Quantitative analysis of pressure levels in manual lymphatic drainage across stages of breast cancer-related lymphedema: implications for optimized treatment protocols

Naifang Xing; Daiqing Liu; Lufeng Chen; Guorong Wang; Yuan Tian; Chen Yang; Yingjie Leng; Xin Jiang; Chengxiang Li; Ruonan Xie; Zhuomiao Nie; Tian Zhang

doi:10.1007/s10549-024-07540-2

Quantitative analysis of pressure levels in manual lymphatic drainage across stages of breast cancer-related lymphedema: implications for optimized treatment protocols

Breast Cancer Res Treat. 2024 Nov 4. doi: 10.1007/s10549-024-07540-2. Online ahead of print.

Authors

Naifang Xing^#¹, Daiqing Liu^#², Lufeng Chen³, Guorong Wang⁴, Yuan Tian⁵, Chen Yang⁵, Yingjie Leng¹, Xin Jiang¹, Chengxiang Li¹, Ruonan Xie¹, Zhuomiao Nie¹, Tian Zhang⁶

Affiliations

¹ School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China.
² School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.
³ School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, 611731, China. lufeng.chen@uestc.edu.cn.
⁴ West China College of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China. wangguorong@scu.edu.cn.
⁵ School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, 611731, China.
⁶ Department of Nursing, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China.

^# Contributed equally.

PMID: 39489842
DOI: 10.1007/s10549-024-07540-2

Abstract

Objective: To quantify the pressure levels necessary for effective Manual Lymphatic Drainage (MLD) in managing Breast Cancer-Related Lymphedema (BCRL) across various stages, and to contribute to the development of standardized protocols for MLD therapy.

Methods: The study included 42 patients with BCRL (Stages I-III) and 14 certified lymphedema therapists. Forearms and upper arm circumferences were measured pre and post a 21-day MLD intervention. A tactile sensor system recorded the applied pressure during treatment. The data were preprocessed and statistically analyzed to assess pressure patterns and their stage-specific impacts on lymphedema.

Results: The mean age of the patients was 52.4 years, and that of the therapists was 39.1 years. A statistically significant reduction in arm circumference was observed post-MLD treatment (P < 0.05). The pressure applied varied across stages: I _forearm 16.5-20.1 mmHg, I _{upper arm} 16.1-20.7 mmHg; II _forearm 16.6-19.8 mmHg, II _{upper arm} 19.7-23.8 mmHg; III _forearm 29.3-34.3 mmHg, III _{upper arm} 29.7-34.3 mmHg. No statistically significant difference was found between forearm and upper arm treatment pressures within Stages I (P = 0.283) and III (P = 0.08), while Stage II exhibited a significant difference (P < 0.001). Across the same treatment area, pressures for Stages I and II in the forearm were significantly lower than those in Stage III (P < 0.001). The treatment pressure differences between forearm stages I and II were not statistically significant (P > 0.05). Differences in upper arm treatment pressures across Stages I, II, and III were also statistically significant (P < 0.001).

Discussion: The study provides quantitative evidence on the pressure ranges needed for MLD across different stages of BCRL. It highlights the importance for stage-specific pressure adjustments to optimize treatment outcomes. These findings contribute to the existing body of knowledge on MLD and offer valuable data that could inform the development of rehabilitation technologies, including intelligent robots and visualization systems, as well as enhance therapist training programs.

Keywords: Breast cancer-related lymphedema; Manual lymphatic drainage; Pressure sensor; Rehabilitation.

Abstract

Grants and funding