MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

When I conduct my regular literature searches, I am invariably delighted to find a paper that shows the effectiveness of a so-called alternative medicine (SCAM). Contrary to the impression that I might give to some, I like positive results as much as the next person. So, today you find me pleased to yet again report about one of my favorite SCAMs.

The purpose of this systematic review was to evaluate the effectiveness of manual lymphatic drainage (MLD) in breast cancer-related lymphedema (BCRL) patients.

In total, 11 RCTs involving 1564 patients could be included, and 10 trials were deemed viable for inclusion in the meta-analysis. Due to the effects of MLD for BCRL, statistically significant improvements were found on the incidence of lymphedema (RR = 0.58, 95% CI [0.37, 0.93], P =.02) and pain intensity (SMD = -0.72, 95% CI [-1.34, -0.09], P = .02). Besides, the meta-analysis carried out implied that the effects that MLD had on volumetric changes of lymphedema and quality of life, were not statistically significant.

The authors concluded that the current evidence based on the RCTs shows that pain of BCRL patients undergoing MLD is significantly improved, while our findings do not support the use of MLD in improving volumetric of lymphedema and quality of life. Note that the effect of MLD for preventing BCRL is worthy of discussion.

Lymph drainage is so well-established in cancer care that most people would probably consider it a conventional treatment. If, however, you read for which conditions its inventor, Emil Vodder, used to promote it, they might change their minds. Vodder saw it as a cure for most illnesses, even those for which there is no plausibility or good evidence.

As far as I can see, lymph drainage works well for reducing lymph edema but, for all other conditions, it is not evidence-based. And this is the reason why I still categorize it as a SCAM.

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