Lymphoedema can be a debilitating side effect of breast cancer surgery if not managed carefully, but research is moving apace to help women with the disorder control it better.

Auckland physiotherapist and lymphatic therapist, Deborah Hurt, describes lymphoedema as the swelling of the arm, hand, or chest wall caused by a build-up of lymph fluid in those tissues. She recently attended the Australasian Lymphology Association’s biennial conference in Cairns and offers this summary of papers related to breast cancer presented at the conference.

Yoga and lymphoedema
A randomised controlled trial of women with secondary arm lymphoedema from breast cancer was held across two locations in Tasmania. Intervention consisted of eight weekly, teacher-led yoga sessions of one-and-a-half hours, with daily home practice by following a DVD.

The control group received advice on best current self management. Measurements were done at baseline, weeks four and eight.

The conclusion was that yoga tailored to the requirements of women with breast cancer-related lymphoedema resulted in lower lymphoedema, fewer symptoms, softening of tissue and improvement of various physical outcomes.

Diet and lymphoedema
Those with lymphoedema often consult a range of medically-related internet sites which provide them with numerous dietary options for the management of lymphoedema, much of which is not peer reviewed or evidence based. This results in patients making wrong choices.

Safe and effective choices for the dietary management of lymphoedema are:

  • achieve and maintain a healthy weight
  • avoid diuretics (coffee, tea, coke, alcohol)
  • exercise   
  • reduce fat intake (long chain fatty acids are absorbed into lymphatics)
  • eat lean meat, low fat dairy, avoid deli meatslow sugar – choose foods with a low glycaemic index
  • protein – adequate intake is essential for wound healing

There is no evidence to support a low salt diet, though this won’t harm you. Nor is there any evidence to support taking vitamin and mineral supplements, though these will not cause any harm either.

However, there is potential harm in the following diets and no evidence to support their use in the management and control of lymphoedema:

  • low carbohydrate diet
  • low protein diet
  • alkaline diet (restrictive)
  • deionised water

Prevention practices
Although common practices taught to patients are theory-based and supported by patient-reported “triggers”, there is little evidence to support many of these practices.

There is substantial supportive evidence that maintaining a normal bodyweight and participating in supervised exercise programmes helps to reduce the risk of developing lymphoedema.

Research supports that early identification and treatment of mild degrees of swelling potentially reverses the early onset of lymphoedema. The focus of healthcare systems should be on early detection and rapid initial treatment.

Directions for the Future
Lymphatic surgery is experiencing a revival in the prevention and treatment of lymphoedema. Lymphatico-venular bypass may have a role in early lymphoedema.  This involves three or four lymphatic vessels being directly connected to veins with the aim of increasing the flow of lymphatic fluid in order to ease the lymphedema.

Microvascular lymph node transfer is entering trials for breast cancer related lymphoedema.  This involves transferring working lymph nodes from another area of the body, ie the groin, to the underarm area.

Liposuction for the fatty change in chronic oedema results in dramatic and sustained reduction in volume for selected patients. Success depends on rigorous selection with a proven high level of commitment to self management and compression therapy, and on lifelong compliance to the wearing of a compression garment. With this comes improvement in symptom, psychosocial and functional outcomes.

Concluding tips
My advice is to be well informed, mindful of prevention practices, stay active and eat well. As the lymphatics drain through the thoracic duct in your abdomen, good diaphragmatic breathing is essential to maintain lymphatic flow. Breathe well and enjoy the summer.

For more information on lymphoedema, check out BCAC's lymphoedema page.