Prophylactic use of compression sleeves reduces the incidence of arm swelling

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. The first speaker, Dr Vincent Paramanandam, qualified cancer case specialist and certified lymphoedema therapist at the University of Sydney, Australia, presented results from a randomised controlled trial investigating the prophylactic use of compression sleeves to reduce the incidence of arm swelling in women at high risk of breast cancer-related lymphoedema. 

Women who undergo axillary lymph node dissection as part of their breast cancer surgery are at high risk for lymphoedema. As management of lymphoedema is burdensome to the patient and the health care system, effective prevention strategies that target those at high risk for lymphoedema are required. Arm swelling in the first year is a predictive factor of lymphoedema for these women.

To determine whether prophylactic use of compression sleeves prevents arm swelling in women who had undergone axillary lymph node dissection for breast cancer surgery, a blinded randomised controlled parallel group trial was conducted at the Tata Memorial Cancer Centre in Mumbai from 2017 to 2020.

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 (20-25 mmHg) to wear postoperatively at least 8 hours per day until 3 months after completion of adjuvant treatments. Outcome parameters were assessed at baseline, immediately after suture removal, and at 6 and 12 months after surgery and included bioimpedance spectroscopy (BIS) and quality of life (QoL). In addition, monthly measurements of arm circumference and prevalence of lymphoedema-related symptoms were obtained. Arm swelling was determined by bioimpedance spectroscopy (BIS) and defined as impedance ratio based on the normative threshold of BIS ratio ≥2 standard deviations (primary outcome) and a ≥10% increase from baseline in relative arm volume (RAVI).

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 BIS (42% vs 52%; HR 0.61, 95% CI 0.43-0.85; p=0.004) and RAVI (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 (BR23) questionnaire 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. Since some women developed arm swelling even with prophylactic compression sleeves, it is paramount to educate women about lymphoedema symptoms so that they can identify arm swelling early and seek help. In addition to being beneficial for the patients, this combined approach may help reducing the burden on the healthcare system.

During the subsequent expert discussion, joined by distinguished panellists Prof Pinar Borman (Turkey), Orsi Kokai (Australia), Nouf Aldhwayan (Saudi Arabia) and Prof Margaret McNeely (Canada), Dr Paramanandam answered questions related to compression garments and patient compliance. A long-term follow-up of 5 years is currently ongoing. Prof Borman emphasised the importance of the study, adding value to the literature.

Take Home Messages

• Arm swelling in the first year post surgery is a predictive factor of breast cancer related lymphoedema.
• Prophylactic use of compression sleeves delayed and reduced the occurrence of arm swelling without negative effects on quality of life, physical function and breast or arm symptoms.
• A combined approach of educating women about lymphoedema symptoms and prophylactic use of compression sleeves may prove beneficial for patients and alleviate the burden on the healthcare system.