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Role of physiotherapy and patient education in lymphedema control following breast cancer surgery

Authors Lu S, Hong R, Chou W, Hsiao P

Received 17 November 2014

Accepted for publication 4 January 2015

Published 25 February 2015 Volume 2015:11 Pages 319—327

DOI https://doi.org/10.2147/TCRM.S77669

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 4

Editor who approved publication: Professor Garry Walsh


Shiang-Ru Lu,1 Rong-Bin Hong,2 Willy Chou,3,4 Pei-Chi Hsiao3,4

1Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 2Departments of Physical Medicine and Rehabilitation, Chi-Mei Medical Center Liouying Campus, Tainan, Taiwan; 3Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, Tainan, Taiwan; 4Department of Recreation and Health Care Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan

Introduction: This retrospective cohort study evaluated whether education in combination with physiotherapy can reduce the risk of breast cancer-related lymphedema (BCRL).
Methods: We analyzed 1,217 women diagnosed with unilateral breast cancer between January 2007 and December 2011 who underwent tumor resection and axillary lymph node dissection. The patients were divided into three groups: Group A (n=415), who received neither education nor physiotherapy postsurgery; Group B (n=672), who received an educational program on BCRL between Days 0 and 7 postsurgery; and Group C (n=130), who received an educational program on BCRL between Days 0 and 7 postsurgery, followed by a physiotherapy program. All patients were monitored until October 2013 to determine whether BCRL developed. BCRL risk factors were evaluated using Cox proportional hazards models.
Results: During the follow-up, 188 patients (15.4%) developed lymphedema, including 77 (18.6%) in Group A, 101 (15.0%) in Group B, and 10 (7.7%) in Group C (P=0.010). The median period from surgery to lymphedema was 0.54 years (interquartile range =0.18–1.78). The independent risk factors for BCRL included positive axillary lymph node invasion, a higher (>20) number of dissected axillary lymph nodes, and having undergone radiation therapy, whereas receiving an educational program followed by physiotherapy was a protective factor against BCRL (hazard ratio =0.35, 95% confidence interval =0.18–0.67, P=0.002).
Conclusion: Patient education that begins within the first week postsurgery and is followed by physiotherapy is effective in reducing the risk of BCRL in women with breast cancer.

Keywords: breast cancer, lymphedema, physical therapy, education


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