Overview of treatment options and review of the current role and use of compression garments, intermittent pumps, and exercise in the management of lymphedema

BACKGROUND. Lymphedema is a relatively frequent complication following the management of breast carcinoma. Numerous therapeutic interventions have bee n offered to treat this potentially disabling and disfiguring condition. Co nsensus has not been attained among oncologists, surgeons, psychiatrists, a nd physical therapists concerning the appropriate treatment of lymphedema. METHODS. This review provides an overview of those treatment regimens that have been used in the past and, in some instances, have gone on to provide the foundation for the most widely prescribed interventions currently emplo yed for the management of upper extremity lymphedema following breast carci noma treatment. The use of intermittent pneumatic compression pumps as a pa rt of an integrated multidisciplinary treatment approach incorporating garm ents, exercises, and massage also is discussed. RESULTS. A review of available literature suggests that a variety of tradit ional and commonly available techniques, when used appropriately in a multi disciplinary fashion, may lessen the cosmetic and physical impairments asso ciated with acquired lymphedema, The role of surgery is unclear. Pharmacoth erapies are a promising adjunct to manual and mechanical therapies. CONCLUSIONS, The appropriate use of readily available treatment approaches may lessen the severity of acquired lymphedema following breast carcinoma t herapy. A comprehensive therapeutic approach should be employed in the mana gement of lymphedema, including attention to the functional, cosmetic, and emotional sequelae of this potentially disabling condition. To that end, a recommendation for a comprehensive treatment regimen is provided. Cancer 19 98;83:2821-7. (C) 1998 American Cancer Society.