Sauna for lymphedema (including breast cancer-related lymphedema)
Evidence review
Overview
No trial of sauna or other whole-body heat as a treatment for lymphedema was found. In a prospective analysis of 295 breast cancer survivors with or at risk for breast cancer-related lymphedema, sauna use was the only one of 30 common exposures that significantly predicted incident arm swelling. The authors concluded that women who have had axillary surgery should avoid sauna use.
Key findings
- 295 breast cancer survivors followed for 1 year: 27 (9%) developed incident arm swelling; sauna use was the only exposure significantly predictive of swelling (p=0.05) (Showalter 2013).
Every study we reviewed
1 found harm
Each study was checked on PubMed. The colored edge shows the direction of the result. The research library lists 2 studies on lymphedema, across all heat and cold therapies, including case reports and older work not graded here.
Lifestyle risk factors associated with arm swelling among women with breast cancer.
Showalter SL et al. Ann Surg Oncol. 2013. PubMed 23054109 · DOI · Free full text
- Who
- Breast cancer survivors with or at risk for breast cancer-related lymphedema (Physical Activity and Lymphedema trial)
- What
- Self-reported exposure to 30 potential risk factors, including sauna use, every 3 months for 1 year
- Protocol
- 52 wk
- Measured
- Incident arm swelling (>=5% increase in interlimb water volume difference)
- Result
- 27 of 295 (9%) had incident arm swelling; sauna use was the only exposure significantly predictive of incident swelling (p=0.05).
- Limitations
- Secondary analysis of an exercise RCT; self-reported exposure; few events; borderline p value; effect size not given in abstract.
Protocols used in the studies
No treatment protocol exists. The cohort recorded self-reported sauna use without temperature or duration.
What is still unknown
Whether the association between sauna and arm swelling is causal and dose-dependent; whether short or lower-temperature sessions with compression garments carry the same risk; effects in primary or lower-limb lymphedema.
Safety
Cautions for sauna in this condition
- Sauna use was associated with incident arm swelling in breast cancer survivors after axillary surgery (PMID 23054109); the authors recommended avoiding sauna in this group.
- Local heating of a lymphedematous limb (hot-water limb immersion or microwave) is a different, local modality and is not covered here.
For clinicians
Suggested rationale
There is no trial evidence that sauna benefits lymphedema, and the only patient data found associate sauna use with incident arm swelling after breast cancer surgery (Showalter 2013); this evidence does not support sauna for lymphedema and suggests caution.
Suggested wording only. The treating clinician decides whether it reflects their clinical judgment for this patient.
Typical ICD-10 codes: I89.0, I97.2. Examples only; the clinician assigns the code.
What a letter of medical necessity should containWho can write it: physicians, NPs, PAs and others