Acupuncture: Could an ancient therapy be the latest advance in the treatment of lymphedema?

Abstract

The BackgroundOne of the most common complications of breast cancer treatment is lymphedema, an incurable condition that affects the lives of approximately 800,000 US breast cancer survivors.1,2 If not detected early and treated, clinical signs and symptoms can develop from the accumulation of lymphatic fluid in the tissues of the affected arm and remaining breast quadrant. Although established therapies for lymphedema management exist, there remains a need for other modalities that can further improve outcomes. Preliminary reports suggest that acupuncture may be a promising adjunctive therapeutic option. Defining the ProblemIn oncology, the most common cause of lymphedema (LE) is the impaired or disrupted flow of lymph fluid through the draining lymphatic vessels and lymph nodes, usually a consequence of surgery and/or radiation therapy to these tissues. Ultimately, this can lead to an accumulation of lymph fluid in the interstitial tissue, causing swelling. If LE remains untreated, this protein-rich fluid can continue to accumulate, leading to further swelling and fibrosis in the affected tissues. In this chronic state, there can be loss of limb function and range of motion, as well as an increased risk of pain, paresthesias, and infections. Although breast cancer-related lymphedema (BCRL) is responsible for the majority of the cases of LE after cancer treatment, LE can also result from treatment of other cancers (ie, cervical, endometrial, vulvar, head and neck, and prostate cancers, sarcomas, melanomas, etc.)The main risk factor for the development of LE is the extent to which the lymphatics are disturbed. For example, patients treated for breast cancer with both surgery and radiation therapy to the axilla have a risk of BCRL as high as 50%. In contrast, those who undergo only surgery to the axilla (without axillary radiation) have a risk of BCRL of 5%-20% depending on the technique (ie, sentinel lymph node biopsy, axillary lymph node dissection). 2Other risk factors have also been associated with BCRL, including infection, trauma, chemotherapy, hormonal therapy, obesity and larger breast size, and tumor location in the upper outer quadrant of the breast. 3It is important for patients, caregivers, and health care providers to recognize that BCRL can present at any time after treatment for breast cancer and to be aware of the signs and symptoms. Preventing the progression of BCRL is possible with continuous monitoring and early detection techniques and minimizing the risk factors for exacerbating LE.Unfortunately, there are no curative treatments for lymphedema yet available. 2,4 The goal of all LE treatments is to reduce the volume of excess interstitial lymph fluid as much as possible and maintain the limb at its smallest size. The existing treatments for LE become increasingly less effective in reducing limb swelling in later stages because as the condition progresses, fibrosis and adipose tissue permanently replace the excess interstitial lymph fluid. Diagnosing BCRLThe National Lymphedema Network (NLN) m...

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