Martin, M.L., Hernandez, M.A., Avendano, C., Rodriguez, F., & Martinez, H. (2011). Manual lymphatic drainage therapy in patients with breast cancer related lymphoedema. BMC Cancer, 11, 94.

To determine the effectiveness of manual lymph drainage (MLD) in reducing lymphedema in patients with breast cancer

Participants were randomly assigned to a control group and an experimental group. The control group received standard lymphedema treatment as well as a month of ambulatory treatment, daily bandaging from hand to shoulder for the first four weeks (removed at night), compression garments, and patient education regarding prevention guidelines and exercises to perform at home. The experimental group received the standard treatment plus MLD. MLD was performed before the bandaging occurred.

• The study sample (N = 58) was comprised of White female patients with breast cancer who had ipsilateral axillary lymphedema.
• Al patients
  • Had prior mastectomy, tumerectomy, or quadrantectomy and axillary lymphadenectomy
  • Finished radiotherapy or chemotherapy six months prior to study
  • Did not have rehab within three months prior to recruitment.

The study took place at a rehabilitation facility in Brazil.

Patients were undergoing active lymphedema treatment.

The study used a randomized controlled trial design.

• The measurement used to determine the effectiveness of MLD was the percentage of volume reduction after treatment using the water-displacement method.
• The investigators defined a good response to treatment as a 20% or more reduction in volume of the effected extremity.
• Measurements were taken at baseline and one, three, and six months.
• Patients also took a quality-of-life questionnaire for cancer in general and for breast cancer.

At 12 months the incidence of lymphedema in the intervention group was very similar to the control group: 24% and 19%, respectively. This difference is not considered statistically significant. There were no incidence differences at three and six months. There was also no difference in the time taken to develop lymphedema, secondary outcome measures of arm circumference, health-related quality of life, and patient reports.

Because of the lack of statistically significant changes in lymphedema incidence between control and intervention groups, it can be concluded that MLD is not effective in preventing lymphedema in the first year post-operatively in patients with breast cancer.

The study had a small sample size, with less than 100 participants.

The study indicates that MLD does not provide a statistically significant improvement in limb volume in patients with lymphedema. One of the greatest limitations of the study is the sample size. If the results of a repeated randomized controlled trial with a larger sample size yields similar results, MLD should not be taught to lymphedema patients because studies suggest it is unnecessary and ineffective.