Cancer related lymphedema - prophylaxis and management

Breast-cancer related lymphoedema is a serious and concerning condition that can occur after breast cancer surgery, lymph node excision, or radiation therapy. Affected patients experience functional disability, psychosocial problems, and impaired quality of life. Thus, prevention strategies are essential. At the current global medical online hub (MOH) webinar “Cancer-related lymphoedema - prophylaxis and management” on October 22, 2022, Prof. Pinar Borman and Dr Vincent Paramanandam discussed preventive measures to avoid lymphoedema in breast cancer patients and highlighted the benefits of compression garments in this context.

The 9th online event of the global MOH series was co-moderated by Sylvain Gaillard, Head of Corporate Medical Marketing at SIGVARIS GROUP in Switzerland and Dr Andrzej Szuba, professor of medicine at Wroclaw Medical University, Poland. In her engaging talk, Dr Pinar Borman, professor of physical medicine and rehabilitation at the University of Health Sciences in Ankara, Turkey, reviewed the importance of preventing lymphoedema in breast cancer patients. Ideally, patient education about risk factors and prevention strategies should be initiated before breast cancer treatment. After treatment, limb volume and patients’ subjective complaints should be regularly monitored in a prospective surveillance approach. In this context, Prof. Borman discussed the pros and cons of different methods to assess breast cancer-related lymphoedema (BCRL).

Literature reviews indicated the benefits of lymphoedema prevention programmes with compression garments in addition to general precautions such as education and exercise. Randomised controlled trials demonstrated the effectiveness of compression sleeves following breast cancer surgery. Prophylactic compression sleeves not only prevented lymphoedema, but also increased functionality and quality of life. Thus, compression garments should be prescribed to all patients at risk of BCRL. The adherence of patients to compression is the most important aspect of prevention. Correspondingly, the incidence of BCRL was significantly lowered in patients who adhered to daily use of compression garments.

Dr Vincent Paramanandam, qualified cancer case specialist and certified lymphoedema therapist at the University of Sydney, Australia, presented results from a blinded randomised controlled parallel group trial conducted at the Tata Memorial Cancer Centre in Mumbai from 2017 to 2020. The study investigated the prophylactic use of compression sleeves to reduce the incidence of arm swelling in women at high risk of BCRL.

A total of 307 adult women referred for breast cancer surgery were randomly assigned to either an intervention or control group. In addition to standard postoperative care, the intervention group received a pair of compression sleeves to wear postoperatively at least 8 h per day until 3 months after completion of adjuvant treatments. In total, 152 and 149 women from the intervention and control group were analysed, respectively. Participants in both groups were well balanced in baseline characteristics. The estimated cumulative incidence of arm swelling at 1 year was lower in the intervention group compared to the control group based on bioimpedance spectroscopy (42% vs 52%; HR 0.61, 95% CI 0.43-0.85; p=0.004) and relative arm volume increase (14% vs 25%; HR 0.56, 95% CI 0.33-0.96; p=0.034). The time to documentation of the first minimally important difference in four scales of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the breast cancer-specific questionnaire (BR23) was comparable between the groups.

Dr Paramanandam concluded that the prophylactic use of compression sleeves delayed and reduced the occurrence of arm swelling, and did not negatively affect quality of life, physical function and breast or arm symptoms.

The subsequent lively discussion, which was joined by distinguished panellist Orsi Kokai (Australia), Nouf Aldhwayan (Saudi Arabia) and Prof Margaret McNeely (Canada), touched on the importance of education, patient compliance, preventive measures, barriers to surveillance and prescribing compression garments in different countries as well as use of compression at night.

Watch the full session

Our line-up

Speakers

 

The importance of prevention of lymphedema in breast cancer-related lymphedema: How and when?

Pinar Borman

Pinar Borman, TUR

Professor of Physical Medicine and Rehabilitation & Algologyand founder member and chair of Turkish Lymphedema Association. She has also formed Hacettepe University Lymphedema Research and Practice Center and was head of this organization until 2020. Dr Borman is the representative of Turkey in International Lymphedema Framework (ILF) International Board and founder member of International Lipoedema Association (ILA). She is a member of the Cancer Rehabilitation Special Interest group of ISPRM. She is currently working academically in the University of Health Sciences Medical Faculty and Ankara City Hospital Department of Physical Medicine and Rehabilitation. She is the author of more than 200 international and national papers.

 

Prophylactic Use of Compression Sleeves Reduces the Incidence of Arm Swelling

Vincent Paramanandam

Vincent Paramanandam, AUS

Onco-Physiotherapist; Cancer survivorship researcher; Exercise in Oncology, Lymphoedema and Fatigue; completed his Doctor of Philosophy degree at The University of Sydney in 2021. His thesis title was Effectiveness of compression sleeve in preventing breast cancer-related lymphoedema. He has completed MSc in Cancer Care with Distinction from Oxford Brookes University, UK. He has an MSc degree in Psychology and a bachelor's degree in Physiotherapy. He has 20 years of experience in cancer physiotherapy. He has conducted Lymphoedema certification programs, been an organizing secretary for Cancer Rehabilitation workshops multiple times, Scientific committee member for the CanRehab conference (2017) and taught in the Onco-physiotherapy program at Tata Memorial Hospital, Mumbai, India.

Panelists

Orsi Kokai

Orsi Kokai, AUS (Linkedin)

Oncology Physiotherapist and Practice Owner
Experienced physiotherapist and leading specialist in cancer care and lymphoedema management with over 20 years' clinical experience in Australia and Germany. Established in private practice in Sydney since 2011, practice owner at Oncology Recovery Services Inc.
Higher degree in research, investigating lymphoedema and compression.

 

 

 

Nouf Aldhwayab

Nouf Aldhwayan, KSA (Twitter)

Outpatient Supervisor of the Physical Therapy Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia; Clinically oversee patient care for Lymphedema and breast cancer patients. On a broader scale, also oversee the training and competency development of Lymphedema Therapists.

 

Margaret McNeely

Margaret McNeely, CA (LinkedIn)

Professor in the Department of Physical Therapy at the University of Alberta, in a jointly funded position with the Department of Oncology, Cancer Care Alberta. She is also the Director of the Cancer Rehabilitation Research Clinic at the University of Alberta. Her research explores the benefit of cancer rehabilitation and exercise interventions for cancer related impairments of pain, fatigue and lymphedema.

Moderators

Andrzej Szuba

Andrzej Szuba, PL (LinkedIn)

Professor of Medicine, Division of Angiology w Wroclaw Medical University, Poland; Head of the Internal Medicine Department at 



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Sylvain Gaillard, CH (LinkedIn)


Head of Corporate Medical Marketing of SIGVARIS GROUP and an experienced clinical / medical expert in pharmaceutical industry

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