Methods of lymphoedema reduction presented in view of literature – systematic review

Abstract

Lymphoedema (LE) is a serious oncological complication of breast cancer treatment. Untreated, it leads to several changes in the upper limbs of patients, including limiting the mobility of joints and functions. Schematic complete decongestive therapy (CDT) is one of the most common methods of conservative treatment of LE. Complete decongestive therapy regimen is also often used as monotherapy for selected items, such as: manual lymphatic drainage, compression therapy and exercises for improvement. This study is a systematic review of scientific publications on the reduction of the lymphoedemas associated with breast cancer (BCRL). The aim of the research study was to present of the methods used to reduce LE associated with breast cancer. All the analysed papers were selected from Medline after ticking the following options: publication type-clinical trail; availability of text-free full text available; published-in the last 5 years. For final analysis, 9 (6 randomised and 3 non-randomised) studies were chosen out of the 1,392 records showing different methods of conservative treatment of BCRL. Based on the available literature, the greatest reduction in LE was obtained using different methods of conservative treatment. Of note are the studies which evaluate the effectiveness of new methods that are not part of the commonly used CDT scheme in practice. The education strategy generally supports such methods. Streszczenie Obrzęk limfatyczny (lymphoedema-LE) jest jednym z najpoważniejszych powikłań onkologicznego leczenia raka piersi. Nieleczony prowadzi do licznych zmian w obrębie kończyny górnej, m.in. ograniczenia ruchomości w stawach i zaburzenia funkcji kończyny. Jedną z najczęściej stosowanych metod leczenia zachowawczego LE jest schemat CDT (complete decongestive therapy). Podobnie często w monoterapii stosowane są wybrane elementy schematu CDT w postaci: manualnego drenażu limfatycznego, kompresjoterapii i ćwiczeń usprawniających. Praca jest systematycznym przeglądem publikacji naukowych dotyczących metod redukcji LE związanego z rakiem piersi. Na podstawie dostępnego piśmiennictwa stwierdzono największą redukcję LE w przypadku łączenia różnych metod leczenia zachowawczego. Uwagę zwracają badania oceniające skuteczność nowych metod niebędących częścią powszechnie stosowanego w praktyce schematu CDT. Metody te najczęściej wspierane są strategią edukacyjną.

The importance of rehabilitation in the treatment of breast cancer

“…The rehabilitation of patients with lymphoedema requires complex procedures [12,13]. Mobility exercises are associated with exerting a mechanical effect on the limb, resulting in lymph drainage.…”

“…The upper extremity on the surgical side should be relaxed and placed on a rehabilitation wedge, foam roller, or cushion in such a way that it is lifted above the shoulder joint. Lymphatic massage may be started several days after surgery [12][13][14][16][17][18].…”

Advances in the surgical treatment of breast cancer and postoperative physiotherapy

“…In the first phase of the treatment, these techniques are carried out every day, and as a result the volume of the limb is reduced. After stabilisation of its size, in the second phase of the treatment, the obtained results are sustained by wearing elastic compression products (compression sleeves) and the use of self-massage and exercises, which restore patency at home [30,31].…”

The role of physical activity in maintaining health after mastectomy

“…In women after breast cancer treatment peak torque, work, and power of flexor and extensor muscles of the trunk decreases by approximately 50% compared with healthy women [17]. Another negative consequence of the treatment may be swollen lymphs of the upper limb on the operated side [18]. As a result, radical treatment of breast cancer and functional disorders resulting from the above treatment lead to a reduction in physical fitness and exercise capacity.…”