Dayes, I.S., Whelan, T.J., Julian, J.A., Parpia, S., Pritchard, K. I., D'Souza, D. P., . . . Levine, M.N. (2013). Randomized trial of decongestive lymphatic therapy for the treatment of lymphedema in women with breast cancer. Journal of Clinical Oncology, 31, 3758-3763.

To investigate the treatment of breast cancer–related lymphedema using massage-based manual lymphatic drainage (MLD) and bandaging and compression versus control using only compression garments

Women previously treated for breast cancer with a minimum 10% difference in volume between arms were randomly assigned to two groups. The control received only compression garments while the experimental group received MLD therapy and compression garments, and assessed for reduction in arm volume.

• N = 95  
• AGE = 59–61
• MALES: 0        
• FEMALES: 95%
• KEY DISEASE CHARACTERISTICS: Patients completed all primary and adjuvant therapy. Breast cancer–related lymphedema, treatment for breast cancer, increase in arm volume of 10% in affected arm
• OTHER KEY SAMPLE CHARACTERISTICS: Exclusions: Ongoing active cancer history of contralateral breast cancer, prior complete decongestive therapy (CDT), contraindication factors such as infection, thrombosis

• SITE:  Multi-site  
• SETTING TYPE: Outpatient  
• LOCATION: Six Canadian regional cancer centers

• PHASE OF CARE: Late effects and survivorship
• APPLICATIONS: Elder care 

• Randomized trial 

• Circumferential limb volume 
• Quality of lIfe SF-36 
• Arm function
• DASH

CDT with MLD appears to be more beneficial to patients with lymphedema for more than one year (experimental group), showing increased volume loss, compared to control of garments only. The reduction in excess arm volume for patients in the experimental group was 29% and 22.6% for the control group (p = .34).

No significant difference in group with lymphedema less than one year, suggesting this group may respond to less intensive treatment.  More research is needed.

• Small sample (< 100)
• Baseline sample/group differences of import
• Other limitations/explanation:  Eight patients dropped out, seven from control group may have reduced the study power; use of circumferential limb volume results in some large variability.

Lymphedema identified within the first year may require less intensive therapy.  It is important for nurses to question patients with breast cancer about their affected extremity, and refer to a professional with specialized training in lymphedema management regarding risk reduction.