Effect of Physiotherapy in the Prevention and Relief of Secondary Lymphoedema in Subjects with Postoperative Breast Cancer- A Systematic Review of Randomised Controlled Trials

Abstract

Introduction: Breast Cancer is the most common type of cancer in women and the 2nd leading cause of death. The treatment of breast cancer includes surgery, chemotherapy, radiation therapy, hormone therapy or combination of these treatments. One of the most important complications which occurs in one out of four women is lymphoedema. Physiotherapy plays an important role in creating awareness, prevention, early diagnosis and treatment of secondary lymphoedema. The systematic reviews which were already done focused on only one intervention or combination of two or more interventions for lymphoedema with or without other complication related to breast cancer. Aim: To systematically review the randomised controlled trials to evaluate the effect of various physiotherapy interventions that are used in the prevention and relief of secondary lymphoedema in postoperative breast cancer patients. Materials and Methods: Relevant studies were retrieved through PubMed, Cochrane, EMBASE and Google Scholar databases ranging from the year 2004 (January) to 2020 (March). The language of search was English. The keywords used for the search were breast cancer, interventions, physiotherapy, postoperative, secondary lymphoedema, treatment, prevention. Total 14 randomised controlled trials were included in this study according to the inclusion criteria. The trials included interventions like Manual Lymphatic Drainage (MLD), compression therapy, Range of Motion (ROM) exercises and massage. Results: A total of 244 relevant articles were found out of which 14 Randomised Controlled Trials (RCTs) were included in this study. MLD showed positive effects on lymphoedema prevention and treatment as an individual intervention or in combination with other interventions. Compression sleeves/corsets also showed positive effect on lymphoedema. Resistance exercises showed no risk of precipitating or increasing lymphoedema. Shoulder programs showed that delayed mobilisation of shoulder after one week is beneficial for reduction of lymphoedema. Physiotherapeutic stimulation showed positive effects on lymphoedema by increasing the lymphatic flow and velocity. Conclusion: Physiotherapy interventions like MLD, compression garments, stretching and strengthening, resistance exercises and ROM exercises have a potential effect in the treatment and prevention of secondary lymphoedema.