Preventing lymphedema with The Optimal Lymph Flow program

This paper studies a lymphedema risk reduction program entitled "The Optimal Lymph Flow".

Many breast cancer survivors are at risk of developing lymphedema (build up of fluid that causes swelling in the affected limb) after surgery. A higher body mass index (BMI) also increases the risk for lymphedema. Patients can be educated on lifestyle behaviors to reduce their risk, but there is insufficient evidence that these behaviors work.

The authors evaluated a patient lymphedema risk-reduction program called "The Optimal Lymph Flow" which promotes lymph flow and optimizes BMI. This program teaches patients to do muscle exercises (such as shoulder mobility exercises, muscle tightening, breathing and muscle pumping) and provides dietary information (including encouraging more vegetables and fruits and controlling portion sizes) in order to reduce the risk of lymphedema.

134 women who were over 21 years, had first time diagnosis of breast cancer and were scheduled for surgical treatment were included in the study. The women were divided into 2 groups: 81 axillary lymph node dissection patients (surgery to remove lymph nodes in the armpit) and 59 sentinel lymph node biopsy patients (surgery to remove and examine under the microscope lymph tissue from the first lymph node to which cancer is likely to spread). 

Limb volume (extent of fluid in limb) and BMI data were collected at presurgery, 2-4 weeks, 6 months and 12 months after surgery. Patients were asked about their perception of safety, feasibility (easiness or convenience) and acceptability of the program.  Patients with lymphedema (defined as a limb volume increase by 10% or more) during treatment were referred to lymphedema therapy. This usually consisted of complete decongestive therapy (including bandaging, compression garments and manual lymphatic drainage).

 3% of the sentinel lymph node biopsy group had 10% limb volume increase at 2-4 weeks and 2% of axillary lymph node dissection group had a 10% increase at 6 months. By the 12 month, limb volume in each of these patients had decreased to less than 5%.

8.5% of all patients had a limb volume increase between 5%-10% at 6 months that decreased to less than 5% at 12 months. No patients in the study had a more than 10% increase in limb volume at 12 months.

Patients' BMI did not change significantly over the 12-months. Patients did not report injury or discomfort due to the program. More than 90% of patients felt the program reduced their anxiety of developing lymphedema.

The authors concluded that The Optimal Lymph Flow program is an effective, practical, and low-cost method that patients find safe, acceptable and feasible.

This was a pilot study and therefore does not carry the same weight as a randomized-controlled study.

Discuss with your doctor methods for reducing lymphedema risk following breast cancer surgery.