Box, R.C., Reul-Hirsch, H.M., Bullock-Saxton, J.E., & Furnival, C.M. (2002). Physiotherapy after breast cancer surgery: Results of a randomised controlled study to minimise lymphoedema. Breast Cancer Research and Treatment, 75(1), 51–64.

The purpose of the study was to evaluate the incidence of lymphedema after axillary dissection to determine the effects of prospective monitoring and early physiotherapy intervention

The study sample (N = 65) was comprised of a treatment group and a control group.

The study used a randomized controlled trial design.

Both arms of patients were measured for circumference, volumetry, and multi-frequency bioimpedance analysis preoperatively and 5 days and 1, 3, 6, 12, and 24 months postoperatively.

A small number of women detected with clinically significant lymphedema (n =12); 91% of women completed measures at two years after surgery. Two women had bilateral surgeries within the first month after enrollment. At 24 months, three times as many women in the control group compared to treatment group showed secondary lymphedema (except for volume criteria). Using volume criteria, a trend toward increased lymphedema in patients with mastectomy complete with breast conservation therapy existed. Hand or arm dominance did not influence lymphedema by these measurements. Logistic regression used to determine risk factors for development of lymphedema included

• Axillary dissection by level
• Number of lymph nodes removed
• Number of lymph nodes affected with disease
• Wound infection
• Body mass index
• Total wound drainage
• Seroma
• Age
• RT
• Occupation
• Clinical.

Clinical incidence of lymphedema in the study was 21% at two years.

The study was very well done and well designed.

• The sample size was small; however, the data are useful in that they suggest a preventative approach with ongoing monitoring to prevent and minimize risk in a population with high-risk criteria for development of symptoms.
• Anecdotal evidence of some specific cases.

Nurses should advocate ongoing measurement to detect changes early and intervene.