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Massage is usually used in breast cancer survivors as part of a complex intervention known as decongestive lymphatic physiotherapy (CDPT). RCTs have reported the validity of this multimodal intervention for the initial reduction of edema and long-term maintenance of limb volume in lymphedema. CDPT includes a type of massage known as manual lymphatic drainage (MLD). To date, the evidence-base for MLD as a single therapeutic approach is limited. Most studies of lymphedema management have focused on the combined effects of compression bandaging therapy (CBT) or have compared manual lymphatic drainage and compression. Some studies showed similar results for MLD when compared to CBT, while other showed decreased edema by adding MLD to CBT Therapy while compared to those therapies alone.

For example, a couple of studies of women with breast cancer related lymphedema, compared patients receiving MLD with those having treatment with pneumatic compression pumps. Limb circumference and subjective assessment of mood were used to measure change. The findings showed similar results for MLD and compression pumps. Another similar study measured the effects of compression bandaging with or without MLD in arm swelling. The group receiving bandaging and MLD had a significant reduction in limb volume and decreased pain despite the fact that MLD was only given for 1 week. Another study that investigated the effect of eight sessions of MLD over 2 weeks, in addition to CBT, skin care, exercises and information, suggested that MLD did not contribute significantly to edema reduction in 42 women with breast cancer-related lymphedema. The study was limited to those with mild to moderate swelling (limb volume <30%).

In a more recent study, patients were recruited into a randomized, controlled crossover trial with two arms: patients who received MLD followed by a simplified version (SLD) and patients who received SLD followed by MLD. For the purposes of the study, SLD was used as a comparative intervention, as it was not believed possible to provide placebo or 'sham' MLD. Results showed that MLD significantly reduces excess limb volume as well as reduced dermal thickness in the upper arm. A number of altered sensations, such as pain and heaviness, were also significantly improved by MLD.

Because CDPT demands substantial time and effort from patients to maintain benefits, some mechanical devices that simulate massage have also been investigated. A recent pilot trial explored the use of a massage device designed for home use by the patient. Such device, called Flexitouch, have been studied in a recent prospective, randomized, crossover study comparing the efficacy of Flexitouch, with massage in self-administered maintenance therapy of lymphedema. Results showed that the device may provide better maintenance edema control than self-administered massage in breast cancer-associated lymphedema.

Most of the studies describe self-administered massage interventions. Few studies have look at the effect of therapist/other person administered massage. However, an RCT has been published that reports the on usefulness of arm massage from a significant other following lymph node dissection surgery. The study was randomized clinical trial with a pretest-posttest design in which data were collected prior to surgery, within 24 hours post surgery, within 10 to 14 days post surgery, and 4 months post surgery. A total of 59 women aged 21 to 78 undergoing lymph node dissection surgery and who had a significant other with them during the postoperative period were included in the trial. Subjects were randomly assigned to intervention and control groups. Subjects' significant others in the intervention group were first taught, then performed arm massage as a postoperative support measure. Participants reported a reduction in pain in the immediate postoperative period and better shoulder function. The intervention also promoted a sense of closeness and support amongst subjects and their significant other.

Safety

When practiced by licensed massage therapists (LMPs) who have been trained in treating people with cancer or recovering from cancer, massage is considered a highly safe practice. Massage therapist may have variable amounts of training in treating people with cancer or recovering from cancer depending on where they have received their education. However, some massage therapists have received special training through continuing education credits or special courses, or have attended internships at hospitals or medical centers.

Recommendations

There is evidence from RCTs in cancer survivors that massage is useful in treating lymphedema as part of a complex intervention that also includes compression bandage therapy (CBT). The massage used in these studies is a special technique called "manual lymphatic drainage" (MLD).

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  • Wilburn O, Wilburn P, Rockson SG. A pilot, prospective evaluation of a novel alternative for maintenance therapy of breast cancer-associated lymphedema BMC Cancer. 2006 Mar 29;6:84.
  • Barclay J, Vestey J, Lambert A, Balmer C. Reducing the symptoms of lymphoedema: is there a role for aromatherapy? Eur J Oncol Nurs. 2006 Apr;10(2):140-9. Epub 2006 Mar 23.
  • McNeely ML, Magee DJ, Lees AW, Bagnall KM, Haykowsky M, Hanson J. The addition of manual lymph drainage to compression therapy for breast cancer related lymphedema: a randomized controlled trial. Breast Cancer Res Treat. 2004 Jul;86(2):95-106.
  • Forchuk C, Baruth P, Prendergast M, Holliday R, Bareham R, Brimner S, Schulz V, Chan YC, Yammine N. Postoperative arm massage: a support for women with lymph node dissection. Cancer Nurs. 2004 Jan-Feb;27(1):25-33.
  • Williams AF, Vadgama A, Franks PJ, Mortimer PS. A randomized controlled crossover study of manual lymphatic drainage therapy in women with breast cancer-related lymphoedema. Eur J Cancer Care (Engl). 2002 Dec;11(4):254-61.
  • Andersen L, Hojris I, Erlandsen M, Andersen J. Treatment of breast-cancer-related lymphedema with or without manual lymphatic drainage--a randomized study. Acta Oncol. 2000;39(3):399-405.