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More on Breast Cancer-Related-Edema

presented by Linda T. Miller, PT, DPT, CLT

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Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

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This course will build upon the concepts introduced in Part One, including the pathology of breast cancer related edema and evidence on current treatment options. Identifying "transient edemas" and their treatment will be discussed. A subset of techniques, including manual lymphatic therapy, multi-layer bandaging, and intermittent pneumatic compression will be explored further and will be demonstrated. Emphasis will be placed on adapting treatment applications based on the presentation of the edema.

Meet Your Instructor

Linda T. Miller, PT, DPT, CLT

Linda T. Miller, PT, DPT, CLT, served as the founder and clinical director of the Breast Cancer Physical Therapy Center in the Philadelphia area for over 20 years. She has over 300 hours of training in lymphedema management and has been an international student of lymphedema, including training in the UK, Italy, Spain, France, and…

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1. A Refresher on the Pathophysiology of Breast Cancer-Related Edemas

A majority of breast cancer-related edemas are actually phlebo-lymphedemas. The recognition of the venous component of the edema directly impacts which treatments may be more effective in this condition.

2. Evaluation of Breast Cancer-Related Edema—How Important is Timing and Mechanism of Onset?

The terms “transient” and “persistent” lymphedema have appeared recently in the literature on breast cancer-related swelling. When left unaddressed, some “transient” edemas can progress to “persistent.” Performing a thorough evaluation, including a detailed cancer treatment history, timing of onset and precipitant can provide clues as to the etiology of the edema. Recognizing that all edemas are phlebo-lymphedemas, identifying whether an edema is more venous or lymphatic in origin can help determine treatment choice.

3. Manual Lymphatic Therapy: Theory, Evidence and Application

Manual lymphatic therapy (MLT) is a technique that is applied in such a way to directly impact the lymphatic vessels. While there are several different schools of thought on how the technique should be applied, most all rely on 2 specific principals: changing tissue pressure; stretching the skin. Evidence on the technique is mixed but it remains a staple of breast cancer-related edema management.

4. Multi-Layer Bandaging: Theory, Evidence and Application

Multi-Layer Bandaging (MLB) is a staple in the management of breast cancer-related edema. Understanding the basic principles of the technique, including product options, gives the clinician the flexibility and creativity to manage each edema successfully. Evidence suggests that results can be obtained with bandages without the usual extended wear. Appropriate use of this important modality will be discussed, including frequency and long-term results.

5. Intermittent Pneumatic Compression: An Underused Modality

Despite strong evidence, the use of intermittent pneumatic compression (IPC) in breast cancer-related edema has been a controversial treatment option. An understanding as to the impact of IPC on tissue fluid mechanics as well as new data on optimal compression pump parameters supports its use as an effective treatment adjunct.

6. Putting It All Together

The ability to tailor a treatment program specific to an individual limb requires a good understanding of the mechanism of action of each technique on the pathophysiology of the presenting edema. Application of these techniques can also be varied depending upon the limb edema, underlying precipitating factory, and timing of onset. Individualizing treatment options and modifying them as the limb improves will provide the best long-term outcomes.

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