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.