Hamner, J.B., & Fleming, M.D. (2007). Lymphedema therapy reduces the volume of edema and pain in patients with breast cancer. Annals of Surgical Oncology, 14(6), 1904–1908.

The data analysis included medical records of 119 patients with lymphedema secondary to breast cancer who were receiving a protocol of complete decongestive therapy (CDT), including manual lymph drainage (MLD), compression bandages, skin care, and exercise. MLD was performed twice weekly by a physical or occupational therapist trained in the Foldi method of lymphatic decongestion. Between sessions, patients wore elastic compression bandages, changed twice daily. Patients were instructed in skin and nail care. Therapy was divided into two phases: induction and maintenance. During the eight-week induction phase, the intervention was performed twice weekly. The maintenance phase was individualized to patient needs. Absolute volume and percentage of volume of lymphedema were compared before and after treatment. The degree of chronic pain and the need for pain medication also were assessed. Using medical records, data were collected for all patients receiving CDT for lymphedema.

Only those with unilateral lymphedema of the upper extremity that resulted from the treatment of breast cancer were included.

The study used a retrospective design.

• Pain was measured on a 1–10 scale.
• Water displacement was used to measure volume.

• Mean initial arm volume was 709 ml, and the percentage of lymph was 31%; the induction phase reduced initial arm volume to 473 ml and 18%.  
• Before therapy, 76 patients had chronic pain, and 41 required oral pain medications, which CDT reduced to 20 and 11, respectively.
• Pain was reduced from 6.9 to 1.1

• Exclusion criteria were not defined.
• The results cannot clearly be attributed to MLD versus physical therapy.
• The study was not randomized.