Harris SR, Hugi MR, Olivotto IA, Levine M;
Steering Committee for Clinical Practice Guidelines for the Care and Treatment of
Breast Cancer.
Clinical practice guidelines for the care and treatment of breast cancer: 11.
CMAJ 2001 Jan 23;164(2):191-9

School of Rehabilitation Sciences, Faculty of Medicine, University of British
Columbia, Vancouver, BC.

OBJECTIVE: To provide information and recommendations for women and their
physicians when making decisions about the management of lymphedema related to
breast cancer. OPTIONS: Compression garments, pneumatic compression pumps,
massage and physical therapies, other physical therapy modalities, pharmaceutical
treatments. OUTCOMES: Symptom control, quality of life, cosmetic results.
EVIDENCE: Systematic review of English-language literature retrieved primarily
from MEDLINE (1966 to April 2000) and CANCERLIT (1985 to April 2000).
Nonsystematic review of breast cancer literature published to October 2000.
RECOMMENDATIONS: Pre- and postoperative measurements of both arms are useful in
the assessment and diagnosis of lymphedema. Circumferential measurements should
be taken at 4 points: the metacarpal-phalangeal joints, the wrists, 10 cm distal
to the lateral epicondyles and 15 cm proximal to the lateral epicondyles.
Clinicians should elicit symptoms of heaviness, tightness or swelling in the
affected arm. A difference of more than 2.0 cm at any of the 4 measurement points
may warrant treatment of the lymphedema, provided that tumour involvement of the
axilla or brachial plexus, infection and axillary vein thrombosis have been ruled
out. Practitioners may want to encourage long-term and consistent use of
compression garments by women with lymphedema. One randomized trial has
demonstrated a trend in favour of pneumatic compression pumps compared with no
treatment. Further randomized trials are required to determine whether pneumatic
compression provides additional benefit over compression garments alone. Complex
physical therapy, also called complex decongestive physiotherapy, requires
further evaluation in randomized trials. In one randomized trial no difference in
outcomes was detected between compression garments plus manual lymph drainage
versus compression garments alone. Clinical experience supports encouraging
patients to consider some practical advice regarding skin care, exercise and body
weight. [A patient version of these guidelines appears in Appendix 2.]
VALIDATION: An initial draft of this document was developed by a task force
sponsored by the BC Cancer Agency. It was updated and revised substantially by a
writing committee and then submitted for further review, revision and approval by
the Steering Committee for Clinical Practice Guidelines for the Care and
Treatment of Breast Cancer. SPONSOR: The steering committee was convened by
Health Canada. COMPLETION DATE: October 2000.