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 56.8years after operation with an average 5.46.4 years of refractory lymphedema. They received an average 5.231.76 sessions LMP. At completion of Phase I(12.415 weeks), the arm showed significant decreased in swelling, LDex decreased from 45.831.8 to 28.422.0(p=0.000), circumference decreased from 118.711.3 to 110.722.3mm(p=0.002). Phase II showed no significant change in LDex(p=0.813), but circumference showed significantly increased from 110.722.3 to 113.420.8.3mm(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.