When a friend of mine went to her first breast cancer support group meeting, she was surprised that the conversation revolved around something she had never heard of—lymphedema. This condition—which involves mild to extreme swelling, usually in the arm—can cause significant pain, loss of arm function, disfigurement and emotional distress. Symptoms can develop soon after surgery or may appear months or even years later. According to the National Cancer Institute, as many as 56% of breast cancer patients experience it within two years after surgery.
Good news: A Spanish study suggests that physical therapy (PT) provided soon after breast cancer surgery can significantly reduce the risk of developing lymphedema. One group of breast cancer patients who did not have lymphedema received typical instruction on prevention strategies…a second group got instruction plus three sessions of PT per week for three weeks. After one year, 25% of the instruction-only group had developed lymphedema—compared with only 7% of the PT group.
I asked physical therapist Gwen White, PT, coauthor of Lymphedema: A Breast Cancer Patient’s Guide to Prevention and Healing and a lymphedema specialist at Kaiser Permanente in Portland, Oregon, to explain how PT helps…
Lymphedema lesson. The lymphatic system, which is part of the immune and circulatory systems, helps clean the body’s tissues and maintain its balance of fluids. It includes vessels that carry lymph fluid through the body, plus nodes that filter out waste. White explained that, if part of the lymphatic system is damaged, lymph fluid can accumulate in nearby tissues, triggering severe swelling, increasing infection risk and eventually causing skin to thicken and harden. Breast cancer patients are at risk because one or more lymph nodes typically are removed during a mastectomy or lumpectomy and because radiation therapy can produce scar tissue—and both these factors can interrupt lymph flow.
What happens in PT. Specially trained physical therapists in the US use the same techniques to prevent and treat lymphedema as the Spanish researchers used. Many insurance policies cover PT—check with your carrier. Generally therapy includes…
Manual lymph drainage: This gentle massage technique moves lymph fluid away from areas that are swollen or at risk for swelling and into areas where it can drain normally. During the 45- to 60-minute massage, the therapist “presses no harder than she would on a newborn baby’s head,” said White. Caution: Deep-tissue massage must be avoided, as it can bring on lymphedema even years after surgery.
Scar tissue massage: Surgery and radiation can leave inflexible scars that inhibit lymph flow. Massage techniques using heavier pressure stretch and soften scar tissue.
Lymph drainage exercises: Specific exercises, done in sequence, help pump lymph fluid through the lymphatic pathways. A typical routine includes pelvic tilts, partial sit-ups, neck rotations, shoulder shrugs, elbow bends and wrist circles.
Self-care instruction: PT patients learn lymphedema-minimizing strategies for home use, including self-massage…exercises…abdominal breathing (which acts as a pump to stimulate lymph flow)…hydration, diet and weight control…infection avoidance…stress reduction…use of a compression garment (a special sleeve that limits lymph accumulation)…and application of elastic Kinesio tape, which lifts the skin to promote lymph flow.
Prevention policy problem. Given the Spanish study’s findings about PT’s effectiveness in preventing lymphedema, you would think that all breast cancer patients would get PT—but that’s not happening. “Ideally, patients would be referred for PT before or shortly after surgery…but doctors tend to send patients to PT only if signs of lymphedema occur,” White said.
Self-defense: Don’t wait for lymphedema to develop. Even if you show no signs of it after breast surgery, ask your doctor for a referral to a physical therapist with expertise in lymphedema…or find one through the National Lymphedema Network (800-541-3259, www.LymphNet.org).
If any symptoms do appear, alert your physician without delay. Unless treated promptly, lymphedema can worsen quickly and eventually become chronic. The area may not look swollen at first, so watch for warning signs—a sensation of fullness, heaviness, heat, numbness or “pins and needles” in the arm, hand, breast or side of the torso.