Completed Studies
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“Breast Cancer Related Lymphedema – The Flexitouch System as an Adjuvant to Maintenance Therapy”
Authors: Sandra G. Terrazas, PT, CWS, CLT-LANA
Abstract: It is estimated that as many as 35 percent of breast cancer survivors will develop arm lymphedema as a result of axillary dissection or nodal radiation therapy for treatment of their breast cancer. Lymphedema can develop anytime, even several years after the damage to the lymphatic system occurred. Lymphedema can be treated and controlled, but not cured. If left untreated or poorly treated, lymphedema will progress and chronic inflammatory changes such as fibrosis and skin breakdown can occur. Recurrent infections and wounds that are difficult to treat may also develop. Lymphedema is usually treated with complete decongestive therapy (CDT). The components of CDT are manual lymphatic drainage (MLD), multilayered compression bandaging, exercise to promote lymph drainage, and skin care. Patients are instructed in the techniques of self-MLD for long-term home management of breast cancer related lymphedema. Self MLD is a difficult regimen for breast cancer survivors as they may have limited range of motion on their affected side, making them unable to reach areas that should be treated. In addition, the techniques of MLD are precise and may be difficult to successfully master. The Flexitouch system is a replacement for MLD in the home and is intended to extend the benefits of in-clinic MLD to the home as part of continued lymphedema therapy maintenance. As with MLD, preparation therapy initiates at the trunk via specially designed trunk and chest garments. Therapy then progresses to a drainage phase with an emphasis on the affected limb as well as the chest and trunk.
This eight week study was intended to demonstrate the use of the Flexitouch system as an adjuvant for long-term home management of breast cancer related lymphedema. In this study, two patients were monitored weekly for eight weeks after initiating twice daily use of the Flexitouch system. Outcomes evaluated included limb volume changes and clinical observation of skin integrity. In addition, functional status and dexterity were measured by evaluating fine motor movements. The effectiveness of this device as an adjuvant to maintenance home therapy is demonstrated in two patients. One patient maintained the limb girth similar to in-clinic therapy. Also, skin fibrosis was reduced and dexterity and fine motor skill improved resulting in a significant quality of life gain. The patient was able to return to some activities that had been stopped due to limitations in motion and dexterity. The second patient also demonstrated significant gains in limb volume reduction, and improvements in fibrosis, limb function, and dexterity. This subject also reported improved ability to perform her job. Unfortunately, the treatment was interrupted for four days by a bout of cellulitis. The infection was not attributable to use of the device. While the interruption likely affected continued progress, after reinstituting treatment, limb measurements returned to baseline by the end of week eight. In conclusion, patients’ lymphedema was controlled, their symptoms alleviated, and their quality of life improved following use of the Flexitouch system. These outcomes demonstrate that the Flexitouch system should be considered as part of home management for lymphedema patients.