Authors' objectives:

This review aims to assess in treating arm lymphedema, to what extent manual lymph drainage combined with compression following breast cancer treatment yields better results than compression therapy alone.

Authors' results and conclusions: Three relatively small randomized controlled trials (RCT) have studied manual lymph drainage combined with compression treatment for arm lymphedema. In each of these studies, edema volume and symptoms decreased in both the study and control groups. Two of the studies, in followup directly after they ended, showed statistically significant differences in the reduction of edema and symptom that favored the group on combined treatment with manual lymph drainage. The third study, however, did not show a statistically significant difference between the groups, neither in reduced edema nor in reduced symptoms. Furthermore, the results from several case studies (including over 400 patients) clearly show that treatment with compression bandaging and manual lymph drainage had a volume-reducing effect. The design of these studies, however, does not offer the possibility to investigate the extent to which combined treatment with manual lymph drainage contributed to the reduction in lymphedema. A few patients with various types of tissue-related pain may find it difficult to tolerate the discomfort associated with compression therapy. Combined treatment with manual lymph drainage has not been shown to cause additional complications.

Authors' recommendations: Some evidence suggests that treatment involving a combination of compression therapy and manual lymph drainage yields reduced edema volume compared to compression therapy alone if volume is measured directly after the conclusion of manual lymph drainage (Evidence grade 3). There is no evidence to show that this effect is permanent. Further randomized controlled trials of sufficient size should be conducted - where treatment effects could be studied more closely in both the short and long term - before a combination of compression therapy and manual lymph drainage can be recommended. Future studies should give particular consideration to the magnitude of lymphedema since some studies suggest that early treatment for minor lymphedema may have greater effects and permanent results. Furthermore, the costs for combined therapy should be calculated and studied in relation to the potential health benefits for patients.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.sbu.se/Published

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Sweden

Organisation Name: Swedish Agency for Health Technology Assessment and Assessment of Social Services

Contact Address: P.O. Box 3657, SE-103 59 Stockholm, Sweden. Tel: +46 8 4123200, Fax: +46 8 4113260

Contact Name: registrator@sbu.se

Contact Email: registrator@sbu.se

Copyright: Swedish Council on Technology Assessment in Health Care (SBU)