Effectiveness of Lymphedema Prevention Programs With Compression Garment After Lymphatic Node Dissection in Breast Cancer: A Randomized Controlled Clinical Trial

Abstract

Background: Patients with breast cancer who undergo axillary lymph node dissection (ALND) are at risk of developing lymphedema, which can negatively impact quality of life. Lymphedema prevention programs, which primarily consist of educational content and exercise, have been shown to reduce the incidence of lymphedema. The addition of compression garments (CG) may increase the effectiveness of these programs.Aim: We aimed to determine whether adding a compression garment to a conventional lymphedema prevention program could improve treatment effectiveness.Design: Randomized clinical trial.Methods: Seventy patients who had undergone ALND for breast cancer were randomized to receive conventional preventative therapy (control arm, n = 35) consisting of a 1-hour educational session and a 12-week exercise program or the same therapy plus upper limb CGs (experimental arm, n = 35). Patients in the experimental arm were instructed to wear the CG ≥ 8 h/day for the first 3 months after surgery and 2 h/day thereafter.Results: At 2-years, the overall incidence of lymphedema in the two groups was 12.3%, with no significant differences between the conventional and experimental arms (12.5 vs. 12.1%). In the experimental arm, the incidence of lymphedema was significantly lower (p = 0.02) in patients who used the CGs daily as recommended compared to patient who did not adhere to this treatment recommendation. Neither exercise (p = 0.518) nor education alone decreased the incidence of lymphedema. Adherence decreased over time.Conclusions: The findings of this RCT show that health education, preventive exercise programs, and patient adherence to therapeutic recommendations all play an important role in preventing lymphedema.Clinical Rehabilitation Impact: Our data demonstrated that the use of a compression garment during the first 3 months after axillary node dissection may reduce the likelihood of lymphedema in high-risk patients.

Immediate Lymphatic Reconstruction Using a Handheld Fluorescence Imaging Device

“…Physical activity plays a pivotal role in these lymphedema prevention programs, as it enhances lymphatic and venous flow. [21][22][23][24][25] Compression stockings or sleeves exert controlled pressure on the affected limb, reducing the accumulation of excess lymphatic fluid and preventing reflux. 21,22,26 Lastly, obesity has been identified as a significant risk factor for the development and progression of lymphedema.…”

“…[21][22][23][24][25] Compression stockings or sleeves exert controlled pressure on the affected limb, reducing the accumulation of excess lymphatic fluid and preventing reflux. 21,22,26 Lastly, obesity has been identified as a significant risk factor for the development and progression of lymphedema. 27,28 Thus, maintaining a healthy weight through diet and exercise can aid patients in reducing the risk of lymphedema-related complications.…”

Various Therapies for Lymphedema and Chronic Venous Insufficiency, Including a Multimodal At-Home Nonpneumatic Compression Treatment

“…Appropriate preemptive use of a compression garment during the first few months after axillary node dissection could reduce the likelihood of lymphedema in high-risk patients. 15 In addition, current lymphatic and CVI guidelines and expert consensus favor routine use of compression garments to reduce lymphedema progression. 7,10 However, the donning and doffing of these garments remain a challenge, which can lead to poor adherence.…”

“…These compression garments are worn daily throughout waking hours, and special garments for night use can also be worn. Appropriate preemptive use of a compression garment during the first few months after axillary node dissection could reduce the likelihood of lymphedema in high-risk patients 15 . In addition, current lymphatic and CVI guidelines and expert consensus favor routine use of compression garments to reduce lymphedema progression 7,10 .…”

Nonsentinel Axillary Lymph Node Status in Clinically Node-Negative Early Breast Cancer After Primary Systemic Therapy and Positive Sentinel Lymph Node: A Predictive Model Proposal

“…10,11 Likewise, surgical management of the axilla has undergone an important shift toward less radicality due to the important morbidities associated with ALND. The most relevant and frequent is lymphedema, occurring in * 5% of patients undergoing exclusive sentinel lymph node biopsy (SLNB), and 12-25% of patients undergoing ALND, [12][13][14] with incidence increasing up to six times when C 15 lymph-nodes are dissected. 15 Lymphedema is an important comorbidity, affecting different areas of physical and social functioning, bodily pain, and general and mental health.…”