The results of the intensive phase of complete decongestive therapy and the determination of predictive factors for response to treatment in patients with breast cancer related‐lymphedema

Abstract

Background: Lymphedema is a common complication of breast cancer or its treatment. The gold standard treatment for lymphedema is complete decongestive therapy. There are few studies about the predictive factors for the effectiveness of complete decongestive therapy.Aim: To evaluate the results of the intensive phase of complete decongestive therapy, and to determine the predictive factors for the response to treatment in patients with breast cancer-related lymphedema.Methods and Results: Fifty-seven patients with breast cancer-related lymphedema (mean age: 56.2 ± 11.2 years) who underwent complete decongestive therapy between 2014 and 2016 were evaluated retrospectively. Extremity volume was calculated using circumferential measurements and the truncated cone formula technique. Response to treatment was evaluated using the percentage reduction of excess volume formula, which was obtained by calculating the extremity volume before and after treatment. The median percentage reduction of excess volume was 27.7% (IQR,13.6-50.3). The history of skin infection was related to lower percentage reduction of excess volume (P = 0.001). Although percentage reduction of excess volume was positively correlated with education level (r = 0.286, P = 0.031), percentage reduction of excess volume was negatively correlated with lymphedema duration (r = −0.361, P = 0.006), postoperative duration (r = −0.314, P = 0.018), percentage of excess volume (r = −0.398, P = 0.002), and number of complete decongestive therapy sessions (r = −0.436, P = 0.001). Univariate and multivariate analyses showed that the independent variables for percentage reduction of excess volume were percentage of excess volume (P = 0.009) and education level (P = 0.021). Conclusion:Complete decongestive therapy is an effective method in patients with breast cancer related-lymphedema. The most important predictive factors for the efficacy of treatment were found as percentage of excess volume and education level. Patients with breast cancer should be followed up regularly and receive complete decongestive therapy in the early stage of lymphedema.Abbreviations: ALND, axillary lymph node dissection; BMI, body mass index; CDT, complete decongestive therapy; IQR, interquartile range; PEV, percentage of excess volume; PREV, percentage reduction of excess volume; SD, standard deviation; SLNB, sentinel lymph node biopsy. 4 of 8 KESKIN ET AL. 4 of 8 KESKIN ET AL. How to cite this article: Keskin D, Dalyan M, Ünsal-Delialio glu S, Düzlü-Öztürk Ü. The results of the intensive phase of complete decongestive therapy and the determination of predictive factors for response to treatment in patients with breast cancer related-lymphedema. Cancer Reports. 2020;e1225. https://doi.org/10.1002/cnr2.1225 8 of 8 KESKIN ET AL. How to cite this article: Keskin D, Dalyan M, Ünsal-Delialio glu S, Düzlü-Öztürk Ü. The results of the intensive phase of complete decongestive therapy and the determination of predictive factors for response to treatment in patients with breast cancer related-lymph...

What do we know about treating breast-cancer-related lymphedema? Review of the current knowledge about therapeutic options

“…Intensive phase of CDT was proved to have a positive influence on lymphedema reduction with effects seen despite previous treatment strategy [45,46]. Keskin et al showed that the benefits were greater if the CDT was applied in the early lymphedema stage (stage I) [45]. Findings were confirmed by Borman et al, who reported that improvements in volume were related negatively with the stage of BCRL, and additionally, with the duration of the disease [47].…”

“…It consists of a life-long self-care therapy including compression therapy, exercises, and selfmade MLD provided with various frequency [44]. Intensive phase of CDT was proved to have a positive influence on lymphedema reduction with effects seen despite previous treatment strategy [45,46]. Keskin et al showed that the benefits were greater if the CDT was applied in the early lymphedema stage (stage I) [45].…”

Surgical rehabilitation of women with upper limb postmastectomy lymphedema

“…Сочетанное использование методов терапии на протяжении всей жизни пациентов с ПМОК может демонстрировать удовлетворительные результаты [26,[43][44][45][46][47][48][49][50][51][52][53][54]. В первую очередь назначают комплексную противоотечную терапию (complex decongestive therapy -CDТ).…”

“…В первую очередь назначают комплексную противоотечную терапию (complex decongestive therapy -CDТ). Она включает в себя мануальный лимфатический дренаж, пневмокомпрессионное лечение, индивидуальные физические упражнения и уход за кожей [43][44][45][46][47][48][49]. Применяют компрессионный эластический трикотаж, обеспечивающий статическую компрессию (минимум 30 мм рт.…”

Pre- and Post-Microsurgical Rehabilitation Interventions and Outcomes on Breast Cancer–Related Lymphedema: a Systematic Review

“…Conservative treatments for BCRL include manual lymphatic drainage (MLD), compression bandaging and garments, exercise, and skin care, which are often provided collectively as complete decongestive therapy (CDT). CDT is considered the mainstay of BCRL conservative treatment and is conducted in a decongestive phase, which is provided by a certified lymphedema practitioner, and a maintenance phase, which is conducted as self-care by the patient [ 12 •]. Sequential pneumatic compression and elastic taping are additional modalities that compliment CDT in the management of BCRL [ 13 ].…”