Cost-Effective Physiotherapy Lymphedema-Management-Program in Tung Wah Hospital to Improve the Arm Lymphedema Complicated by Breast Cancer Operation with Lymph-Node Involvement

Abstract Description

Authors (including presenting author) :

Leung SY(1), Ho Gemma(1), Chau Abbey(1), Chan ML(1), Mo Frankie(1)

Affiliation :

(1)Physiotherapy Department, Tung Wah Hospital

Introduction :

Arm lymphedema, life-long incurable disease, is common after breast cancer operation with lymph-node involvement. Complete Decongestive Therapy is the International Gold Standard treatment including Phase I daily intensive treatment (Manual Lymph Drainage, Compression Bandaging, Remedial Exercise, Skin Care and Self-management training). When the progress plateaus, Phase II maintenance stage starts with an additional of pressure garment. Physiotherapy Lymphedema-Management-Program (LMP) has been established in Tung Wah Hospital since 2013. Over 100 new lymphedema cases are referred yearly. For better managing the growing demands with cost-effective therapy, LMP is emphasised on self-management training to patients rather than hand-on physiotherapy.

Objectives :

To evaluate the effectiveness of self-manage LMP for arm lymphedema patients post breast cancer operation involving lymph-node dissection.

Methodology :

Subjects were female having unilateral arm lymphedema post breast cancer operation with either sential lymph-node biopsy (SLNBx) or axillary dissection (AD). Outcome measures (1)Bio-impedance LDex (lymphedema index) (2)Affected arm circumference at Pre-treatment, completion of Phase I and Phase II were compared by using Wilcoxon Signed-ranks Test. LDex normal range is -10 to 10. The higher the index, the more severe the lymphedema.

Result & Outcome :

From 10/2016 to 7/2018, 43 patients were treated. They developed lymphedema with an average 56.8years after operation with an average 5.46.4 years of refractory lymphedema. They received an average 5.231.76 sessions LMP. At completion of Phase I(12.415 weeks), the arm showed significant decreased in swelling, LDex decreased from 45.831.8 to 28.422.0(p=0.000), circumference decreased from 118.711.3 to 110.722.3mm(p=0.002). Phase II showed no significant change in LDex(p=0.813), but circumference showed significantly increased from 110.722.3 to 113.420.8.3mm(p=0.002). It showed the stable condition after Phase I could barely be maintained at Phase II.
LMP is effective in improving the arm refractory lymphedema post breast cancer operation with lymph-node involvement. Phase I needed only about 5 follow-up sessions rather than 86.8 sessions(12.4 weeks) daily hand-on physiotherapy, net saving was $31,736/patient(hourly rate). For Phase II, more follow-up sessions is suggested.