The role of physiotherapy treatment in arm lymphoedema associated with breast cancer

Abstract

Ipsilateral arm lymphoedema is the most frequent long-term complication due to breast cancer surgery, chemo- and radiotherapy, affecting approximately 40% of women treated for this condition. We conducted a retrospective study to assess the efficiency of physiotherapy procedures in reducing arm lymphoedema in women who underwent an exhaustive treatment plan for breast cancer. The study included 32 patients out of the 641 with breast cancer, who were treated by the same multidisciplinary team at the “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology in Bucharest. They underwent unilateral modified radical mastectomy with axillary clearance between 1 January 2016 and 31 December 2019 due to developing ipsilateral arm lymphoedema, stage 2. Of the 18 patients who received individual counselling and education, manual lymph drainage and compressive bandage, 10 (55.5%) decreased arm lymphoedema from stage 2 to 1 after 3 months of treatment. Of the 14 patients who associated these procedures and also benefitted from additional individual physiotherapy including stretching exercises (for the levator scapulae, trapezius, pectoralis major and minor) and progressive active and action-assisted shoulder exercises, 11 (78.5%) reduced arm lymphoedema to stage 1 and regained upper arm mobility and sensitivity. Early initiation of physiotherapy after modified radical mastectomy with axillary lymph node dissection, along with patient education, is associated with a higher regression rate of arm lymphoedema compared to only patient education and awareness. The treatment response rate was 85.7% in patients benefitting from lymphatic drainage, compressive bandage and an individual physiotherapy plan compared to 55.5% in patients only benefitting from lymphatic drainage and compressive bandage.