Abstract
Breast cancer-related lymphedema affects between 10-40% of the 3.1 million women in the U.S. with a history of breast cancer.[1] Breast cancer-related lymphedema (BCRL) not only decreases quality of life, but can develop into chronic lymphedema, which potentially leads to fibrosis, infection, and even sepsis.[2] This article outlines a stand-alone, non-invasive, low-risk method for addressing BCRL called reflexology lymph drainage (RLD) developed by Sally Kay of the UK. This method is based on the manual lymph drainage (MLD) technique, which is one part of complete decongestive therapy (CDT), the current “gold standard” treatment for BCRL.[15] CDT is comprised of four treatments, including MLD, compression garments, exercise, and skin care.[17] RLD provides an effective stand-alone option for women wanting to manage their BCRL.
Background
As of January 2019, more than 3.1 million women across the United States have a history of breast cancer. In 2019 alone, 268,600 new cases of breast cancer were recorded.[1] Of the new cases, 10-40% are at risk of developing breast cancer-related lymphedema (BCRL) over the next 2 years.[2] The likelihood varies depending on how invasive the surgery, as well as whether the patient received radiation. Both radiation and increased lymph node involvement during surgery increase the chances of developing BCRL.[9] This would mean a conservative estimate of 26,000 women from 2019 who could develop BCRL over the next two years. In addition, 1 in 5 women with breast cancer are already experiencing BCRL.[3] Unfortunately, the risk of developing BCRL is a lifelong concern for women who have been treated for breast cancer. Not only does this complication decrease the quality of life for these women, but left untreated, it could lead to additional complications such as cellulitis and even sepsis.[2]
Currently, complete decongestive therapy (CDT) is the “gold standard” treatment for breast cancer-related lymphedema. CDT requires a complex regimen of manual lymph drainage (MLD), compression garments, exercise, and skin care. While research shows it to be effective, compression garments often cause women discomfort like decreased arm function[4] and social challenges.[2] Additional treatment options can include added surgeries and medications; however, these interventions come with further side effects and can be ineffective.[6]
The MLD portion of CDT is the basis for reflexology lymph drainage (RLD).[12] In one feasibility study, as well as in countless case studies, RLD produced a decrease in lymph volume in the affected arm.[12] Another published study outlined patient feedback, which showed an improvement in the quality of life.[13]
Given its effectiveness and safety profile, RLD is a compelling option for women with BCRL. RLD produces a decrease in lymph volume,[12] improves quality of life,[13] and likely reduces additional complications from BCRL.
Problem Statement
Women who have been treated for breast cancer live with a lifelong fear of developing lymphedema and the additional side effects that BCRL can bring. Pain, quality of life, and social and psychological stigmas influence the wellbeing of these women.[5] Maintaining a healthy weight, exercising, manual lymph drainage, and skin care can be useful,[15] but it is difficult to balance so many commitments after going through such a significant life event.
Solution
Reflexology lymph drainage provides a low-risk, stand-alone option for the management of breast cancer-related lymphedema. RLD is a non-invasive, safe,[14] integrative option available to breast cancer patients. One feasibility study of 26 women shows a significant reduction in volume in just one session, with continued improvement over the course of a 4-week intervention.[12] These results not only provide relief to patients, but likely decrease the complications of BCRL.
Reflexology is a non-invasive and safe modality.[14] When doctors prescribe CDT, they might want to consider RLD as a viable alternative. The benefit of using RLD over CDT is that there are other positive side effects from reflexology. Specifically, women with advanced breast cancer reported a decrease in pain after reflexology in a randomized controlled trial of 209 women.[8] The benefit of pain reduction will likely lead to increased compliance.
Basics of Reflexology
The science of reflexology is the application of a precise amount of pressure to specific points on the feet and hands. Reflexologists use these reflex points that correspond to different body organs and systems to address various wellness concerns. Applying pressure to these reflexes aims to balance the body, provide relaxation, improve nerve and blood supply, increase circulation, reduce pain,[8] and more.
Overview of the Reflexology Lymph Drainage Technique
RLD addresses the lymph and elimination systems using a variety of hand, thumb, and finger techniques on the reflexes located on the feet and/or hands. The RLD approach is based on the manual lymph drainage technique, which aims to create a vacuum in the lymph system, thereby pulling the lymph from the damaged system into a functional lymph network. RLD begins by applying pressure to the reflexes on the unimpaired side to clear the lymph system. Next, the reflexes on the impaired side are similarly addressed in an effort to direct the lymph towards the functioning side. The reflexologist completes the procedure by returning to the unimpaired side to target lymph clearance.[16] An RLD session lasts approximately 40 minutes and addresses the reflexes associated with the lymphatic network and also the organs of elimination. The research used a protocol of RLD weekly for a total of four consecutive weeks. The image below outlines the percent difference between the normal and affected arms during the 4-week intervention, with the greatest decrease in the first week. Follow-up continued to show success.[16]
Graph by Sally Kay
Conclusion
Reflexology lymph drainage is a safe, effective alternative to complete decongestive therapy. The benefits of using RLD include its stand-alone success, decrease in lymph volume, improved quality of life, decreased pain, less need for compression garments (improved social wellbeing), and a return to optimism and usual activities of life.[12,13] Empowering women affected with BCRL with options can lead to success in the management and prevention of breast cancer-related lymphedema.[15]
Although studies on the RLD technique are currently limited, the safety profile, stand-alone protocol, and improved well being reported by patients who have used RLD, makes this a strong option for consideration. It is reasonable to deduce that medical practitioners and patients can assume safety in the use of RLD when CDT is indicated.
Photo by Sally Kay
References
U.S. Breast Cancer Statistics | Breastcancer.org. Breastcancer.org. https://www.breastcancer.org/symptoms/understand_bc/statistics. Published February 13, 2019. Accessed January 15, 2020.
Shah C, Arthur DW, Wazer D, Khan A, Ridner S, Vicini F. The impact of early detection and intervention of breast cancer-related lymphedema: a systematic review. Cancer medicine. 2016;5(6):1154-1162. doi:10.1002/cam4.691
Sayegh TC. Breast cancer-related lymphedema: risk factors, precautionary measures, and treatments. Gland Surgery. 2018;7(4):379-403. http://gs.amegroups.com/article/view/18144/20340. Accessed January 13, 2020.
King M, Deveaux A, White H, Rayson D. Compression garments versus compression bandaging in decongestive lymphatic therapy for breast cancer-related lymphedema: a randomized controlled trial. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2012;20(5):1031-1036. doi:10.1007/s00520-011-1178-9
Barlow S, Dixey R, Todd J, Taylor V, Carney S, Newell R. ‘Abandoned by Medicine’? A qualitative study of women’s experiences with lymphoedema secondary to cancer, and the implications for care. Primary Health Care Research & Development. 2013;15(04):452-463. doi:10.1017/s1463423613000406
Morrell RM, Halyard MY, Schild SE, Ali MS, Gunderson LL, Pockaj BA. Breast Cancer-Related Lymphedema. Mayo Clinic Proceedings. 2005;80(11):1480-1484. doi:10.4065/80.11.1480
Torres Lacomba M, Yuste Sanchez MJ, Zapico Goni A, et al. Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial. BMJ. 2010;340(jan12 1):b5396-b5396. doi:10.1136/bmj.b5396
Sikorskii A, Niyogi PG, Victorson D, Tamkus D, Wyatt G. Symptom response analysis of a randomized controlled trial of reflexology for symptom management among women with advanced breast cancer. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2019:10.1007/s00520-019-04959-y. doi:10.1007/s00520-019-04959-y
Lee TS, Kilbreath SL, Refshauge KM, Herbert RD, Beith JM. Prognosis of the upper limb following surgery and radiation for breast cancer. Breast Cancer Research and Treatment. 2007;110(1):19-37. doi:10.1007/s10549-007-9710-9
Learn What You Need to Know About Lymphedema at Susan G. Komen®. @SusanGKomen. https://ww5.komen.org/BreastCancer/Lymphedema.html. Published 2020. Accessed January 22, 2020.
Boyages J, Kalfa S, Xu Y, et al. Worse and worse off: the impact of lymphedema on work and career after breast cancer. SpringerPlus. 2016;5(1). doi:10.1186/s40064-016-2300-8
Whatley J, Street R, Kay S, Harris PE. Use of reflexology in managing secondary lymphoedema for patients affected by treatments for breast cancer: A feasibility study. Complementary therapies in clinical practice. 2016;23:1-8. doi:10.1016/j.ctcp.2016.01.002
Whatley J, Street R, Kay S. Experiences of breast cancer related lymphoedema and the use of reflexology for managing swelling: A qualitative study. Complementary therapies in clinical practice. 2018;32:123-129. doi:10.1016/j.ctcp.2018.06.006
Wyatt G, Sikorskii A, Rahbar MH, Victorson D, You M. Health-Related Quality-of-Life Outcomes: A Reflexology Trial With Patients With Advanced-Stage Breast Cancer. Oncology Nursing Forum. 2012;39(6):568-577. doi:10.1188/12.onf.568-577
Fu MR. Breast cancer-related lymphedema: Symptoms, diagnosis, risk reduction, and management. World Journal of Clinical Oncology. 2014;5(3):241. doi:10.5306/wjco.v5.i3.241
Kay, S. Reflexology Lymph Drainage: Illustrated Step by Step Guide to the Sally Kay Method. Rogerstone, Newport NP10 9LG. First Publishing, 2019.
Complete Decongestive Therapy (CDT). Breastcancer.org. https://www.breastcancer.org/treatment/lymphedema/treatments/cdt. Published February 5, 2015. Accessed February 9, 2020.