Role of physiotherapy and patient education in lymphedema control following breast cancer surgery

Abstract

Introduction

This retrospective cohort study evaluated whether education in combination with physiotherapy can reduce the risk of breast cancer-related lymphedema (BCRL).

Methods

We analyzed 1,217 women diagnosed with unilateral breast cancer between January 2007 and December 2011 who underwent tumor resection and axillary lymph node dissection. The patients were divided into three groups: Group A (n=415), who received neither education nor physiotherapy postsurgery; Group B (n=672), who received an educational program on BCRL between Days 0 and 7 postsurgery; and Group C (n=130), who received an educational program on BCRL between Days 0 and 7 postsurgery, followed by a physiotherapy program. All patients were monitored until October 2013 to determine whether BCRL developed. BCRL risk factors were evaluated using Cox proportional hazards models.

Results

During the follow-up, 188 patients (15.4%) developed lymphedema, including 77 (18.6%) in Group A, 101 (15.0%) in Group B, and 10 (7.7%) in Group C (P=0.010). The median period from surgery to lymphedema was 0.54 years (interquartile range =0.18–1.78). The independent risk factors for BCRL included positive axillary lymph node invasion, a higher (>20) number of dissected axillary lymph nodes, and having undergone radiation therapy, whereas receiving an educational program followed by physiotherapy was a protective factor against BCRL (hazard ratio =0.35, 95% confidence interval =0.18–0.67, P=0.002).

Conclusion

Patient education that begins within the first week postsurgery and is followed by physiotherapy is effective in reducing the risk of BCRL in women with breast cancer.

Keywords:

• breast cancer
• lymphedema
• physical therapy
• education

Supplementary material

Table S1 Physiotherapy program

Disclosure

The authors have no financial relationships to disclose with regard to this study. The authors report no conflicts of interest in this work.