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


CONCLUSIONS
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.
Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Shiang-Ru
SR
Lu
Departments of Physical Medicine and Rehabilitation, Chi-Mei Medical Center Liouying Campus, Tainan, Taiwan.
Rong-Bin
RB
Hong
Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, Tainan, Taiwan ; Department of Recreation and Health Care Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
Willy
W
Chou
Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, Tainan, Taiwan ; Department of Recreation and Health Care Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
Pei-Chi
PC
Hsiao
breast cancer; education; lymphedema; physical therapy