Lymphedema study

A recent study on Lymphedema indicates a side effect for up to 15% of women treated for breast cancer. It can be triggered after the removal of under arm lymph nodes and can develop into severe, painful swelling in the arm impairing it’s use. Treatment for this chronic condition is limited. But with the help of 100 breast cancer survivors, researchers at McMaster University compared the standard approach of wearing an elastic sleeve with a more experimental option that included daily lymphatic massage. Dr. Ian Dayes with the Michael G. DeGroote School of Medicine says the results were surprising: “We were actually calculating the size of the arms, based on circumferenctial tape measurements, and then we’d use a special formula and calculate up the actual volume of the arm, and then compare that to the unaffected arm. And it was really the difference between the two arms that we were looking at. And at the end of the day, we found that those patients that had the experimental treatment, they had a 29 percent reduction in their excess volume,while the patients that were on the standard treatment had a 23% reduction. So at the end of the day, the difference between the two groups was only 6%.”

Research is continuing in this field. Dr. Dayes says some are studying lyposuction, plastic surgery and even stem cell treatments. But results are still a long way off.


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John Mulligan says:

As a lymphedema therapist for the last 15 years I would like to correct some misconceptions found in this piece. The gold standard for lymphedema treatment in Complex Decongestive Physiotherapy or CDT. It consists of manual lymph drainage, referred to in your piece as “lymphatic massage,” and compression bandaging along with therapeutic exercise and patient education. CDT is NOT an experimental therapy, but is accepted as the gold standard of treatment for lymphedema. It is endorsed by the International Lymphology Society (ISL), The International Lymphedema Framework, the Canadian Lymphedema Framework, the National Lymphedema Network (US), and all the Canadian provincial lymphedema associations. Please clarify this with a retraction or correction on your health news segment. Dr. Ian Dayes mentioned that Complex Decongestive Therapy (referred to as “experimental”) reduced the arms 6% more effectively than compression alone. He acts as though this is insignificant, but keep in mind that a 2% difference in limb sizes (affected vs. unaffected) is enough for a diagnosis of lymphedema. 6% more reduction is a fairly significant difference. This misrepresentation of lymphedema therapy will have a negative effect on patients seeking treatment and will impact lymphedema patients’ access to proper medical care. I look forward to seeing a correction on your show soon.

John Mulligan says:

Correction: I inadvertently called the International Society of Lymphology (ISL) the International Lymphology Society.

John Mulligan says:

Correction: A measurement consistent with a diagnosis of lymphedema is 2cm in the affected arm, not 2%.
a 6% difference in outcomes is still a significant difference. As I said, Complex Decongestive Therapy is not experimental; it has been in use in Europe since the 1960’s. It is the internationally agreed upon Gold Standard for the treatment of lymphedema.

Robert Weiss, M.S. says:

The press releases of the results of this study present the trial results in a biased manner. It is obvious that the press releases are designed to sell the idea that manual lymph drainage can be dispensed with. But that is not what the study shows. Another way to read the data is that the data is that elastic compression alone is only 79.3% as effective than the standard treatment of manual lymph drainage (MLD), compression and exercise. Another way to view the data is that addition of manual lymph drainage (not massage!) improves the beneficial effects of compression alone by 25%. What is not stressed is that the speed reduction of limb swelling is far greater with manual lymph drainage than with compression alone. And, although not the subject of this trial, but a very important factor to be considered before recommending omitting MLD is that compression alone does nothing to treat axillary, truncal and breast swelling which often accompanies upper limb lymphedema. In fact, it makes it worse by “squeezing” the lymphatic fluid unto areas of the body which already have diminished capability to accommodate fluid transfer.