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Management

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    Integrative Modalities

    Manual lymphedema therapy

    Manual lymphedema therapy, a type of massage technique, involves the use of a very light superficial massage with gentle, rhythmic skin distention, ideally limited to pressures of approximately 30 mmHg to 45 mmHg.[3] In comparison to many other massage techniques, manual lymphedema therapy is very light to the touch. The strokes often feel like a "brushing" technique. Manual lymphedema therapy decreases congested lymph nodes by directing it to the circulatory and lymphatic system.[3] Manual lymphedema therapy begins on unaffected areas to direct the lymph away from the affected extremity.

    A limited number of trials have been conducted among women with breast cancer who are experiencing lymphedema. These trials have reported significant reductions in limb volume when manual lymphedema therapy is administered as the sole intervention or as an adjunct to standard of care.[18,19,20][Level of evidence: I] However, large randomized controlled trials are needed to confirm these preliminary findings.

    Manual lymphedema therapy should be introduced in a closely supervised medical setting, by a clinician specifically trained in manual lymphedema therapy.[21] No adverse events have been reported in the pilot studies that administered manual lymphedema therapy to women with breast cancer. The reported adverse events are associated with the general discipline of massage therapy and are largely related to treatments delivered by unlicensed massage therapists or treatments that include deep and rigorous massage techniques. Manual lymphatic therapy, also known as manual lymphatic drainage, can be taught to patients for self-care.

    Despite the safety profile, the following special precautions should be considered when massage therapy is delivered to individuals with cancer:

    • Avoid directly massaging any open wounds, hematomas, or areas with skin breakdown.
    • Avoid directly massaging tumors that are apparent on the skin surface.
    • Avoid massaging areas with acute deep venous thrombosis.
    • Avoid directly massaging radiated soft tissue when the skin is sensitive.[22]

    Additional integrative modalities have been under investigation for their role in the treatment of secondary lymphedema. Selenium has been studied in clinical trial NCT00188604, and acupuncture and moxibustion are being studied in clinical trial LJMC-AMWELL-SL as treatments for lymphedema.

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