gms | German Medical Science

Aim: Axillary lymph node dissection (ALND) is part of the surgical treatment of breast cancer. It is the cause of breast cancer related morbidity concerning lymphedema (LE) and pain. Common options for the treatment of these complications are lymph drainage (LD) and physical therapy. Aim of this study was to examine the patient’s motivation to use LD in the post operative setting.

Patients and methods: From July 2004 to October 2005 a structured questionnaire was administered to 629 patients who have been treated for breast cancer more than 3 months ago. The response rate was 87,7% (n=552). Mean follow-up after the primary treatment was 4,57 years. 63,2% had breast conserving surgery, 31,9% an unilateral mastectomy, and 4,9% a bilateral mastectomy. The questionnaire consisted of 49 structured questions. The data was analysed statistically using the t test, the chi-square test and Analyses of variance.

Results: 18% of the patients stated to have a LE within 3 months after surgery. Within the next 6 months further 5,9 % of the patients stated a newly diagnosed LE. This percentage decreased to 5,8% in the second year after the diagnosis and 1% in the third year. However 33,5% of patients used LD within the first 3 months after surgery and 13,2% in the following 6 months. Thus 150 patients used LD without ever having a LE. LD for asymptomatic patients was recommended in 45% of cases by their primary gynaecologist, in 28,8% by the operating gynecologist. Only 6,2% of women used LD based on their own initiative.

Conclusion: More patients used lymph drainage than patients were diagnosed with lymphedema. Lymph drainage seems to be used as a preventive tool in these patients. This group of patients includes a total of more than 25% of all breast cancer patients. Based on the cost-benefit relation there is no rational for this treatment. As the advantage of preventive lymph drainage is not documented with the quality criteria of evidence based medicine preventive LD should not be prescribed for women without symptoms, but only to symptomatic patients as stated in the S3-guidelines of the Deutsche Krebsgesellschaft e.V.