Lymphedema is a common and debilitating condition that affects millions of people worldwide. It is a chronic swelling of the arm, hand or torso that can occur after breast cancer treatment, causing physical discomfort, functional limitations, and psychological distress.
Although there are several treatment options available for lymphedema, such as compression therapy and manual lymphatic drainage, they are often time-consuming, costly, and have limited efficacy. That’s why researchers are exploring alternative therapies to manage this condition, and one such therapy is shockwave therapy.
In this blog post, we will explore the role of extracorporeal shock wave therapy (ESWT) in the management of breast cancer-related lymphedema. Whether you are a patient, caregiver, or healthcare provider, this article will provide you with valuable insights into the latest treatment options for this challenging condition.
Breast Cancer-related Lymphedema
Breast cancer-related lymphedema (BCRL) is a chronic and debilitating condition caused by the removal of lymph nodes in the armpit. It is estimated that up to 40% of breast cancer survivors will develop it, and it can have a significant impact on their quality of life (Stout et al, 2018). The impact of BCRL on patients can be significant, as it can cause physical limitations, discomfort, and psychological distress.
There are various treatment options available to manage the symptoms. Shockwave therapy is a non-invasive medical technology that uses acoustic waves to stimulate the healing and regeneration of tissues. It is commonly used to treat various musculoskeletal disorders. Several studies have shown promising results, with significant reductions in arm volume and improvements in range of motion and pain.
The underlying mechanisms of how shockwave therapy works in BCRL are not yet fully understood, but it is believed that the acoustic waves stimulate the lymphatic vessels and promote lymphatic drainage, which helps to reduce swelling and improve tissue health. However, it may not be suitable for everyone due to certain medical conditions. In addition, there may be some risks associated with the treatment, such as skin irritation and pain.
Studies that have investigated the use of shockwave therapy in BCRL
Several clinical studies have investigated the effectiveness of shockwave therapy for BCRL. These clinical studies have shown promising results, with significant reductions in arm volume and improvements in range of motion and pain in patients with BCRL. Majority of studies have combined ESWT with complex decongestive therapy (CDT), which is considered the gold standard therapy for treating lymphedema and its effectiveness has been proven in all stages.
CDT is divided into two phases:
Phase 1 is an intensive treatment period that consists of skin care, manual lymphatic drainage, application of multilayer compression bandage, and exercise.
Phase 2 is initiated when oedema subsides and focuses on self- care through application of daytime elastic sleeves or stocking compression, night bandage and continued exercise.
A randomised study by Lee et al (2022) looked at the long-term effects of extracorporeal shock wave therapy (ESWT) on breast cancer-related lymphedema (BCRL). The researchers enrolled 28 female patients with stage 2 lymphedema and randomly divided them into two groups. One group received ESWT three times a week for three weeks, along with complex decongestive therapy (CDT), while the other group only received CDT. The researchers measured the circumference of the arm, fluid volume, ratio of water content, and skin thickness before treatment, 3 weeks after ESWT completion, and 3 months post-ESWT completion.
The study found that the group that received ESWT showed statistically significant improvement in the circumference of the whole arm, volume, ratio of water content and skin thickness at 3 weeks and 3 months post-treatment. Overall, the study found that ESWT improved lymphedema in patients with stage 2 BCRL, and the effects persisted for at least 3 months. This suggests that ESWT may be an additional treatment method for patients with lymphedema.
A systematic review of eight studies by Tsai et al (2021) reviewed the effectiveness of ESWT combined with CDT on BCRL. The primary outcomes were the volume of lymphedema and arm circumference. The review found that ESWT significantly improved the volume of lymphedema, skin thickness, and shoulder range of motion in BCRL patients.
One potential advantage of shockwave therapy compared to other treatment options is that it is non-invasive and does not require surgery or the use of drugs. This therapy can be administered in an outpatient setting and does not require a long recovery period. Additionally, shockwave therapy has been found to be well-tolerated and safe, with few reported adverse effects.
Conclusion
Shockwave therapy offers a non-invasive, safe, and promising treatment option for breast cancer-related lymphedema. Its physiological effects have been demonstrated in multiple studies, including increased lymphatic drainage and growth of new lymphatic vessels. Compared to other treatment options, shockwave therapy is convenient, requires no downtime, and is well-tolerated. While more research is needed to determine optimal dosing and duration, the potential benefits of this therapy make it a compelling option for patients looking to alleviate the symptoms of lymphedema.
If you are a breast cancer survivor experiencing lymphedema, discuss with your healthcare provider, to see if shockwave therapy is right for you.
If you are interested in learning more about the practical application of SWT, visit our training page with multiple courses on all key areas of SWT practice.
Benoy Mathew, MSc, MCSP
Advanced Practice Physio
MSK SWT Specialist
References:
- Lee, J.H., Kim, S.B., Lee, K.W. and Ha, W.W., 2022. Long-Term Effects of Extracorporeal Shock Wave Therapy on Breast Cancer-Related Lymphedema. Journal of Clinical Medicine, 11(22), p.6747.
- Stout, N.L., Alfano, C.M., Belter, C.W., Nitkin, R., Cernich, A., Lohmann Siegel, K. and Chan, L., 2018. A bibliometric analysis of the landscape of cancer rehabilitation research (1992–2016). JNCI: Journal of the National Cancer Institute, 110(8), pp.815-824.
- Tsai, Y.L., Chuang, Y.C., Cheng, Y.Y. and Lee, Y.C., 2021. Extracorporeal Shock Wave Therapy Combined with Complex Decongestive Therapy in Patients with Breast Cancer-Related Lymphedema: A Systemic Review and Meta-Analysis. Journal of Clinical Medicine, 10(24), p.5970.
