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Efficacy of self-administered complex decongestive therapy on breast cancer-related lymphedema: a single-blind randomized controlled trial

  • M. B. Ligabue
  • I. CampaniniEmail author
  • P. Veroni
  • A. Cepelli
  • M. Lusuardi
  • A. Merlo
Clinical trial
First Online:

Abstract

Purpose

After surgery, breast cancer-related lymphedema (BCRL) is a frequent chronic condition. The complex decongestive therapy (CDT) delivered by physiotherapists at hospitals is the state-of-the-art treatment choice. As lymphedema requires continuous management, we designed a 1-month-long course to train women to professionally carry out a self-administered CDT (saCDT) and tested its efficacy while keeping the benefits of CDT.

Methods

Consecutive patients treated with CDT over a 1-year period at an Italian facility were randomly assigned to either experimental (EXP, saCDT course) or control (CTRL, usual care) group. Women were assessed before, at 1, and 6 months from enrolment. Pain assessed by the numerical pain rating scale (NPRS) was the primary outcome. Arm asymmetry assessed by the excess limb volume (ELV) was the secondary outcome. Outcome variations were compared to their MCID to classify women as improved, stable, or worsened.

Results

Forty-one women were included. The proportion of stable or improved women was significantly different between EXP and CTRL groups at 6 months after enrolment for both arm pain (p = 0.01) and asymmetry (p < 0.01). Noteworthy, only one EXP woman had worsened after 6 months. NPRS significantly decreased in the EXP group only, with a median variation of 2 points. Arm ELV significantly decreased with respect to the baseline value in the EXP group only, with a median reduction of 8%.

Conclusions

Teaching saCDT to women with BCRL is effective in maintaining or improving the benefits of CDT and can be used as a self-care tool in the management of BCRL.

Keywords

Lymphedema Breast cancer Self-care Complex decongestive therapy 
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Notes

Acknowledgements

The authors would like to acknowledge Dr. Franca Coppadoro and her team at the Fatebenefratelli Hospital, Milan, Italy, for their kind and fruitful suggestions on the use of self-treatment in the management of lymphedema.

Author contributions

MBL, IC, AM: Conceptualization—Ideas; formulation or evolution of overarching research goals and aims. IC, AM: Data Curation—Management activities to annotate (produce metadata), scrub data, and maintain research data (including software code, where it is necessary for interpreting the data itself) for initial use and later reuse. AM: Formal Analysis—Application of statistical, mathematical, computational, or other formal techniques to analyze or synthesize study data. ML: Funding Acquisition—Acquisition of the financial support for the project leading to this publication. IC, AC, PV, MBL: Investigation—Conducting a research and investigation process, specifically performing the experiments, or data/evidence collection. IC: Methodology—Development or design of methodology; creation of models. IC: Project Administration—Management and coordination responsibility for the research activity planning and execution. n.a.: Resources—Provision of study materials, reagents, materials, patients, laboratory samples, animals, instrumentation, computing resources, or other analysis tools. AM: Software—Programming, software development; designing computer programs; implementation of the computer code and supporting algorithms; testing of existing code components. IC: Supervision—Oversight and leadership responsibility for the research activity planning and execution, including mentorship external to the core team. n.a.: Validation—Verification, whether as a part of the activity or separate, of the overall replication/reproducibility of results/experiments and other research outputs. AM, IC: Visualization—Preparation, creation and/or presentation of the published work, specifically visualization/data presentation. AM, IC: Writing—Original Draft Preparation—Creation and/or presentation of the published work, specifically writing the initial draft (including substantive translation). n.a.: Writing—Review & Editing—Preparation, creation, and/or presentation of the published work by those from the original research group, specifically critical review, commentary, or revision—including pre- or post-publication stages.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed during studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and comply to the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the local Ethics Committee (2017/0123714). All women signed an informed consent to data treatment.

Supplementary material

10549_2019_5136_MOESM1_ESM.pdf (330 kb)
Supplementary material 1 (PDF 329 KB)

References

  1. 1.
    Badger C, Preston N, Seers K, Mortimer P (2004) Physical therapies for reducing and controlling lymphoedema of the limbs. Cochrane Database Syst Rev.  https://doi.org/10.1002/14651858.CD003141.pub2 Google Scholar
  2. 2.
    Ezzo J, Manheimer E, McNeely ML, Howell DM, Weiss R, Johansson KI, Bao T, Bily L, Tuppo CM, Williams AF, Karadibak D (2015) Manual lymphatic drainage for lymphedema following breast cancer treatment. Cochrane Database Syst Rev 5:CD003475.  https://doi.org/10.1002/14651858.CD003475.pub2 Google Scholar
  3. 3.
    McNeely ML, Campbell K, Ospina M, Rowe BH, Dabbs K, Klassen TP, Mackey J, Courneya K (2010) Exercise interventions for upper-limb dysfunction due to breast cancer treatment. Cochrane Database Syst Rev 6–8.  https://doi.org/10.1002/14651858.CD005211.pub2
  4. 4.
    Mondry TE, Riffenburgh RH, Johnstone P, a S (2004) Prospective trial of complete decongestive therapy for upper extremity lymphedema after breast cancer therapy. Cancer J 10:42–48; discussion 17–19.  https://doi.org/10.1097/00130404-200401000-00005 CrossRefGoogle Scholar
  5. 5.
    Douglass J, Graves P, Gordon S (2016) Self-care for management of secondary lymphedema: a systematic review. PLoS Negl Trop Dis 10:1–20.  https://doi.org/10.1371/journal.pntd.0004740 CrossRefGoogle Scholar
  6. 6.
    Taghian NR, Miller CL, Jammallo LS, O’Toole J, Skolny MN (2014) Lymphedema following breast cancer treatment and impact on quality of life: a review. Crit Rev Oncol Hematol 92:227–234CrossRefGoogle Scholar
  7. 7.
    Koul R, Dufan T, Russell C, Guenther W, Nugent Z, Sun X, Cooke AL (2007) Efficacy of complete decongestive therapy and manual lymphatic drainage on treatment-related lymphedema in breast cancer. Int J Radiat Oncol Biol Phys 67:841–846.  https://doi.org/10.1016/j.ijrobp.2006.09.024 CrossRefGoogle Scholar
  8. 8.
    Stuiver MM, ten Tusscher MR, McNeely ML (2017) Which are the best conservative interventions for lymphoedema after breast cancer surgery? BMJ 2330:j2330.  https://doi.org/10.1136/bmj.j2330 CrossRefGoogle Scholar
  9. 9.
    Norman SA, Localio AR, Potashnik SL, Torpey HAS, Kallan MJ, Weber AL, Miller LT, Demichele A, Solin LJ (2009) Lymphedema in breast cancer survivors: incidence, degree, time course, treatment, and symptoms. J Clin Oncol 27:390–397.  https://doi.org/10.1200/JCO.2008.17.9291 CrossRefGoogle Scholar
  10. 10.
    Finnane A, Janda M, Hayes SC (2015) Review of the evidence of lymphedema treatment effect. Am J Phys Med Rehabil 94:483–498.  https://doi.org/10.1097/PHM.0000000000000246 CrossRefGoogle Scholar
  11. 11.
    McNeely ML, Magee DJ, Lees AW, Bagnall KM, Haykowsky M, Hanson J (2004) The addition of manual lymph drainage to compression therapy for breast cancer related lymphedema: a randomized controlled trial. Breast Cancer Res Treat 86:95–106.  https://doi.org/10.1023/B:BREA.0000032978.67677.9f CrossRefGoogle Scholar
  12. 12.
    Andersen L, Højris I, Erlandsen M, Andersen J (2000) Treatment of breast-cancer-related lymphedema with or without manual lymphatic drainage: a randomized study. Acta Oncol (Madr) 39:399–405.  https://doi.org/10.1080/028418600750013186 CrossRefGoogle Scholar
  13. 13.
    Rogan S, Taeymans J, Luginbuehl H, Aebi M, Mahnig S, Gebruers N (2016) Therapy modalities to reduce lymphoedema in female breast cancer patients: a systematic review and meta-analysis. Breast Cancer Res Treat 159:1–14.  https://doi.org/10.1007/s10549-016-3919-4 CrossRefGoogle Scholar
  14. 14.
    Casley-Smith JR (1995) Alterations of untreated lymphedema and it’s grades over time. Lymphology 28:174–185Google Scholar
  15. 15.
    Jeffs E, Wiseman T (2013) Randomised controlled trial to determine the benefit of daily home-based exercise in addition to self-care in the management of breast cancer-related lymphoedema: a feasibility study. Support Care Cancer 21:1013–1023.  https://doi.org/10.1007/s00520-012-1621-6 CrossRefGoogle Scholar
  16. 16.
    Sagen Å, Kåresen R, Risberg MA (2009) Physical activity for the affected limb and arm lymphedema after breast cancer surgery. A prospective, randomized controlled trial with two years follow-up. Acta Oncol (Madr) 48:1102–1110.  https://doi.org/10.3109/02841860903061683 CrossRefGoogle Scholar
  17. 17.
    Van Dijck S, Nelissen P, Verbelen H, Tjalma W, Gebruers N (2016) The effects of physical self-management on quality of life in breast cancer patients: a systematic review. Breast 28:20–28.  https://doi.org/10.1016/j.breast.2016.04.010 CrossRefGoogle Scholar
  18. 18.
    Urbaniak GC, Plous S (2013) Research randomizer (version 4.0) [Computer Software]Google Scholar
  19. 19.
    Williamson A, Hoggart B (2005) Pain: a review of three commonly used pain rating scales. J Clin Nurs 14:798–804.  https://doi.org/10.1111/j.1365-2702.2005.01121.x CrossRefGoogle Scholar
  20. 20.
    Farrar JT, Young JP, LaMoreaux L, Werth JL, Poole RM (2001) Clinical importance of changes in chronic pain intensity measured on an 11-point numerical rating scale. Pain 94:149–158.  https://doi.org/10.1016/S0304-3959(01)00349-9 CrossRefGoogle Scholar
  21. 21.
    Cho Y, Do J, Jung S, Kwon O, Jeon JY (2016) Effects of a physical therapy program combined with manual lymphatic drainage on shoulder function, quality of life, lymphedema incidence, and pain in breast cancer patients with axillary web syndrome following axillary dissection. Support Care Cancer 24:2047–2057.  https://doi.org/10.1007/s00520-015-3005-1 CrossRefGoogle Scholar
  22. 22.
    Moseley AL, Piller NB, Carati CJ (2005) The effect of gentle arm exercise and deep breathing on secondary arm lymphedema. Lymphology 38:136–145Google Scholar
  23. 23.
    Dönmez AA, Kapucu S (2017) The effectiveness of a clinical and home-based physical activity program and simple lymphatic drainage in the prevention of breast cancer-related lymphedema: a prospective randomized controlled study. Eur J Oncol Nurs 31:12–21.  https://doi.org/10.1016/j.ejon.2017.09.004 CrossRefGoogle Scholar
  24. 24.
    Hayes SC, Speck RM, Reimet E, Stark A, Schmitz KH (2011) Does the effect of weight lifting on lymphedema following breast cancer differ by diagnostic method: results from a randomized controlled trial. Breast Cancer Res Treat 130:227–234.  https://doi.org/10.1007/s10549-011-1547-6 CrossRefGoogle Scholar
  25. 25.
    Leduc O, Leduc A, Bourgeois P, Belgrado JP (1998) The physical treatment of upper limb edema. Cancer 83:2835–2839CrossRefGoogle Scholar
  26. 26.
    Buchan J, Janda M, Box R, Schmitz K, Hayes S (2016) A randomized trial on the effect of exercise mode on breast cancer-related lymphedema. Med Sci Sports Exerc 48:.  https://doi.org/10.1249/MSS.0000000000000988
  27. 27.
    Basen-Engquist K, Taylor CLC, Rosenblum C, Smith MA, Shinn EH, Greisinger A, Gregg X, Massey P, Valero V, Rivera E (2006) Randomized pilot test of a lifestyle physical activity intervention for breast cancer survivors. Patient Educ Couns 64:225–234.  https://doi.org/10.1016/j.pec.2006.02.006 CrossRefGoogle Scholar
  28. 28.
    Haines TP, Sinnamon P, Wetzig NG, Lehman M, Walpole E, Pratt T, Smith A (2010) Multimodal exercise improves quality of life of women being treated for breast cancer, but at what cost? Randomized trial with economic evaluation. Breast Cancer Res Treat 124:163–175.  https://doi.org/10.1007/s10549-010-1126-2 CrossRefGoogle Scholar
  29. 29.
    Hwang JM, Hwang JH, Kim TW, Lee SY, Chang HJ, Chu IH (2013) Long-term effects of complex decongestive therapy in breast cancer patients with arm lymphedema after axillary dissection. Ann Rehabil Med 37:690–697.  https://doi.org/10.5535/arm.2013.37.5.690 CrossRefGoogle Scholar
  30. 30.
    Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang XS et al (2015) Global surveillance of cancer survival 1995–2009: analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet 385:977–1010.  https://doi.org/10.1016/S0140-6736(14)62038-9 CrossRefGoogle Scholar
  31. 31.
    Bartholomay M, Mannix C, Barton-Burke M, ML B, Delaney R, Doherty C, Lewis M (2008) A feasibility study of low-cost patient-administered skin care intervention among head and neck cancer patients receiving chemo-radiation. Oncol Nurs Forum 35:494Google Scholar
  32. 32.
    Jansen F, Cnossen IC, Eerenstein SEJ, Coupé VMH, Witte BI, van Uden-Kraan CF, Doornaert P, Braunius WW, De Bree R, Hardillo JAU, Honings J, Halmos GB, Leemans CR, Verdonck-de Leeuw IM (2016) Effectiveness and cost-utility of a guided self-help exercise program for patients treated with total laryngectomy: protocol of a multi-center randomized controlled trial. BMC Cancer 16:580.  https://doi.org/10.1186/s12885-016-2613-6 CrossRefGoogle Scholar
  33. 33.
    Humphreys I, Thomas MJ, Morgan KM (2017) Managing chronic oedema in community settings. Wounds UKGoogle Scholar
  34. 34.
    Do JH, Kim W, Cho YK, Lee J, Song EJ, Chun YM, Jeon JY (2015) Effects of resistance exercises and complex decongestive therapy on arm function and muscular strength in breast cancer related lymphedema. Lymphology 48:184–196Google Scholar
  35. 35.
    Caffo O, Amichetti M, Ferro A, Lucenti A, Valduga F, Galligioni E (2003) Pain and quality of life after surgery for breast cancer. Breast Cancer Res Treat 80:39–48.  https://doi.org/10.1023/A:1024435101619 CrossRefGoogle Scholar
  36. 36.
    Bell RJ, Robinson PJ, Nazeem F, Panjari M, Fradkin P, Schwarz M, Davis SR (2014) Persistent breast pain 5 years after treatment of invasive breast cancer is largely unexplained by factors associated with treatment. J Cancer Surviv 8:1–8.  https://doi.org/10.1007/s11764-013-0306-6 CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Functional Rehabilitation and Recovery Service, San Sebastiano Hospital, Correggio, Neuromotor and Rehabilitation DepartmentAzienda USL-IRCCS di Reggio EmiliaReggio EmiliaItaly
  2. 2.LAM-Motion Analysis Laboratory, San Sebastiano Hospital, Correggio, Neuromotor and Rehabilitation DepartmentAzienda USL-IRCCS di Reggio EmiliaReggio EmiliaItaly
  3. 3.Clinical and Experimental Medicine PhD ProgramUniversity of Modena and Reggio EmiliaModenaItaly
  4. 4.Neuromotor and Rehabilitation DepartmentAzienda USL-IRCCS di Reggio EmiliaReggio EmiliaItaly

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