This trial was unable to demonstrate a significant improvement in lymphedema with decongestive therapy compared with a more conservative approach. The failure to detect a difference may have been a result of the relatively small size of our trial.

The systematic review search strategy identified ten randomized controlled trials which form the basis of this evidence summary report. Four key opinions offered by the SCGG are outlined below. Responses from the practitioner feedback process supported the validity of these opinions in Ontario. (1) There is some evidence to suggest that compression therapy and manual lymphatic drainage may improve established lymphedema, but further studies are needed. Compression garments should be worn from morning to night and be removed at bedtime. Patients should be advised that lymphedema is a lifelong condition and that compression garments must be worn on a daily basis. Patients can expect stabilization and/or modest improvement of edema with the use of the garment in the prescribed fashion. (2) There is no current evidence to support the use of medical therapies, including diuretics. (3) Additional efforts to define relevant clinical outcomes for the assessment of patients with lymphedema would be valuable. (4) These opinions are appropriate for patients with more than mild lymphedema, where the signs and symptoms are considered significant from the patients' perspective.

Hormone-suppression therapies are used for the treatment of breast cancer in the adjuvant and metastatic settings alike. However, side effects—including hot flashes—are frequently reported by patients as a cause of therapy discontinuation. This paper presents an overview of hormonal therapies and the evidence-based management options for hot flashes, summarized in a treatment algorithm.

Aromatase inhibitors (ais) are commonly used as adjuvant treatment in postmenopausal women with hormone receptor–positive early breast cancer. With both steroidal and nonsteroidal ais, ai-induced arthralgia is frequently observed. The mechanism of ai-induced arthralgia remains unknown, and the data available from clinical trails using ais are limited. We review the pertinent information from a clinical perspective, including an algorithm to treat ai-induced arthralgia.

The finding of moderate to severe lymphedema observed in clinics screening for trial eligibility was less than expected. The natural history of lymphedema in breast cancer patients is potentially changing. Some patients may be presenting with sensory changes suggestive of lymphedema but due to other causes, such as nerve disruption following axillary dissection.

Background: Peripheral neuropathy is a common side effect induced by chemotherapy agents like Cisplatin, Paclitaxel and Docetaxel. At present, there is no preventive strategy available against the development of neuropathy. This pilot study was performed to evaluate the feasibility of cold therapy and its impact on the incidence and severity of neuropathy induced by paclitaxel in a dose dense adjuvant regimen among patients with breast cancer. Methods: All adult female patients with early breast cancer planned to be treated with dose-dense schedule of Adriamycin, cyclophosphamide and Paclitaxel were eligible. Ice boot and glove were applied for the duration of all four Paclitaxel infusions on one side while the contralateral limbs were taken as control. Peripheral neuropathy was evaluated and graded prior to each Paclitaxel infusion and then at 3 and 6 months post treatment. Results: A total of 23 patients were recruited. Cold therapy was found to be feasible as no patient discontinued the ice glove and boot during Paclitaxel infusions. Neuropathy symptoms were observed more frequently and with higher grade of severity on control limbs compared to experimental side. There were 5 patients who were switched to ice glove and boot therapy after they developed peripheral neuropathy in the control limbs. These patients observed improvement in their symptoms subsequently. Conclusion: Cold therapy appears to be feasible and appears to have some potential to prevent Paclitaxel induced peripheral neuropathy in this pilot study. This role of cold therapy may be further explored and confirmed in future randomized trials.

Oxybutynin seems promising in the management of hot flashes with tolerable side effects in the majority of refractory patients. A placebo-controlled, randomized study is being developed to look more closely at the effectiveness of oxybutynin in reducing hot flashes.

Background: Lymphedema has been a prevalent and often severe side effect for patients receiving treatment for breast cancer typically resulting in physical and psychosocial distress as well as decreased quality of life. With no widely effective or safe drug treatment(s) for lymphedema, this study aimed to assess the efficacy of combined Lymphdiaral™ drops and ointment for treatment-related lymphedema. Methods: This open label, randomized, parallel-group trial ran over 12 weeks with a final follow-up visit at 24 weeks. One hundred and thirty-four (n = 134) patients were consented to the study. Of these, 119 patients were randomized to either standard care group (compression garment) or treatment group (compression garment plus Lymphdiaral™ drops and ointment) and follow-up data was obtained. The primary objective was the reduction in lymphedema as measured by change in arm volume. Results: The values for the arm volumes did not show a statistically significant decrease in both the standard care or treatment groups. Additionally, there was no statistical difference in arm volume reduction between the groups. Conclusions: This first randomized trial shows, that the homeopathic drug combination of Lymphdiaral™ drops and ointment does not improve lymphedema in breast cancer patients. Citation Format: Jawaid Younus, Morgan Black, Lyn Kligman, Brenda Leung. Efficacy of Lymphdiaral™ in breast cancer patients with lymphedema [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-12-15.