Lymphoedema and Breast Cancer. A Physiotherapeutic Approach

Sammanfattning: Ten percent of the female population in Sweden will be diagnosed with breast cancer during their lifetime, but only a minority will die from the disease. Arm lymph oedema is a well-known complication following breast cancer treatment and the incidence varies between about 10% when axillary node dissection is performed and about 40% when axillary radiotherapy is added.

The general aim of this thesis was to identify risk factors and onset, evaluate treatments and explore, from a physiotherapeutic perspective, the experiences of patients with arm lymphoedema following breast cancer treatment.

Results revealed that patients treated with additional axillary radiotherapy were associated with early development of arm lymphoedema and reduced shoulder mobility that remained during a 2-year follow-up period. Shoulder muscle strength was reduced to all patients treated with axillary node dissection independent of radiotherapy treatment. Women treated for breast cancer with axillary node dissection, with or without adjuvant radiotherapy, can be recommended to maintain their level of occupational workload and physical activity without an added risk of developing arm lymphoedema. However, it is reasonable to assume that a higher body mass index increases the risk.

Two intervention studies showed that compression with low-stretch bandaging was the most effective short-time lymphoedema reducing treatment. Manual lymph drainage, a massage technique, also reduced the lymphoedema considerably. Manual lymph drainage, combined with compression bandaging, was more effective than compression bandaging alone. Sequential pneumatic compression also had a lymphoedema reducing effect and in comparison with manual lymph drainage, no difference between the treatments was found.

In a qualitative interview study, women with slight or moderate arm lymphoedema expressed their experiences, revealing problems with attitudes from people in the surroundings and problems with the chronic disease. The problems integrated in daily life were of low frequency but of considerable importance to the women. The women used both problem-focused and emotion-focused coping strategies. Thus, it is of importance that health care professionals are aware of and have knowledge about these problems. It is reasonable to believe, that he women's need to express their experiences, should be encouraged and efforts made to strengthen the women's coping skills.