A systematic review on the effects of manual lymphatic drainage in operated breast cancer patients with lymphoedema

Abstract

Background: Lymphoedema is one of the most disabling side effects in patients treated for breast cancer. Complex Decongestive Therapy (CDT) (incl. Manual Lymphatic Drainage (MLD), compression therapy, lymph-reducing exercises and skin care) is considered as the therapy of choice. The aim of this study was to evaluate whether MLD should be provided for operated breast cancer patients with lymphoedema. Methods: A systematic review to assess the effects, and womeńs preferences, of MLD in the treatment of breast cancer-related lymphoedema, following standard Cochrane Collaboration methods, was carried out. Systematic reviews and studies were searched until November 2015 from the following databases: The Cochrane Database of Systematic Review, DARE, MEDLINE, EMBASE, CINHAL, CAM and NHS EED. GRADE methodology was applied, and qualitative studies were evaluated using the CERQual approach. Results: For evaluation of effects, from 268 unique citations, five studies (three systematic reviews and two randomised controlled trials, 425 women) were included. None of the studies evaluated MLD as a stand-alone therapy. MLD improved by 7% the percentage of volume reduction when added to compression bandaging (moderate quality evidence). There were no significant differences in volumetric outcomes when adding MLD to CDT (moderate quality evidence), and no significant differences in pain reduction, quality of life, satisfaction with the services or adverse events when adding MLD to CDT or compression bandaging (low quality evidence). No significant differences were found in patient's body image and self-confidence, and maintenance of the working capacity (low quality evidence). From 347 unique citations on women's values and preferences, four studies were included. Women placed a relatively low value to the standard volumetric outcomes and valued more highly aesthetic and functional outcomes. The burden of MLD compared to compression therapy was not important (low confidence). Conclusions: MLD alone cannot be recommended in routine practice. Further research on MLD as part of CDT is recommended. Consideration of women's values and preferences is crucial while selecting outcomes for such studies.