title: Manual lymph drainage when added to advice and exercise may not be effective in preventing lymphoedema after surgery for breast cancer.
abstract: Summary of: Devoogdt N et al (2011) Effect of manual lymph drainage in addition to guidelines and exercise therapy on arm lymphoedema related to breast cancer: randomized controlled trial. BMJ 343: d5326. [Prepared by Nicholas Taylor, CAP Editor.]
  
  
  OBJECTIVE
  Does manual lymph drainage prevent lymphoedema in patients who have had surgery for breast cancer?.
  
  
  METHODS
  Randomised, controlled trial with concealed allocation and blinded outcome assessment.
  
  
  METHODS
  A multidisciplinary breast centre of a tertiary hospital in Belgium.
  
  
  METHODS
  Patients were eligible to be included if they received unilateral surgery with axillary node dissection for breast cancer, and agreed to participate. Randomisation of 160 participants allocated 79 to the intervention group and 81 to a control group.
  
  
  METHODS
  Both groups received guidelines about the prevention of lymphoedema in the form of a brochure, and exercise therapy involving supervised individualised 30 minute sessions - initially twice a week, reducing to once fortnightly as patients progressed. Participants in both groups were also asked to perform exercises at home twice/day. In addition, the intervention group received 40 sessions of manual lymph drainage over 20 weeks with each session lasting 30 minutes and performed by trained therapists.
  
  
  METHODS
  The primary outcomes were the cumulative incidence of and the time to develop arm lymphoedema (defined as a 200 ml increase) as measured with the water displacement method with measures taken at baseline and 1, 3, 6, and 12 months after surgery. Secondary outcome measures were lymphoedema measured with the arm circumference method, health-related quality of life using the SF-36 scale, and a patient reported questionnaire to score the presence of subjective arm lymphoedema.
  
  
  RESULTS
  154 participants (96%) completed the study at 12 months. At 12 months the incidence of lymphoedema in the intervention group (n=18, 24%) was similar to the incidence of lymphoedema in the control group (n = 15, 19%, OR 1.3, 95% CI 0.6 to 2.4); also there was no difference in incidence at 3 or 6 months. There was no difference between the groups in the time taken to develop lymphoedema, and no difference between the groups in any secondary outcome measure.
  
  
  CONCLUSIONS
  The application of manual lymph drainage after axillary node dissection for breast cancer in addition to providing guidelines and exercise therapy did not prevent lymphoedema in the first year after surgery.
authors.affiliation: Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia.
authors.forename: Hildegard
authors.initials: H
authors.lastname: Reul-Hirche