According to the American Cancer Society, 15 to 28 percent of all breast cancer survivors will develop Breast Cancer Related Lymphedema (BCRL).
An estimated 5 to 10 percent of these women will develop lymphedema after a modified radical mastectomy.
Risk factors for the development and exacerbation of BCRL are:
1. Axillary dissection.
4. Surgical revisions and node removal.
6. Diabetes Mellitus.
7. Traumatic injury to the affected arm.
8. Excessive use of the affected arm.
9. Newest addition. Medications!
Years ago at the International Lymphatic Society meeting in Europe, a Spanish doctor spoke and stated that he believed that certain medications exacerbated lymphedema. Someone in the group questioned him on whether he was studying this and he said he was working on it.
Well, it appears that researchers have been working on correlations between medications and the development of peripheral edema and its effects on the body and they are finding that medications sometimes are part of the problem, as it will then escalate the risk for lymphedema in our breast cancer population.
In 2008, Keeley actually identified certain drug categories that can contribute to peripheral edema and that could then be associated with exacerbating lymphedema issues. These include calcium channel blockers, antidepressants, anticonvulsants, antineuralgics, nonsteroidal anti-inflammatories (NSAIDS), antidiabetics, and cytotoxic agents.
Some of these medications are used to treat chronic diseases such as “cardiac disease, cancer, diabetes or the sequelae that can occur with chronic disease such as pain and depression.”
Cancer agents that were studied were taxoid medications. It was evidenced that among this group over 44.65 percent of the patients experienced an increase in peripheral edema as a result of these systemic effects. As a result, our BCRL patients will be particularly at risk for lymphedema issues if they are on these medications.
It appears that with the use of NSAIDs up to 25 percent of all people will get fluid retention. This occurs due to the influence of these meds on sodium water retention mechanism in the kidneys. Women with BCRL often use these meds due to stiffness and pain associated with treatment regimes and they could put them at increased risk as a result.
Up to 50 percent of all breast cancer patients have postoperative pain. Often medications for neuropathic pain is used. The medications often used are Lyrica and Gabapentin. According to a study by Frishman, these pregabalin meds can increase peripheral edema by 15 percent, so BCRL patients are at risk.
Antidepressants such as Trazadone were studied and it was found in the 10 cases that every person had an elevation in peripheral edema and as soon as they were titrated off the meds their edema was gone.
If a woman had Type-2 diabetes, it appears that 5.2 percent of all them on the medications for this disease will get peripheral edema. So it is anticipated that women with breast cancer who are also diabetic are at increased risk for lymphedema issues.
As you can see, medications can play a significant role in the development of peripheral edema and the exacerbation of breast cancer-related lymphedema.
Please refer your cancer patients for a physical therapy evaluation as soon as they begin treatment so that healthy habits for the system can be set in motion and the likelihood of lymphedema is mitigated.
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Sheree DiBiase, PT, is the owner of Lake City Physical Therapy and if you are a breast cancer patient please come see us so we can help. Your health is important to us.
Call Hayden, 208-762-2100; Coeur d’Alene, 208-667-1988; and Spokane Valley, 509-891-2623.