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Yzer J1,2
1South Florida Breast Cancer Rehab Center, Pembroke Pines, United States, 2Nova Southeastern University, Fort Lauderdale, United States
Background: The management of secondary lymphedema has become recognized as a costly consequence of the interruption of the lymphatic system such as occurs in surgical procedures and treatments for cancer. In the advanced medical communities of the West a vast array of modalities has been developed and brought to market to aide the patient suffering from lymphedema. Patients in developed countries have greater access to the products required for managing lymphedema and these may include compression garments for day and night, compression pumps, special bandages, and management by a skilled lymphedema therapist. Innovations on the breast surgical front promise a future where post-op lymphatic congestion may be reduced if not entirely avoided by state-of-the-art micro surgical procedures. Yet for now, a great discrepancy still exists between the treatment of lymphedema in developed as compared to less developed countries where lymphedema professionals may be completely absent or where the costly products are not readily available. There is a need to make the management of lymphedema more equitable and to achieve this goal we must continue to search for new and cost-effective treatment techniques.
Purpose: Based on preliminary observations that topical cooling appeared to soften lymphedematous and fibrotic tissue, our goal was to systematically and quantitatively evaluate this effect. For this purpose, topical cooling was used as part of treatment of lymphedematous and fibrotic skin of women with breast cancer related lymphedema (BCRL) and localized fibrosis.
Methods: Skin tissue hardness was assessed via the force required to indent skin to 4 mm (F4.0) and 1.3 mm (F1.3) and skin water was assessed by measurements of tissue dielectric constant (TDC). Measurements were done before cooling, after cooling, and after a single treatment session in 20 women with arm involvement and in 12 women with breast involvement. Pre-cooled arm and breast skin temperatures (mean ± SD) of 32.4 ± 1.4 °C and 33.8 ± 1.0 °C were reduced to 23.7 ± 2.0 °C and 24.7 ± 1.6 °C respectively via application of cold washcloths.
Results: Cooling was associated with a significant (p 0.001) decrease in F4.0 and F1.3 at arm and breast sites. At arm sites, force reductions ranged from 24% to 28% depending on indentation depth.
Conclusion(s): The near immediate tissue softening is associated with less pressure on underlying nerve endings and less input to sensory nerves thereby interrupting the pain cycle resulting in rapid pain relief. The rapidly softened tissue and decrease perception of pain offers the patient hope and encouragement in their therapeutic journey to reclaiming functional use of their affected body. Further, because softer tissue becomes more pliable, myofascial lengthening, scar tissue releasing, and other aspects of treatment are easier to perform thereby reducing clinical treatment time and effort while achieving improved functional mobility.
Implications: Since cryotherapy is generally considered to be a cost-effective treatment, cooling therapy for lymphedema would be widely available around the world where ever refrigeration exists, helping to make the management of lymphedema more equitable.
Keywords: Lymphedema, Breast cancer, cryotherapy
Funding acknowledgements: There are no funding acknowledgements.
Purpose: Based on preliminary observations that topical cooling appeared to soften lymphedematous and fibrotic tissue, our goal was to systematically and quantitatively evaluate this effect. For this purpose, topical cooling was used as part of treatment of lymphedematous and fibrotic skin of women with breast cancer related lymphedema (BCRL) and localized fibrosis.
Methods: Skin tissue hardness was assessed via the force required to indent skin to 4 mm (F4.0) and 1.3 mm (F1.3) and skin water was assessed by measurements of tissue dielectric constant (TDC). Measurements were done before cooling, after cooling, and after a single treatment session in 20 women with arm involvement and in 12 women with breast involvement. Pre-cooled arm and breast skin temperatures (mean ± SD) of 32.4 ± 1.4 °C and 33.8 ± 1.0 °C were reduced to 23.7 ± 2.0 °C and 24.7 ± 1.6 °C respectively via application of cold washcloths.
Results: Cooling was associated with a significant (p 0.001) decrease in F4.0 and F1.3 at arm and breast sites. At arm sites, force reductions ranged from 24% to 28% depending on indentation depth.
Conclusion(s): The near immediate tissue softening is associated with less pressure on underlying nerve endings and less input to sensory nerves thereby interrupting the pain cycle resulting in rapid pain relief. The rapidly softened tissue and decrease perception of pain offers the patient hope and encouragement in their therapeutic journey to reclaiming functional use of their affected body. Further, because softer tissue becomes more pliable, myofascial lengthening, scar tissue releasing, and other aspects of treatment are easier to perform thereby reducing clinical treatment time and effort while achieving improved functional mobility.
Implications: Since cryotherapy is generally considered to be a cost-effective treatment, cooling therapy for lymphedema would be widely available around the world where ever refrigeration exists, helping to make the management of lymphedema more equitable.
Keywords: Lymphedema, Breast cancer, cryotherapy
Funding acknowledgements: There are no funding acknowledgements.
Topic: Oncology, HIV & palliative care
Ethics approval required: Yes
Institution: Nova Southeastern University
Ethics committee: IRB
Ethics number: Oct 12 2015
All authors, affiliations and abstracts have been published as submitted.
