Abstract
BackgroundThe aim of this study was to evaluate the effects of complete decongestive therapy (CDT) in patients with breast cancer-related lymphedema (BCRL), in regard to volume reduction, functional status and quality of life (QoL). MethodsFifty patients with unilateral BCRL were included. The demographic variables focusing on lymphedema were recorded. All patients received combined phase 1 CDT including skin-care, manual lymphatic drainage, multilayer bandaging and supervised exercises, 5 times a week for 3 weeks, as a total of 15 sessions. Patients were assessed by limb volumes and excess volumes according to geometric approximation derived from serial circumference-measurements of the limb, prior and at the end of third week. The functional disability was evaluated by quick disability of arm, shoulder and hand questionnaire (Q-DASH). QoL was assessed by the European Organization for Research and Treatment of Cancer Core Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its breast-cancer-module (EORTC QLQ-BR23). ResultsFifty females with mean age of 53.22 ± 11.2 years were included. The median duration of lymphedema was 12 months. There were 22 patients in stage1, 26 in stage2 and 2 patients in stage3. The mean baseline limb and excess volumes were significantly decreased at the end of therapies (3262 ± 753 cm³ vs. 2943 ± 646.6 cm³ and 31.36% ± 16.5% vs. 19.12% ± 10.4%, pP= 0.000 respectively). The Q-DASH and EORTC QLQ-C30 and BR23 scores were also decreased significantly (pP< 0.05). The improvements in volumes were related negatively with the duration of lymphedema, and the stage of lymphedema. ConclusionIn conclusion phase 1 CDT in a combined manner performed daily for 3 weeks, greatly reduces the volumes as well as improves the disability and QoL, especially when performed earlier.
Highlights
Lymphedema is defined as a gradual abnormal swelling of a limb and/or the related quadrant of the trunk due to the accumulation of protein-rich fluid in the tissue spaces of the skin
The presence of macromolecules, proteases and pro-inflammatory molecules may lead to chronic inflammation, fibrosis and hardening of the skin and eventually prone to infections. These symptoms can result in functional disability, psychosocial problems and impaired quality of life in patients with breast cancer-related lymphedema (BCRL) [3,4,5]
Phase 1 therapy includes education and meticulous skin care, manual lymphatic drainage (MLD), multilayer non-elastic compression bandaging and exercises while phase 2 comprises the continuation of skin care and exercise in addition to self -massage and pressure garments
Summary
Lymphedema is defined as a gradual abnormal swelling of a limb and/or the related quadrant of the trunk due to the accumulation of protein-rich fluid in the tissue spaces of the skin. Upper extremity lymphedema is a concerning complication occurred after treatment for breast cancer. It is a chronic disease caused by surgery and/or radiation therapy involving lymph drainage routes of the breast and axillary areas and considered as a potentially serious and debilitating condition [1,2]. The presence of macromolecules, proteases and pro-inflammatory molecules may lead to chronic inflammation, fibrosis and hardening of the skin and eventually prone to infections These symptoms can result in functional disability, psychosocial problems and impaired quality of life in patients with breast cancer-related lymphedema (BCRL) [3,4,5]. The aim of this study was to evaluate the effects of complex decongestive therapy (CDT) in patients with breast cancer-related lymphedema (BCRL), in regard to volume reduction, functional status and quality of life (QoL)
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