The Potential of Preventing Lymphedema

Introduction

The information in this article is based on the results of a study supported by the National Navel Medical Center. The results were promising in demonstrating the potential of preventing the development of lymphedema after treatment for breast cancer.

The Goals of This Study

Breast cancer treatment commonly includes surgery, the removal of lymph nodes near the affected breast, and possibly radiation. These treatments disrupt the functioning of the lymphatic system and causes from 7 to 47% of all breast cancer patients to develop the chronic condition known as lymphedema.

The purpose of this study was to prove that lymphedema could be prevented through early detection of developing lymphedema, the prompt beginning of treatment, and the ongoing following the treatment regime.

What is Lymphedema?

Lymphedema associated with breast cancer treatment is abnormal swelling that occurs because the lymphatic system has been damaged by surgery or radiation. Lymphedema is a chronic condition that cannot be cured. It diminishes the patient’s quality of life, contributes to the impairment of the limb’s range of motion, and is controlled only by a daily treatment regimine of massage, wearing compression garments, careful skin care, weight control, and exercise.

• Most frequently breast cancer related lymphedema results in swelling of the hand, arm, and joints of the adjacent to the affected breast area; however, it also affects the area of the trunk surrounding where the breast was removed.
• If a lumpectomy was performed, the remaining breast tissue can be affected by swelling and becoming fibrotic (hardened)
• Because lymphedema is due to the inability of the lymph to drain normally, the swollen area consisting of protein-rich stagnant lymph. Bacteria thrive in this fluid and, if there is a break in the skin bacteria enter the tissues, thrive, reproduce, and cause serious infections.
• This abnormal fluid also causes these tissues to deteriorate and become fibrotic (hardened).

You Need to Know

Through public education, most women are now aware of the need to detect developing breast cancer at an early stage. These important preventive steps include regular mammograms and routine self-examinations. Early detection has been proven to save lives! Since lymphedema does not develop until after the breast cancer has been treated, most women are not familiar with it and are unaware of this problem until the painful swelling develops.

This study was performed successfully and has demonstrated that being aware of the risk of developing lymphedema, and taking prompt action, can prevent this condition from developing.

Any woman, who suffers daily from the pain and lowered quality of life due to lymphedema, will testify that there is an urgent need for a public education program to make women, physicians, and oncologists aware of the simple step that must be taken as soon as a woman is diagnosed with breast cancer.

The Protocol

This study demonstrated that there is hope of preventing lymphedema; however this requires that action be taken in a timely manner. This protocol to prevent lymphedema should be made a routine part of early breast cancer treatment.

The goal is to detect any change in the “at risk tissues” as soon as possible so that treatment can be started. The starting point is to obtain baseline measurements of the arms before any cancer treatment is started. The procedure is painless, takes only approximately 5 minutes, and could prevent a lifetime of suffering with lymphedema.

Step One: Obtaining Baseline Measurements

It is essential that baseline measurements be obtained before any treatment begins. The easiest, and most accurate measurements, are taken using technology known as bioimpedance. This non-invasive test measures the composition of body tissues and fluids including lymph. This technology is known as known as bioelectrical impedance analysis or BIA.

Imp™ XCA (Courtesy of Impedimed)

To date, ImpediMed is the only bioimpedance device cleared by the FDA for use by health care providers to accurately and quickly detect the clinical assessment of an upper limb at risk of developing lymphedema. These measurements must be taken as part of a pre-operative visits.

These measurements will be used to detect changes in the tissues before any visible signs or symptoms of lymphedema are detectable.

Step Two: Follow-up Measurements

• Post-operative measurements are taken at 3 month intervals. These should be compared with the baseline measurements and other previous readings.
• If any indications of lymphedema such as a change in measurements, feelings of heaviness, swelling, or pain measurements are observed measurements should be taken again immediately and the results are compared with the baseline.
• When a post-operative change in the upper limb indicates a change of greater than 3% a diagnosis of subclinical, or stage 0, lymphedema is made.

When Change Occurs: Stage 0 -- Take Prompt Action!

When lymphedema is diagnosed, or suspected, a physician or lymphedema therapist should be consulted immediately and a conservative compression intervention should be started.

The following were the steps taken during the study.

• The patients wore a ready-made knit Jobst garment of 20-30 mm HG compression. (The abbreviation HG stands for mercury and this is a measurement of the amount of pressure the sleeve places on the affected limb.)
• These garments consist of a sleeve and a gauntlet. A gauntlet is a style of compression for the hand that is a partial glove that leaves with the fingers completely exposed. A thumb stub holds this garment in place.
• These garments should be fitted by a lymphedema therapist; however for some patients it is possible that an “off-the-shelf” garment will fit. The fit of these garments is important. If necessary, it may be necessary to obtain a custom-made garment.
• The garments are worn during waking hours for a period of four weeks only. They are not worn at night because there is a risk that the garment could become tangled during sleep and cause a tourniquet-like effect.
• At four weeks measurements are taken again.
• If the next measurements indicate that the lymphedema swelling is reduced, the regimine is changed so that the compression garment and glove are worn only during strenuous activity, air travel, or if symptoms of heaviness develop.
• The patient should return for remeasurement every three months. On the average during the study, volume reduction was maintained at an average follow-up period of 4.8 months. (At this point the study was discontinued.)
• If swelling is not controlled by these garments, the patient should enter a more traditional lymphedema treatment program.

The Results

Preoperative assessment and early intervention at the earliest signs of changed significantly reduced the affected limb volume to near baseline measurements and prevents progression to a more advanced state of lymphedema for at least the first year postoperatively.

The Study

In 2008, the American Cancer Society published the results of a study titled “Preoperative Assessment Enables the Early Diagnosis and Successful Treatment of Lymphedema.” This study was supported by the National Navel Medical Center (NNMC) and the study team included: Nicole L. Stout Gergich, PT, MPT, CLT-LANA, Lucinda Pfalzer, PT, MA, PhD, Charles McGarvey, PT, DPT, MS, Barbara Springer, PT, PhD, OCS, SCS, Lynn H. Gerber, MD, and Peter Soballe, MD

Got a question or comment? Post in the 'How Lymphedema is Treated' forum.
Category: How Lymphedema is Treated Updated: 2014-10-01