Ridner, S.H., Poage-Hooper, E., Kanar, C., Doersam, J.K., Bond, S.M., & Dietrich, M.S. (2013). A pilot randomized trial evaluating low-level laser therapy as an alternative treatment to manual lymphatic drainage for breast cancer-related lymphedema. Oncology Nursing Forum, 40, 383–393. 

To examine the impact of advanced practice nurse (APN)-administered low-level laser therapy (LLLT) as a stand-alone and complementary treatment for arm volume, symptoms, and quality of life (QOL) in women with breast cancer–related lymphedema

Three interventions were used, including LLLT alone, manual lympatic drainage (MLD) alone, and combined MLD and LLLT. LLLT alone used a RianCorp LTU 904, FAD-approved, class I laser. Grids for the areas to be treated were identified. The laser was applied, and exposure was limited to 20–30 seconds per point in each grid. Time for each session using this procedure was about 20 minutes. MLD alone included treatment that followed international standards. A standard number of strokes was used at each anatomical location. Each MLD session took about 40 minutes. Combined MLD and LLLT included participants receiving 20 minutes of LLLT, followed by 20 minutes of MLD. In addition, compression bandaging was applied after each treatment regardless of group assignment. Baseline and outcome data were collected pretreatment and on the last day of treatment after therapy was concluded.

• N =  46   
• MEAN AGE = 66.6 years (SD = 10.4 years)
• MALES: 0%, FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Breast cancer survivors with treatment-related lymphedema
• OTHER KEY SAMPLE CHARACTERISTICS:  95.7% Caucasian

• SITE:  Single site 
• SETTING TYPE:  Other 
• LOCATION:  Private medical practice in Florida

• PHASE OF CARE: Late effects and survivorship

• A pilot, randomized clinical trial

• Extracellular fluid with bioelectrical impedance
• Arm volume with circumferential measurement
• Height and weight
• Skin assessment checklist
• Lymphedema Symptom Intensity and Distress Scale-Arm (LSIDS-A)
• Brief Fatigue Inventory (BFI)
• Profile of Mood States-Short Form (POMS)
• Center for Epidemiologic Studies-Depression (CES-D)
• Upper Limb Lymphedema-27 (ULL27)
• Functional Assessment of Cancer Therapy-Breast (FACT-B)

All groups had clinically and statistically significant reduction in volume (p < 0.05); however, no statistically significant between-group differences were found in volume reduction. Treatment-related improvements were noted in symptom burden within all groups; however, no group differences were noted in psychological and physical symptoms or QOL. Skin improvement was noted in each group that received LLLT.

LLLT with compression bandaging may offer a time-saving therapeutic option to conventional MLD.

• Small sample (< 100)
• Risk of bias (no blinding)
• Other limitations/explanation: The dose of each intervention varied by individual patient because current reimbursement does not cover lymphedema therapy once reduction has slowed or stopped.

The study demonstrates that a trained APN could implement lymphedema therapy in clinical practice. LLLT with bandaging may offer a time-saving therapeutic option to conventional MLD. Studies with a larger sample size are needed to compare MLD and LLLT.