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PROSPECTIVE SURVEILLANCE, EARLY DIAGNOSIS AND TREATMENT OF PATIENTS AT RISK
KARIN JOHANSSON 1, KATARINA KARLSSON 2, POLYMNIA NIKOLAIDIS 3
1 Department of Health Sciences, Lund University, Lund, Sweden
2 Lymphedema Unit, Department of Cancer Rehabilitation, Skåne University Hospital, Lund 3 Department of Cancer Rehabilitation, Karolinska University Hospital, Stockholm, Sweden
Introduction: Highest risk for development of arm lymphedema (AL) occur among breast cancer patients treated with both axillary surgery and radiotherapy. Scanning of these patients 1 month after surgery and again 4 months after RT for early diagnosis and compression treatment has proven effective to maintain AL at a minimum in a 10-year follow-up and 80% of the patients never exceeded lymphedema relative volume(LRV) 10% (Johansson, 2010). A hypothesis was generated that slight AL could be treated only with self-care and no compression.
Methods: Slight AL was defined as (LRV)5-8% using water displacement method (WDM) and/or TDC ratio>1.45 for upper arm and >1.3 for forearm using MoisterMeterD. Fifty-nine patients have been included, randomized to either no compression treatment (NCT, n=29) or daily treatment with standard compression sleeve ccl 1 (CT, n=30). Follow-up are made after 1, 2, 3, 6, 9 and 12 months.
Results: 29% were diagnosed with both WDM and TDC, 27% with only WDM and 44% with only TDC. The mean LRV for diagnosis by WDM was 6.3±0,8% and mean TDC ratio for upper arm was 1.66±0.2 and forearm 1.53±0.2. Forty-eight patients have passed 6 months follow-up. In the CT group (n=23) LRV has not increased in any patient. In the NCT group (n=25) there has been an increase of ≥2%LRV in 14 who therefore have started CT, but 11(44%) have no increase of LRV.
Conclusion: Preliminary results indicate that when early diagnosed, AL can be effectively treated by compression garment but is only needed for about half of the patients when LRV is ≤8% at diagnosis.
LYMPHEDEMA AND SPORT - AN OVERVIEW OF THE LITERATURE
ST. WAGNER
Professor Winiwater recommended 1892 in his first publication for the treatment of lymphedema exercising as one of the four important points of treatment, as it is recommend until today. But the question remains: are sport and gymnastic that save and beneficial to the extremities of patients with lymphedema as we think? Does it really not harm the patients? Thinking about the physiology of the lymphedema we have to consider the following points: stimulation of the circulation by physical training raises the filtration volume including the lymphatic volume, which may burden the lymphatic system additionally.
> There are many studies of lymphedema, mainly concerning the upper extremities, as it is shown by a review of the literature between 2000 and 2017. The main question of all these studies is not if there is an additional advantage to the lymphedema extremity, but do we not harm to the involved extremity ?
> All studies dealing with physical training and lymphedema of the upper extremities show that they are not harmful, even when started soon after surgery or activities like heavy weights lifting. No study shows a worsening of the lymphedemavolume. Only exercise such as Nordic Walking with walking poles and compressing stockings are showing a decreasing lymphedema volume.
> There are only a few studies investigating the effect of sport or special strength training of the lower extremities with lymphedema. All these studies show no worsening of the lymphedema by physical trainings. In summery patients in good health but suffering from lymphedema have under physical training a significant better health- related quality of life. This is one of the main reasons to motivate those patients to take part in sport and or physical training.
> From the physiological point of view, physical activities in water should be ideal for those patients. But there are only two studies dealing with physical activities in water with controversial results.
> In summery, all these studies show that physical training, even with heavy weights don`t worsen the lymphatic edemas of the affected extremities. Exercise like Nordic Walking with walking poles seems to have a positive effect on a decreasing lymphedema volume in theupper extremities. Sport in all those cases should be recommended for a better mood and health- related quality of life.
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THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXIX - Nr. 76 - 2017