Decongestive lymphatic therapy for patients with cancer-related or primary lymphedema

PURPOSE: A prospective evaluation was undertaken to assess the efficacy of intensive, short-term decongestive lymphatic therapy coupled with focused patient instruction in long-term self-care for the management of lymphedema. METHODS: The therapeutic responses of 79 patients with lymphedema were analyzed prospectively. Each patient received intensive, short-term decongestive lymphatic therapy, with quantification of the extent and durability of the clinical response. Decongestive lymphatic therapy was performed by therapists trained in these techniques. The mean (+/- SD) duration of therapy was 8 +/- 3 days. Instruction in self-management techniques was incorporated into the therapeutic regimen by day 3 of the patient's treatment. The mean period of follow-up was 38 +/- 52 days. Changes in the volume of the affected limb were assessed with a geometric approximation derived from serial measurements of circumference along the axis of the limb. RESULTS: The mean short-term reduction in limb volume was 44% +/- 62% of the excess volume in the upper extremities and 42% +/- 40% in the lower extremities. At follow-up, these results were adequately sustained: mean long-term excess volume reductions of 38% +/- 56% (upper extremities) and 41% +/- 27% (lower extremities) were observed. CONCLUSION: Decongestive lymphatic therapy, combined with long-term self-management, is efficacious in treating patients with lymphedema of the extremity. Am J Med. 2000; 109:296-300. (C) 2000 by Excerpta Medica, Inc.