Lima, M.T., Lima, J.G., de Andrade, M.F., & Bergmann, A. (2014). Low-level laser therapy in secondary lymphedema after breast cancer: Systematic review. Lasers in Medical Science, 29, 1289–1295. 

DOI Link

Purpose

STUDY PURPOSE: To discuss the treatment of breast cancer-related lymphedema with low-level laser therapy (LLLT), its usefulness, and safety

TYPE OF STUDY: General review/\"semi\" systematic review

Search Strategy

DATABASES USED: LILACS, MEDLINE, PEDro, PubMed, and SCIELO
 
INCLUSION CRITERIA: Studies published in Portuguese, Spanish, and English using individually and combined keywords; clinical trial (intervention) studies; women with breast cancer–related lymphedema (BCRL); studies that used LLLT as the treatment group intervention (no restriction used for control group); changes in limb volume or perometry pre- and postintervention used as the primary area of interest
 
EXCLUSION CRITERIA: Articles with quality scores less than 5 were excluded.

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 41
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: The PEDro scale was used, with a score greater than or equal to 5 representing high methodological quality. Of 41 articles, four were scored. Of the four studies, three achieved a score greater than or equal to 5. One study not scored using the Pedro scale was used, because it was considered to have high methodological quality. A total of four studies were included for review. No meta-analysis was done.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 4
  • TOTAL PATIENTS INCLUDED IN REVIEW = 149 (n = 75 treatment, n = 74 control)
  • SAMPLE RANGE ACROSS STUDIES: 12–66
  • KEY SAMPLE CHARACTERISTICS: All treatment groups received LLLT, and all subjects were breast cancer survivors with BCRL. Ages in both groups were similar, ranging from 45–63 years in the treatment group and 49–65 years in the control group. Baseline excess limb volumes were also similar between the treatment and control groups, although varied measures were used.

Phase of Care and Clinical Applications

PHASE OF CARE: Late effects and survivorship

Results

Three of four studies were able to show statistical significance in limb volume after treatment; however, follow-up times varied. Carati et al. reported a significance of 0.017 (89.7 ml versus 32.1 ml) three-months post-treatment, Kaviani et al. reported a greater reduction in all weeks except one (no statistical reference), Kozanoglu et al. reported a greater reduction with LLLT (p = 0.04 at post-treatment and p = 0.02 at 12 months), and Lau et al. reported a statistically significant reduction at four weeks post-treatment (448.2 to 320.9 ml, p = 0). Two studies reported significance in a decrease in tissue hardness. No improvement in subjective symptoms were reported (pain, range of motion [ROM], heaviness, grip strength); however, Lau et al. reported significantly decreased mean scores on the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire in the treatment group (p = 0.04) post-treatment, but they were not statistically significant at four weeks follow-up.

Conclusions

LLLT was reported a favorable intervention to reduce limb volume compared to pneumatic compression, no treatment, and placebo. All but one study reported statistical significance in limb volume reduction. Subjective lymphedema-related symptom differences were not significant in either group with the exception of the Lau et al. study, which reported a statistically significant increase in DASH scores post-treatment in the LLLT group. 
 
Reviewer conclusion: The variable methodologies in the studies reviewed prohibited uniformity of the results. Clinical trials using LLLT and complete decongestive therapy (CDT) with the same protocols and a second area of interest emphasizing safety are suggested. The length of follow-up is not long enough to encompass most often reported periods of onset.

Limitations

  • Limited search
  • Low sample sizes
  • Control group protocols, treatment protocols, and lymphedema assessment measures were dissimilar in all four studies.
  • Quality was assigned to articles; however, evidence levels were not assigned (the authors address this in the article).
  • Lack of operational definitions and comparison with standard therapy (CDT) were also limitations.

Nursing Implications

Nurses need to be knowledgeable of clinical trials involving LLLT and stay current with lymphedema management, as well as educate patients on LLLT.

Legacy ID

6131