 2nd ed. Elsevier, Munich, Germany2006 (525-38, 644-6)
        • Cohen J.
        Statistical power analysis for the behavioral sciences.
        2nd ed. Psychology Press, New York1988
        • Shah C
        • Vicini F
        • Beitsch P
        • et al.
        The use of bioimpedance spectroscopy to monitor therapeutic intervention in patients treated for breast cancer related lymphedema.
        Lymphology. 2013; 46: 184-192
        • Faul F
        • Erdfelder E
        • Lang AG
        • Buchner A
        G* Power, 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences.
        Behav Res Methods. 2007; 39: 175-191
        • Greene AK
        • Goss JA
        Diagnosis and staging of lymphedema.
        Semin Plast Surg. 2018; 32: 12-16
        • Tánori-Tapia JM
        • Romero-Pérez EM
        • Camberos NA
        • et al.
        Determination of the minimum detectable change in the total and segmental volumes of the upper limb, evaluated by perimeter measurements.
        Healthcare (Basel). 2020; 8: 285
        • Harrington S
        • Michener LA
        • Kendig T
        • Miale S
        • George SZ
        Patient-reported upper extremity outcome measures used in breast cancer survivors: a systematic review.
        Arch Phys Med Rehabil. 2014; 95: 153-162
        • Beurskens CH
        • van Uden CJ
        • Strobbe LJ
        • Oostendorp RA
        • Wobbes T
        The efficacy of physiotherapy upon shoulder function following axillary dissection in breast cancer, a randomized controlled study.
        BMC Cancer. 2007; 7 (166-6)
        • Portela AL
        • Santaella CL
        • Gómez CC
        • Burch A
        Feasibility of an exercise program for Puerto Rican women who are breast cancer survivors.
        Rehabil Oncol. 2008; 26: 20-31
        • Lau RW
        • Cheing GL
        Managing postmastectomy lymphedema with low-level laser therapy.
        Photomed Laser Surg. 2009; 27: 763-769
        • Coroneos CJ
        • Wong FC
        • DeSnyder SM
        • Shaitelman SF
        • Schaverien MV
        Correlation of L-Dex bioimpedance spectroscopy with limb volume and lymphatic function in lymphedema.
        Lymphat Res Biol. 2019; 17: 301-307