Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trialBMJ 2010; 340 doi: https://doi.org/10.1136/bmj.b5396 (Published 13 January 2010) Cite this as: BMJ 2010;340:b5396
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The study by Lacomba and colleagues (1) makes a substantial
contribution to the prevention of lymphoedema developing after axillary
lymph node dissection for breast cancer. Patients with lymphoedema
experience physical problems as well as psychosocial problems. It is a
phenomenon feared by many breast cancer patients. Research into
interventions that prevent its development should be encouraged. To our
knowledge, the only randomised controlled trial about the prevention of
lymphoedema is the study of Box et al (2). They concluded that patients
who followed a physiotherapy management care plan, consisting of exercises
and educational strategies, had a lower incidence rate for lymphoedema
(9%) than patients who did not receive any treatment (30%), although this
difference was not statistical significant.
The article of Lacomba et al (1) describes the positive results of an
early physiotherapy program in a large group of breast cancer patients
(N=120) followed up to one year after the axillary dissection. The
methodological quality of this study is high, achieving a PEDro score of
7/10. Blinding of therapists and patients was not possible and an
intention-to-treat analyse was not applied. Positive aspects of the design
are that a power calculation is performed and that both arms are measured
before the surgery.
The early physiotherapy program consisted of the combination of
manual lymph drainage and exercises. The study cannot answer whether
manual lymph drainage on the one hand and exercises on the other hand are
effective treatment modalities for the prevention of lymphoedema.
From this study we can conclude that an early physiotherapy program
consisting of manual lymph drainage and exercise and applied immediately
after the surgery during 3 weeks is effective for the prevention of
lymphoedema. Breast surgeons and gynaecological oncologists should be
aware of these results so that they can refer these patients to
In our current research, we hope to give an answer if manual lymph
drainage can prevent lymphoedema after axillary lymph node dissection for
(1) Lacomba MT, Sanchez MJY, Goni AZ, Merino DP, del Moral OM, Tellez
EC, Mogollon EM. Effectiveness of early physiotherapy to prevent
lymphoedema after surgery for breast cancer: randomised, single blinded,
clinical trial. BMJ 2010;340:b5396.
(2) Box R, Reul-Hirche H, Bullock-Saxton J, Furnival C. Physiotherapy
after breast cancer surgery: results of a randomised controlled study to
minimise lymphedema. Br Cancer Res Treat 2002;75:51-64.
Competing interests: No competing interests