Koul, R., Dufan, T., Russell, C., Guenther, W., Nugent, Z., Sun, X., & Cooke, L. (2007). Efficacy of complete decongestive therapy and manual lymphatic drainage on treatment-related lymphedema in breast cancer. International Journal of Radiation Oncology, Biology, Physics, 67(3), 841–846.

Researchers analyzed the medical records for 250 patients referred for lymphedema treatment during the first two years of the program and included 138 in the final analysis. Patients were included if their affected arms were larger than their unaffected arms at baseline and one-year follow-up measurements were available. Pre- and postvolumetric measurements were compared. The correlation with age, body mass index, and type of surgery, chemotherapy, and radiotherapy was determined. Treatment was stratified on the basis of the treatment modality used for breast cancer management. The therapy could include all four components of complete decongestive therapy (CDT) or only some components were omitted at the discretion of the therapists. Fifty-five percent of patients received all four components and 32% manual lymph drainage (MLD) alone. Thirteen percent with mild lymphedema received instructions and counseling for the home program, which included self-administered lymph drainage and exercises. All patients received compression wraps during the intensive phase.

The mean age of patients in the sample was 54.3 years.

The study was conducted at an outpatient lymphedema clinic staffed by two certified Vodder therapists in Winnipeg.

Circumference was measured from the wrist to axilla.  

CDT and MLD with exercises were associated with a significant reduction in lymphedema volume. The mean affected arm pretreatment volume was 2,929 ml (range 1,474–5,879). The normal arm volume range was (1,320–4,299) with a mean volume of 2,531 ml. The mean difference at baseline was 398 ml. The number of MLD or CDT sessions was related to mastectomy (versus lumpectomy) and chemotherapy. After one year, absolute volume was reduced by 188 ml to 2,741 ml.

The study examines CDT and its components for a variety of patient needs and supports modifications of components of CDT and individualization of care.

• The study was not randomized. 
• No control group was provided for the study.
• Research relied on retrospective studies. 
• The components could not be qualified.

Evidence supports a need for expert therapists.