Vignes, S., Porcher, R., Arrault, M., & Dupuy, A. (2007). Long-term management of breast cancer-related lymphedema after intensive decongestive physiotherapy. Breast Cancer Research and Treatment, 101(3), 285–290.

Patients were followed for 12 months. Lymphedema volume was recorded prior to and at the end of intensive treatment and at 6- and 12-month follow-up visits. Multivariate models analyzed the role of three components of complete decongestive therapy (CDT): manual lymph drainage (MLD), low-stretch bandage, and elastic sleeve on lymphedema volume during one-year maintenance (after intensive CDT). Lymphedema treatment was managed with an 11-day hospital stay for intensive therapy. The second maintenance phase was carried out by the patient and family at home. At the hospital, patient education on implementing self-management was an important goal. Patients and families were taught the self-bandaging technique throughout the intensive phase.

• The sample (N = 537) was comprised of patients with secondary arm lymphedema who were recruited in a single lymphology unit.
• Four hundred and twenty-six patients presented at 6-month follow up and 356 patients at 12 months.
• The final study sample was 426 female patients referred to the center dedicated to lymphedema management from January 2001 to December 2004.
• Patients were excluded from the study if they had a past history of lymph reduction by any method.

The study used a prospective cohort design.

• Lymphedema volume was calculated for each 5 cm segment by truncated cone formula.
• Lymphedema was defined as the difference between the lymphedematous limb and the healthy limb.
• Upper-limb volumes were measured by the same operator at each of the four measurements.
• Included at each ffollow-up visit was a recording of treatments applied, including MLD, self-bandages and the number per week, and elastic sleeve.
• Breast cancer stage and treatment (age at cancer diagnosis, mastectomy and lumpectomy, radiotherapy, chemotherapy, and anti-estrogens), complications, patient characteristics, body mass index, date of onset of lymphedema, and lymphedema volume at inclusion were also recorded.

• Data collection was lost for 2 patients and 24 died during follow up.
• Mean volume of lymphedema was 1054 +/- 633 ml prior to and 647 +/- 351 after intensive decongestive physiotherapy.
• During the one-year maintenance phase therapy, the mean lymphedema volume increased by 84 ml.
• Increased volume of more than 10% was experienced by 52% of patients.
• Noncompliance to low-stretch bandage and elastic sleeve were risk factors for increased lymphedema after one year of maintenance treatment (p < 0.0001 and p = 0.002).
• Non-compliance to MLD was not a risk factor (p = 0.91).
• Multivariable covariance analysis model for the use of low-stretch self-bandages allowed a 99 ml additional volume reduction during maintenance therapy, compared to no use of bandages.
• Use of an elastic sleeve allowed for a 118 ml additional volume reduction during maintenance therapy, compared to no use of elastic sleeve.
• Effects of self-bandages and an elastic sleeve were independent from each other (p = 0.49) or interaction. The effects did not depend on the magnitude of lymphedema volume.
• During the maintenance phase, compliance to the use of an elastic sleeve and low-stretch bandage should be encouraged to stabilize lymphedema volume.
• MLD did not have an additional independent effect on post-treatment lymphedema.

Researchers concluded that bandages and an elastic sleeve are significant factors for maintenance if the sleeve is worn daily and self -bandages are worn nightly three times per week.

• Interventions were not randomized so there is no control and confounding factors cannot be identified.
• A large number of patients was lost at 12-month follow up.
• Assessment of compliance not very accurate and only full compliance was noted.
• Study did not define maintenance MLD.