Szuba, A., Achalu, R., & Rockson, S.G. (2002). Decongestive lymphatic therapy for patients with breast carcinoma-associated lymphedema. Cancer, 95(11), 2260–2267.

To provide a prospective evaluation of pneumatic compression therapy in patients with breast cancer-related lymphedema

During phase I, adjunctive intermittent pneumatic compression (IPC) was assessed for its role as a component of the initial decongestive therapy with previously untreated lymphedema. Phase II was a prospective study to evaluate adjunctive benefit to IPC for maintenance. All patients received standard decongestive lymphatic therapy, which included MLD, compressive wrapping, and decongestive exercises. Each patient received 10 days of daily decongestive lymphatic therapy. The study group had IPC applied to the affected arm daily for 30 minutes, in addition to the treatment as noted previously.

• Patients were included in the study if they presented with lymphedema related to breast cancer, defined as greater than 20% in volume compared to the other arm.
• There was a 12-week interval between cancer treatment and enrollment to study.
• Patients were excluded from the study if there was evidence of bilateral disease, breast cancer recurrence, active clinical infection, or clinically evident venous occlusion.

The study took place at Stanford University in California.

The study used a randomized prospective design.

• Assessments of limb volume, tissue elasticity, and joint mobility were performed at enrollment and on days 10 and 40 of the study.
• Water displacement volumetry was used.
• Skin tonometry was used to determine tissue elasticity.
• Goniometry was used to assess shoulder, elbow, and wrist joints range of motion.
• Data analysis was done using both paired and unpaired t-tests and analysis of variance.

In phase I, 23 women were recruited; 12 patients were randomized to group receiving DLT and IPC, while 11 were randomized to the group receiving DLT alone. After two weeks of treatment, reduction in volume of edematous arm was 45.3% for group 1 and 26% for group 2 (p < 0.05). Both groups showed no sign of improvement in skin elasticity study pre- or post-treatment. Also, 48% of patients had objective evidence of impaired range of motion at baseline. After initial therapy, joint mobility improved uniformly (p < 0.011) between both groups. In phase II, 27 patients were recruited. During a month of self-administered treatment, there was a mean increase in volume of the treated limb in group 1 with DLT alone. During the month of therapy, which included self-administered DLT and IPC, there was a mean volume reduction (p < 0.05). Skin elasticity showed no difference between the groups. Data collected poststudy showed that 20 of the 25 patients elected to continue using the IPC. Measurements showed additional reduction of limb volume.

IPC, when used as an adjunct to the other established elements of DLT, provides an enhancement of the therapeutic response.

Initial cost of pneumatic pumps might limit applicability, but researchers noted that documented improvement of lymphedema may offset the cost of care.