Early physiotherapy reduces breast surgery complications
MedWire News: Early physiotherapy, including massage and shoulder exercises, could help to prevent and reduce secondary lymphedema after breast surgery, study findings indicate.
Secondary lymphedema is the most significant chronic complication after dissection of the axillary lymph nodes, explain María Torres Lacomba (Alcala de Henares University, Madrid, Spain) and colleagues.
It affects 71% of women within 12 months of surgery, causing fluid retention and arm swelling as well as cosmetic disfigurement, anxiety, depression, and emotional distress in some cases.
Currently, women with breast cancer have a 77% probability of surviving at least 10 years, so effective prevention and management of complications that can impair function and quality of life after treatment are important, say the researchers.
Torres Lacomba and team set out to determine the effectiveness of early physiotherapy in reducing the risk for secondary lymphedema in 120 women who had undergone breast surgery involving dissection of axillary lymph nodes.
The researchers randomly assigned 60 patients to receive early physiotherapy and an educational strategy (intervention group) and 60 to receive the educational strategy only (control group). Both programs lasted 3 weeks and patients were followed-up regularly for 12 months.
Physiotherapy included manual lymph drainage, massage of scar tissue, and shoulder exercises by a physiotherapist. The educational strategy included materials about the lymphatic system, and advice on how to avoid injury and prevent infection.
Of the 116 women that completed the 1-year follow-up, 18 (16%) developed secondary lymphedema. The incidence was significantly lower in the intervention group, at 7% (four cases) compared with 25% (14 cases) in the control group.
A survival analysis also showed a significant difference, with secondary lymphedema being diagnosed four times earlier in the control group than in the intervention group.
“Early physiotherapy could be an effective intervention in the prevention of secondary lymphedema in women for at least 1 year after surgery for breast cancer involving dissection of axillary lymph nodes,” conclude Torres Lacomba and co-authors in the British Medical Journal.
They add: “Further studies are needed to clarify whether early physiotherapy after breast cancer surgery can remain effective in preventing secondary lymphedema in the longer term.”
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By Laura Dean