Lymphovenous Canada: The Cross Cancer Institute and University of Alberta collaborate on lymphedema research

Dr. Mackey is a medical oncologist and researcher with the Cross Cancer Institute in Edmonton and Chair of the Northern Alberta Breast Cancer Program. Margie McNeely is a Physical Therapist with a Master's Degree in Physical Therapy. Margie worked at the Centre's Rehabilitation Medicine Department up until Spring 2004 and now is completing her PhD in the area of exercise oncology at the University of Alberta.

Dr. John Mackey:
We've always had an interest in lymphedema. It has been taken as a very important issue by this center because untreated lymphedema can be a major quality of life detriment for these individuals. Unfortunately, the rates of breast cancer are expanding - even if you account for age. Therefore, more and more women are undergoing axillary dissection surgery (surgery to remove lymph nodes in the armpit).

Edmonton physician, Dr. Mackey is the Chair of the Northern Alberta Breast Cancer Program.

Though less invasive surgical techniques, such as the sentinel node biopsy, offer hope for lower rates of lymphedema, this is not yet proven. In addition, we are using more axillary radiation than we have used before. As soon as you radiate the armpit, you put that woman at risk for lymphedema. While we do ultimately want to prevent lymphedema, for women with breast cancer that has spread to the lymph nodes in the armpit, there is a substantial improvement in survival rates when women receive axillary radiation. If it were me, I would seriously consider radiation even if I knew lymphedema would happen.

That leads to the question about what is the best way to treat lymphedema if it does occur. At the Cross Cancer Institute (CCI) we've been doing dedicated lymphedema work for over 20 years. In that time we've treated thousands of patients with lymphedema, most of which have been breast cancer patients who have acquired lymphedema as a result of breast cancer and/or the treatments for it. Our physical therapists introduced Comprehensive Lymphedema Treatment (CLT) (now entitled the Lymphedema Management Program) as part of our Intensive lymphedema program in 1995. Our clinical work eventually led to Margie's randomized trial, which looked at the two components of Comprehensive Lymphedema Treatment (CLT).

Margie McNeely:
My purpose in going back to school was to make sure that my study was designed and performed in a scientifically correct manner. I was interested in the CLT components of manual lymph drainage (MLD) and multi-layered compression bandaging. MLD and compression bandaging are the components that require expertise and time on the part of the physical therapist. Time and expertise are issues in the clinical setting, as there are resource constraints and waiting lists for treatment.

Margie McNeely has spearheaded a randomized trial on the effectiveness of using CLT in breast cancer patients who develop lymphedema.

Fifty women with breast cancer related lymphedema took part in the study and were randomly assigned to one of two groups. Both groups received four weeks of treatment. One group received both MLD and compression bandaging, while the other group received only compression bandaging. All subjects were fitted with compression garments at the end of their treatment. Data collection took place over a one-year period.

Independent assessors measured both arm volume and arm circumference measurements. The assessors were blinded to the subject's treatment assignment (which means that they were not aware of which treatment the subject was receiving). This was an important feature of the study as it eliminated any potential bias towards a specific treatment.

The main finding of our study was that compression bandaging, with or without MLD, is an effective treatment for chronic lymphedema. We also found, however, that women with mild lymphedema had a greater reduction when they received both MLD and CB. It is not surprising that when we treat lymphedema aggressively in its milder stage it responds better to treatment. While this finding needs further research, we have some evidence now in support of early detection and treatment of lymphedema.

It is important to realize, however, that this study had a sample of only 50 women. We need studies with larger numbers of lymphedema patients before we can make any clear conclusions in regards to the potential benefit of MLD. We also need studies examining other components and combinations of CLT.

Dr. John Mackey:
We intend to continue research in the area of lymphedema. Our intent is to create a program that spans from research to clinical practice so that our patients with lymphedema receive the most effective treatment.