Combined Decongestive Therapy for Lymphedema following Breast Cancer

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Lindsay Davey, Registered Physiotherapist and Clinic Director of Toronto Physiotherapy provides a brief overview of Lymphedema for breast cancer and the gold standard treatment, Combined Decongestive Therapy. The target audience for this presentation is the medical community. To learn more about lymphedema please visit http://www.torontophysiotherapy.ca/services/toronto_lymphedema_treatment.html

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Combined Decongestive Therapy for Lymphedema following Breast Cancer

  1. 1. LYMPHEDEMA FOLLOWING BREAST CANCER: EFFECTIVE TREATMENT BY COMBINED DECONGESTIVE THERAPY Lindsay Davey, MScPT, MSc, CDTRegistered Physiotherapist, Certified in Combined Decongestive Therapy Owner/Clinic Director of Toronto Physiotherapy
  2. 2. What is Lymphedema? Chronic condition Impaired drainage of lymphatic fluid secondary to surgery and/or radiation therapy to lymph nodes (axilla) Can lead to fibrosis, pain, paresthesia, infection Patients report decreased quality of life, function, self-image issues, anxiety (c) Toronto Physiotherapy 2012
  3. 3. Incidence and Risk Factors Ranges from 6 – 30% depending on  Method of detection  Length of follow-up  Surgical population Risk Factors:  Total mastectomy  Axillary lymph node dissection (ALND)  Tumour positive axillary lymph nodes  Axillary radiation after ALND  Post-operative complications (c) Toronto Physiotherapy 2012
  4. 4. Treatment of Lymphedema Gold Standard approach: Combined Decongestive Therapy*:  1. Manual Lymphatic Drainage Massage  2. Compression  3. Education  4. Exercise *ISL Consensus Document, Lymphology 2009:42; 51-60. (c) Toronto Physiotherapy 2012
  5. 5. 1. Manual Lymphatic Drainage Massage NOT the same as a typical massage Specific pressure Specific strokes Specific sequence Re-routes fluid to bypass deficient pathways where nodes have been removed/irradiated (c) Toronto Physiotherapy 2012
  6. 6. 2. Compression In limb volume reduction phase: short stretch bandages In maintenance phase: compression garment Assistive Devices Program covers 75% of cost of garments (c) Toronto Physiotherapy 2012
  7. 7. 3. Education The Do’s and Don’t’s about lymphedema management Skin care Scar management Self-massage / Self-bandaging (as necessary) (c) Toronto Physiotherapy 2012
  8. 8. 4. Exercise Strong evidence for the safety and benefits of exercise to decrease lymphedema risk* Individualized guidelines provided Functional exercise emphasized Program includes aerobic exercise AND low-load resistance training components *Schmitz K et al, JAMA 2010:304;2699-2705. (c) Toronto Physiotherapy 2012
  9. 9. Who Can Benefit From CDT? ALL post-operative breast cancer patients can benefit from CDT.  Acute onset / early stage lymphedema  Chronic / later stage lymphedema  Preventative: CDT decreases risk of lymphedema after ALND* *Lacomba M. et al, BMJ 2010:340;b5396. (c) Toronto Physiotherapy 2012
  10. 10. Summary Breast cancer survival rates increasing Lymphedema incidence as high as 30% Lymphedema associated with decreased quality of life 4 Pillars of CDT treatment approach CDT can help prevent lymphedema CDT effectively treats lymphedema All patients should consult a CDT therapist post-operatively (c) Toronto Physiotherapy 2012
  11. 11. Thank you! Lindsay Davey, MScPT, MSc, CDT www.TorontoPhysiotherapy.ca

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