Medknow Publications on behalf of Indian Cancer Society
Abstract
Background: Lymphedema following breast cancer treatment is one of the
most morbid conditions affecting breast cancer survivors. Currently, no
therapy completely cures this condition. Comprehensive Decongestive
Therapy (CDT), a novel physiotherapeutic method offers promising
results in managing this condition. This therapy is being widely used
in the West. Till date, there are no studies evaluating the
effectiveness and feasibility of this therapy in the east. Materials
and Methods: The therapeutic responses of 25 patients with
postmastectomy lymphedema were analyzed prospectively in this study.
Each patient received an intensive phase of therapy for eight days from
trained physiotherapists, which included manual lymphatic drainage,
multi layered compression bandaging, exercises, and skin care.
Instruction in self management techniques were given to the patients on
completion of intensive therapy. The patients were followed up for
three months. Changes in the volume of the edematous limb were assessed
with a geometric approximation derived from serial circumference
measurements of the limb and by water displacement volumetry. Changes
in skin and sub cutis thickness were assessed using high frequency
ultrasound. Results: The reduction in limb volume observed after
therapy was 32.3% and 42% of the excess, by measurement and volumetry,
respectively. The maximum reduction was obtained after the intensive
phase. The reduction in skin and subcutis thickness of the edematous
limb followed the same pattern as volume reduction. Patients could
maintain the reduction obtained by strictly following the protocols of
the maintenance phase. Conclusions: CDT combined with long-term self
management is effective in treating post mastectomy lymphedema. The
tropical climate is a major factor limiting the regular use of bandages
by the patients