Low-Level Laser Therapy May Reduce Limb Volume and Pain in Patients With Breast Cancer–Related Lymphedema
In a meta-analysis of patients with breast cancer–related lymphedema, low-level laser therapy was associated with reduced limb volume and pain levels, according to a report by Smoot et al in the Journal of Cancer Survivorship. However, the investigators noted that regarding pain management, there was insufficient evidence that treatments utilizing low-level laser therapy provide additional benefit beyond treatments that do not include low-level laser therapy.
Up to one in five women will develop lymphedema in the upper extremity after undergoing breast cancer treatment. In addition, women with breast cancer–related lymphedema experience more pain, poorer upper extremity mobility, poorer quality of life, and greater restrictions in activity than women without breast cancer–related lymphedema.
The current standard of care for women with breast cancer–related lymphedema is complete decongestive therapy, which includes compressive bandaging, exercise, manual lymphatic drainage, and compression garments. Unfortunately, these treatment approaches are time-consuming, labor-intensive, and costly. One such alternative approach is low-level laser therapy. This technique is usually applied by handheld units (contact or noncontact devices) using spot application to specific anatomic surfaces. However, few studies have been conducted on its efficacy and safety.
With that in mind, the investigators conducted a meta-analysis to determine whether low-level laser therapy is effective and safe in women with breast cancer–related lymphedema. In particular, they centered their analysis on the use of low-level laser therapy to reduce limb volume and pain.
Study Details
The investigators included nine studies extracted from PubMed and the Cumulative Index to Nursing and Allied Health Literature centering on low-level laser therapy in patients with breast cancer and lymphedema. All studies included measurement of upper extremity total limb volume using either water displacement (volumetry) or circumferential assessment (either with a tape measure or infrared perometry). Of the five studies that included independent measures of pain, either a visual analog scale or a numeric pain rating scale was utilized.
Reduction in Limb Volume and Pain
From the pooled data of the nine studies, the investigators’ consensus results were that low-level laser therapy was associated with reduced levels of limb volume and pain levels. There was a 90.9-mL greater reduction in limb volume with treatment including low-level laser therapy than with treatment not including low-level laser therapy.
As for the effect of low-level laser therapy on pain, the investigators reported a clinical reduction in pain of 13.5 mm on the 0 to 100 mm visual analog scale. However, they noted that due to the limited number of studies analyzed that evaluated pain, there was insufficient evidence that treatments utilizing low-level laser therapy provide additional benefit beyond treatments that do not include low-level laser therapy.
Adverse effects were reported in six of the nine studies. They included cellulitis and arm infection. It should be noted that women with lymphedema of the upper extremity after breast cancer treatment are at a greater risk for developing cellulitis than are women without lymphedema, likely due to stagnation of proteins and fluid in the edematous limb. One patient in one of the studies did not complete treatment.
Closing Thoughts
According to the investigators, the results of this study provided moderate evidence that low-level laser therapy may have a beneficial effect on breast cancer patients with lymphedema of the upper extremity. They also emphasized that important contraindications and precautions for low-level laser therapy should be considered when using this modality.
Betty Smoot, PT, DPTSc, of the Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, is the corresponding author of this article in the Journal of Cancer Survivorship. The authors disclosed no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
