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 MOH Talk “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 Dr Sylvain Gaillard, corporate medical affairs manager 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.
Take Home Messages:
- BCRL is a serious and concerning complication after treatment of breast cancer, leading to functional disability, limiting daily living activities and impairing quality of life.
- Patients should be well informed and aware of their BCRL risk.
- Arm swelling in the first year post surgery is a predictive factor of lymphoedema.
- Prophylactic intervention and self-management techniques can help to prevent and reduce BCRL.
- 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.