Rinehart-Ayres ME.
Conservative approaches to lymphedema treatment.
Cancer 1998 Dec 15;83(12 Suppl American):2828-32

Thomas Jefferson University, College of Health Professions, Philadelphia,
Pennsylvania 19107, USA.

BACKGROUND: Upper extremity lymphedema can develop after surgery for breast
carcinoma. Once developed, it becomes a chronic problem that women must cope with
for the rest of their lives. Steps to prevent lymphedema should begin immediately
after surgery. However, there is little information available about what actually
causes lymphedema; therefore, it is difficult to prevent, and there is some
controversy over how women should be treated once lymphedema has developed.
METHODS: The literature was reviewed to understand the education about arm care
provided to women during and after the short hospital stay for breast carcinoma
surgery. Evaluation and treatment options for lymphedema and complications
resulting from lymphedema were explored. RESULTS: Women are provided with basic
arm care information after surgery; however, many women require reinforcement
from health professionals, such as physical or occupational therapists, to reach
optimum functional outcomes. If lymphedema does develop, then there are two
treatment regimes that have been used. The compression pump, along with skin
care, exercise, and compression garments, is one option. However, there is little
consistency with the length of time the pump should be used or the optimum number
of days required to receive the best results. The second treatment option is
known as complex decongestive physiotherapy or complex physical therapy. Arm
care, therapeutic exercises, manual lymph drainage, and compression bandages
and/or garments comprise this treatment regime. Decreases in lymphedema are noted
if women are compliant with the prescribed treatment program. CONCLUSIONS: Women
must be educated about possible complications after breast surgery. This should
be a team effort, with physicians, nurses, physical and occupational therapists,
and Reach to Recovery volunteers from the American Cancer Society all
participating in the process. If women do develop lymphedema, then an individual
treatment program must be established, and adherence to the program must be
stressed. More research is needed to determine the optimum treatment regime for
women who develop lymphedema.