A randomized controlled trial comparing two types of pneumatic compression for breast cancer-related lymphedema treatment in the home

Abstract

PurposePneumatic compression devices (PCDs) are used in the home setting as adjunctive treatment for lymphedema after acute treatment in a clinical setting. PCDs range in complexity from simple to technologically advanced. The objective of this prospective, randomized study was to determine whether an advanced PCD (APCD) provides better outcomes as measured by arm edema and tissue water reductions compared to a standard PCD (SPCD) in patients with arm lymphedema after breast cancer treatment.MethodsSubjects were randomized to an APCD (Flexitouch system, HCPCS E0652) or SPCD (Bio Compression 2004, HCPCS E0651) used for home treatment 1 h/day for 12 weeks. Pressure settings were 30 mmHg for the SPCD and upper extremity treatment program (UE01) with standard pressure for the APCD. Thirty-six subjects (18 per group) with unilateral upper extremity lymphedema with at least 5% arm edema volume at the time of enrollment, completed treatments over the 12-week period. Arm volumes were determined from arm girth measurements and suitable model calculations, and tissue water was determined based on measurements of the arm tissue dielectric constant (TDC).ResultsThe APCD-treated group experienced an average of 29% reduction in edema compared to a 16% increase in the SPCD group. Mean changes in TDC values were a 5.8% reduction for the APCD group and a 1.9% increase for the SPCD group.ConclusionThis study suggests that for the home maintenance phase of treatment of arm lymphedema secondary to breast cancer therapy, the adjuvant treatment with an APCD provides better outcomes than with a SPCD.

Intermittent pneumatic compression in patients with postmastectomy lymphedema

“…the value of pneumatic compression pressure in treatment of the upper limb is: 40 mm Hg [10], 50 mm Hg [20] or 30 mm Hg [6], which corresponds to the values of 30-60 mm Hg [1] recommended by IsL. In the aforementioned paper, a cuff pressure of 60 mm Hg was used, which significantly influenced the changes in hand and upper limb circumference on the mastectomy side.…”

“…Pneumatic compression is used as an independent method, e.g. at home [6], and is addressed to a broad spectrum of patients as cheaper and easily accessible [7].…”

Usefulness of intermittent pneumatic compression in medicine

“…In the treatment of lymphedema, despite the lack of consensus [32][33][34][35][36][37][38][39] regarding additional benefits of IPC, it is an integral part of complete decongestive therapy. This comprehensive procedure is useful in the treatment and prevention of lymphedema after breast cancer surgery, but it turns out effective in any case of lymphedema not only because of its very action but also owing to good patient compliance.…”

Terapia complexa descongestiva no tratamento intensivo do linfedema: revisão sistemática

“…The lymphedema conservative treatment aims to reduce the edema and production of interstitial fluid, as well as stimulate the lymph's mobility 4 . Among the physiotherapeutic techniques used to reduce lymphedema we have the complex decongestive therapy (CDT) 12 . The International Society of Lymphology 6,7 supports the use of CDT, which involves a two-stage treatment program: intensive and maintenance care.…”