This is the author’s version of a work that was submitted/accepted for pub-
lication in the following source:
Finnane, Anna, Liu, Yuan, Battistutta, Diana, Janda, Monika, & Hayes,
Sandra C. (2011) Lymphedema After Breast or Gynecological Cancer:
Use and Effectiveness of Mainstream and Complementary Therapies.
Lymphedema After Breast or Gynecological Cancer: Use and Effective-
ness of Mainstream and Complementary Therapies, 17(9), pp. 867-869.
This file was downloaded from: http://eprints.qut.edu.au/46303/
Notice: Changes introduced as a result of publishing processes such as
copy-editing and formatting may not be reflected in this document. For a
definitive version of this work, please refer to the published source:
Lymphedema After Breast or Gynecological Cancer:
Use and Effectiveness of Mainstream
and Complementary Therapies
Anna Finnane, BHSc,1,2Yuan Liu, MTCM,1,2Diana Battistutta, PhD,2
Monika Janda, PhD,1,2and Sandra C. Hayes, PhD1,2
Objectives: The purpose of this study was to describe the use, as well as perceived effectiveness, of mainstream
and complementary and alternative medicine (CAM) therapies in the treatment of lymphedema following breast
or gynecological cancer. Further, the study assessed the relationship between the characteristics of lymphedema
(including type, severity, stability, and duration), and the use of CAM and/or mainstream treatment.
Methods: This was a cross-sectional study using a convenience sample of women with lymphedema following
breast and gynecological cancers. A self-administered questionnaire was sent to 247 potentially eligible women.
Of those returned (50%), 23 were ineligible and 6 were excluded due to level of missing data.
Results: In the previous 12 months, the majority of women (90%) had used mainstream treatments to treat their
lymphedema, with massage being the most commonly used (86%). One (1) in 2 women had used CAM to treat
their lymphedema, and 98% of those using CAM were also using mainstream treatments. Over 27 types of CAM
were reported, with use of a chi machine, vitamin E supplements, yoga, and meditation being the most com-
monly reported forms. The perceived effectiveness ratings (1–7 with 7=completely effective) of mainstream
(mean–standard deviation (SD): 5.3–1.5) and CAM therapies (mean–SD: 5.2+1.6) were considered high.
Conclusions: These results demonstrate that mainstream and CAM treatment use is common, varied, and
considered to be effective among women with lymphedema following breast or gynecological cancer. Fur-
thermore, it highlights the immediate need for larger prospective studies assessing the inter-relationship be-
tween the use of mainstream and CAM therapies for treatment success.
swelling and skin changes.1Mainstream or complementary
and alternative medicine (CAM) treatments for lymphedema
aim to reduce swelling, prevent progression, reduce risk of
infection, and alleviate associated symptoms.2Early diag-
noses, rapid initiation of treatment, and high adherence to
treatment have been reported to optimize treatment success,3
and lack of treatment has been associated with lymphedema
progression.2Unfortunately, access to treatment, associated
costs, and the time and/or discomfort associated with daily
treatment is considered unacceptable to some and may in-
fluence treatment effectiveness.4,5The purpose of this study
was to describe the use and perceived effectiveness of main-
stream and CAM therapies in the treatment of lymphedema
following breast or gynecological cancer.
ymphedema is a condition characterized by impaired
drainage of lymphatic fluid, commonly resulting in
Self-administered questionnaires were sent to 247 mem-
bers of the Lymphedema Association of Queensland and
were returned by half of them (n=124). A further 29 par-
ticipants were excluded due to ineligibility or missing data,
leaving data from 95 participants for analysis.
Information on demographic characteristics, lymphedema
characteristics, and lymphedema treatment types used were
collected via a self-administered questionnaire. Twenty-two
(22) treatment types were listed, and additional space was
provided to record unlisted treatments. Treatment types
were classified as CAM if they were considered an approach,
practice, or product that did not fit within conventional or
mainstream medicine.6Perceived effectiveness of treatments
in improving symptoms of lymphedema was measured
using a 7-point Likert scale, whereby 0 denoted ‘‘not at all
effective’’ and 7 denoted ‘‘completely effective.’’
1School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia.
2Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE
Volume 17, Number 9, 2011, pp. 867–869
ª Mary Ann Liebert, Inc.
Descriptive statistics were used to summarize personal
and lymphedema characteristics of the sample. Unadjusted
logistic regression was used to determine the relationship
between mainstream or CAM treatment use, and personal
and lymphedema characteristics. Statistical significance was
set at <0.05 (two tailed) for all analysis. Data analyses were
performed using SPSS version 17.0.
Characteristics of the sample are presented in Table 1. In
summary, all respondents were females and had undergone
(22%). Over two thirds (69%) reported household annual in-
Nearly 75% of the sample had upper-limb lymphedema,
18% had lower-limb lymphedema, and the remaining par-
ticipants (n=7, 7%) had lymphedema in both upper and
lower limbs. A range of lymphedema severities were re-
ported, with 19%, 27%, and 13% of participants describing
their lymphedema as mild, moderate, and severe, respec-
tively. Those remaining (41%) reported experiencing a mix-
ture of symptom severities over the involved limb segments.
The majority (76%) described their lymphedema as fluctu-
ating in stability, and most of the respondents (70%) reported
having had lymphedema for longer than 5 years.
Table 2 provides the list of therapies used by participants
in the previous 12 months. Of those who reported using
CAM therapy in the previous 12 months (45% of sample),
more than half reported using two or more forms and 98%
also reported using some form of mainstream treatment. Use
of a chi machine, t’ai chi, vitamin E supplements, meditation,
and/or yoga were used by 21%–35% of those reporting CAM
therapies, while other forms of CAM including selenium
supplements, spiritual healing, reiki, naturopathy, acupunc-
ture, and homeopathy were reported by 5%–11%. The per-
ceived effectiveness of mainstream therapies (mean–SD:
5.3–1.5) and CAM therapies (mean–SD: 5.2–1.6) was sim-
Compared with women 65 years or older, the odds of using
CAM were at least twofold higher for those aged 64 years or
less (p=0.05). Those with stable lymphedema also had higher
odds of using CAM (odds ratio [OR]=4.95, 95% confidence
interval (CI)=1.27–19.35, p<0.05), compared with those who
described their lymphedema as fluctuating. Although not
statistically supported, employed women and women with
Table 1. Patient Characteristics
of the Sample (n=95)
Patient characteristicsn (%)
65 years and older
Living with partner
Living without partner
Yearly household income
$50,000 and over
Private health insurance
Number of cancers
aMultiple responses possible.
Table 2. Treatment Types Used by People
with Lymphedema, Classified as Mainstream
or Complementary and Alternative Medicine
Mainstream treatment types
Manual lymph drainage
Complementary and alternative medicine
Detox water treatment
Vegetable bristle body brushing
Vitamin and mineral supplements
868 FINNANE ET AL.
yearly household incomes of $50,000 or more had higher odds
of using CAM therapy (OR=2.41, 95% CI=0.86–6.79 and
OR=2.43, 95% CI=0.92–6.39, respectively), compared with
those who were retired or did home duties and those with
incomes below $50,000 per year, respectively.
Despite the high perceived effectiveness of mainstream
treatment, about 1 in 2 women reported multiple mainstream
treatments, and 1 in 2 also used at least one of the 22 CAM
therapies to treat their lymphedema during the same period.
CAM therapies maybe used as an alternative treatmentoption
following poor response to mainstream lymphedema thera-
pies.7However, since almost all women in our sample re-
the same period, it seems morelikelythat CAM therapies were
considered complementary rather than alternative.
Previous work by others has described the financial, time,
and lifestyle burden of typical forms of mainstream treat-
ment options.8,9Despite high perceived effectiveness ratings,
the burden may be sufficient to encourage those with lym-
phedema to source alternative treatment options. This may
be more likely for particular subgroups, such as younger
women and those who are employed, who were more likely
to use CAM treatments in this study. It could be assumed
that treatment options scoring similar or higher effectiveness
ratings that place lower burden on the women might become
the sole or alternative forms of treatment, replacing main-
stream options. Consequently, it seems plausible that while
the forms of CAM treatment reported were perceived to be
effective, multiple barriers prevented them from becoming
alternative forms of treatment.
The generalizability of the results presented is limited to
women who developed lymphedema following breast or
gynecological cancer, and the cross-sectional design pre-
cludes the identification of specific treatment effects on
lymphedema symptoms. All respondents were members of a
support organization and may not be representative of the
general secondary lymphedema population. In addition,
there were insufficient data to explore the use and effec-
tiveness of individual mainstream or CAM treatment mo-
dalities. Nonetheless, this work provides initial insight into
the extent of mainstream and CAM use in the treatment of
lymphedema following cancer, as well as the perceived ef-
fectiveness of such treatment from the perspective of the
patient. Given the extent and range of CAM therapies used
by women in this study, future research attention should be
given to the inter-relationship between mainstream and
CAM therapies for treatment success.
No competing financial interests exist.
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Address correspondence to:
Anna Finnane, BHSc
School of Public Health
Institute of Health and Biomedical Innovation
Queensland University of Technology
Victoria Park Road
Kelvin Grove, Queensland 4059
TREATMENT FOR LYMPHEDEMA: USE AND EFFECTIVENESS869