A Pilot Randomized Trial Evaluating Low-Level Laser Therapy as an Alternative Treatment to Manual Lymphatic Drainage for Breast Cancer-Related Lymphedema

Abstract

Purpose/Objectives To examine the impact of advanced practice nurse (APN) administered low level laser therapy (LLLT) as both a stand-alone and complementary treatment for arm volume, symptoms, and quality of life (QOL) in women with breast cancer related lymphedema. Design A three-group, pilot, randomized clinical trial. Setting A private rehabilitation practice with two locations in the southwestern United States. Sample 46 breast cancer survivors with treatment related lymphedema. Methods Patients were screened for eligibility and then randomized to either manual lymphatic drainage (MLD) for 40 minutes, LLLT for 20 minutes, or, 20 minutes of MLD followed by 20 minutes of LLLT. Compression bandaging was applied after each treatment. Data were collected pre-treatment, daily, weekly, and at the end of treatment. Main Research Variables Independent variables consisted of three types of APN administered lymphedema treatment. Outcome variables included limb volume, extracellular fluid, psychological and physical symptoms, and QOL. Findings No statistically significant between group differences were found in volume reduction; however, all groups had clinically and statistically significant reduction in volume. No group differences were noted in psychological and physical symptoms, or QOL; however, treatment related improvements were noted in symptom burden within all groups. Skin improvement was noted in each group that received LLLT. Conclusions LLLT with bandaging may offer a time saving therapeutic option to conventional MLD. Alternatively compression bandaging alone could account for the demonstrated volume reduction. Implications for Nursing APNs can effectively treat lymphedema. APNs in private healthcare practices can serve as valuable research collaborators.

The use of low-level light therapy in supportive care for patients with breast cancer: review of the literature

“…The proposed underlying mechanism is that LLLT increases the lymphatic drainage by stimulating the formation of new lymph vessels, by improving the lymphatic motricity, and by preventing the formation of fibrotic tissue [33][34][35][36].…”

Review of Current Surgical Treatments for Lymphedema

“…Adjunct treatment modalities such as the use of low-level topical lasers and/or mechanical compression pumps also have been used. 17,18 High treatment costs, variability in the quality of therapy and compression garments, lack of adequate insurance coverage, and delayed diagnosis often hinder prompt access to sufficient treatment. 19,20 Patients may develop chronic pain, anxiety, or depression as well as difficulties with range of motion, gait, activities of daily living, stress on their joints, and fitting into normal clothing.…”

The effects of complete decongestive therapy on the extent of secondary lymphoedema in women after breast cancer treatment

“…Obecnie to jedno z najpoważniejszych następstw leczenia nowotworów złośli-wych [1]. Wtórny obrzęk chłonny występuje średnio u 40% kobiet leczonych z powodu raka piersi (w grupie tej znajdują się także kobiety, u których wykonano biopsję węzła wartownika) [2][3][4] i nie stanowi jedynie problemu estetycznego, ale wpływa na zdrowie [1,5]. Wraz z progresją obrzęku chłonnego spada podatność tkanki podskórnej na rozciąganie.…”

“…It currently ranks among the most serious complications of malignant cancer treatment [1]. On average, secondary lymphoedema develops in around 40% of women who received breast cancer treatment (the group includes women who underwent a biopsy of the sentinel lymph node) [2][3][4] and it is more than just an aesthetic issue, as it has serious consequences for the health [1,5]. As the lymphoedema progresses, the capacity of the subcutaneous tissue to extend is dropping.…”