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
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
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]