Simplifying evidence-based management of breast cancer-related lymphedema

Armer, Jane M.; Feldman, Joseph L.; Ostby, Pamela L.; Thrift, Kathryn Mc Killip; Lasinski, Bonnie B.; Beck, Malcolm L.; Rodrick, Julia R.; Norton, Stephen J.; Sun, Yidan; Udmuangpia, Tipparat; Armer, Nathan C.; Stewart, Bob R.

doi:10.1080/23809000.2016.1230019

Cited by 6 publications

(9 citation statements)

References 105 publications

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“…Two-phase CDT is considered by clinical experts 12 , 14 , 94 to be the recommended treatment for lymphedema, supported by the findings of a review of systematic reviews. 27 This review found some evidence for the effect of CDT to reduce arm volume, as four studies 35 , 36 , 75 , 82 reported a statistically significant post intervention reduction; however, Dayes et al 35 reported a significantly greater arm volume reduction with self-treatment on completion of the three-week intervention period, although there was no statistically significant difference in volume reduction between the groups at six weeks or 12 months.…”

Section: Discussionmentioning

confidence: 98%

“…95 The effect of treatment has primarily been measured by changes to limb volume, however there was no consensus regarding a standardized format to ensure that a comparison could be made between different protocols; this is reflective of the published research into lymphoedema treatments. 94 Similarly, there was wide variation in the patient-centered outcomes measured and methods used. Although the statistical significance of findings was reported for some study results, the importance of these findings for patients and practitioners was not reported; the minimal clinically important change is not known, either for objective measures such as changes in arm volume or subjective measures of changes to patient symptoms or quality of life.…”

Section: Discussionmentioning

confidence: 99%

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Clinical effectiveness of decongestive treatments on excess arm volume and patient-centered outcomes in women with early breast cancer-related arm lymphedema: a systematic review

Jeffs

Ream

Taylor

et al. 2018

JBI Database of Systematic Reviews and Implementation Reports

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Objective:To identify the effect of decongestive lymphedema treatment on excess arm volume or patient-centered outcomes in women presenting within either 12 months or a mean nine months of developing arm lymphedema following breast cancer treatment.Introduction:Lymphedema is a common consequence of breast cancer treatment requiring life-long treatment to reduce symptoms and prevent complications. Currently, evidence to inform the optimal decongestive lymphedema treatment package is lacking.Inclusion criteria:The review included studies on women who received lymphedema treatment within either 12 months or a mean of nine months of developing unilateral breast cancer-related arm lymphedema. The intervention was any decongestive lymphedema treatment delivered with the purpose of reducing arm lymphedema, compared to another form of lymphedema treatment (whether self or practitioner-administered), placebo or no treatment. The clinical outcome was excess arm volume; patient-centered outcomes were health-related quality of life, arm heaviness, arm function, patient-perceived benefit and satisfaction with treatment. Experimental study designs were eligible, including randomized and non-randomized controlled trials, quasi-experimental, prospective and retrospective before and after studies were considered.Methods:A three-step search strategy was utilized to find published and unpublished studies. The search identified studies published from the inception of each database to July 6, 2016. Reference lists were scanned to identify further eligible studies. Studies were critically appraised using appropriate standardized critical appraisal instruments from the Joanna Briggs Institute. Details describing each study and treatment results regarding outcomes of interest were extracted from papers included in the review using appropriate standardized data extraction tools from the Joanna Briggs Institute. Due to heterogeneity in included studies, results for similar outcome measures were not pooled in statistical meta-analysis. A narrative and tabular format was used to synthesize results from identified and included studies.Results:Seven studies reporting results for outcomes of interest were critically appraised and included in the review: five randomized controlled trials and two descriptive (uncontrolled) studies. Reported outcomes included excess arm volume (five studies), health-related quality of life (three studies), arm heaviness (one study), arm function (two studies) and patient-perceived benefit (two studies). There was some evidence that decongestive treatments were effective for women presenting within either 12 months or a mean of nine months of developing breast cancer-related arm lymphedema, but the wide range of data prevented comparison of treatment findings which limited our ability to answer the review questions.Conclusions:Weak evidence (grade B) for the impact of decongestive lymphedema treatment on women with early lymphedema (i.e. less than 12 months duration of BCRL symptoms) did not allow any conc...

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Clinical effectiveness of decongestive treatments on excess arm volume and patient-centered outcomes in women with early breast cancer-related arm lymphedema: a systematic review

Jeffs

Ream

Taylor

et al. 2018

JBI Database of Systematic Reviews and Implementation Reports

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“…Failure to manage the signs and symptoms, such as increased heaviness, swelling, and pain, increases the possibility of the more serious sequelae of loss of function or debilitating infection. 15 Selfmanagement techniques include wearing compression garments at night and/or during the day. Other techniques include specialized self-massage to assist with lymphatic flow and drainage.…”

mentioning

confidence: 99%

“…5 If self-management is neglected, more intensive (and expensive) therapies are typically necessary and most require additional clinic and therapist visits, and even hospitalization. 7,15 Given that BCRL has an impact on both physiological and psychological function, it is little wonder that this illness impacts QOL. 5,18,19 Pusic et al 4 conducted a systematic review of QOL instruments and outcomes, and found that many studies examined QOL of patients with BCRL by using quantitative designs.…”

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confidence: 99%

Breast cancer-related lymphedema and quality of life: A qualitative analysis over years of survivorship

2019

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Objectives The study purpose was to examine perspectives of women with newly diagnosed breast cancer-related lymphedema (BCRL) regarding their quality of life over seven years. Method Data were collected over seven years using the Lymphedema and Breast Cancer Questionnaire (LBCQ). Participants with BCRL answered open-ended questions corresponding to changes in mood and lifestyle from post-op through annual interviews and surveys. Self-reported data from 97 participants with BCRL were analyzed using in vivo coding and template-style content analysis to elicit the impact of BCRL on quality of life domains. Results Data saturation was achieved as participants neared 30 to 36 months post- breast cancer diagnosis. Three major themes were identified related to BCRL’s impact on: physical function; daily living and social function; and psychological function. Discussion Findings suggest that BCRL impacts quality of life not only soon after diagnosis, but also throughout survivorship years. Healthcare providers should develop programs to enhance quality of life for survivors with BCRL.

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“…Understanding the complex nature of lymphedema and its treatment requires competence in risk assessment, early detection, health promotion and complex interventions [10,[12][13][14]. Within this context, lymphedema practitioners play an important role in service provision leading to improve lymphedema management and increased patient knowledge and self-management of lymphedema [15,16].…”

Section: Introductionmentioning

confidence: 99%

Lymphedema Rehabilitation: Provision and Practice Patterns among Service Providers: National Survey

Omar¹,

Aldhwayan

et al. 2019

Preprint

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Background: Information on the current practices and quantification of lymphedema service may be beneficial to promote and improve health care system. Therefore, this study aimed to describe characteristics of lymphedema practitioners, and lymphedema patients’ profile, and provide a comprehensive picture of lymphedema service provision in Saudi Arabia. Methods: A cross-sectional study involved use of an online survey. The survey questionnaires included information about demographic and professional characteristics of lymphedema practitioners, lymphedema profile, questions on the services provided, and perceived barriers in providing a service. Results: Eighteen lymphedema practitioners (37.50%) responded to the survey. They worked in the major cities: Riyadh (78%), Jeddah (17%), and Dammam (5%), and most of them working in public hospitals (67%). Respondents typically had a background in physical or occupational therapy and had completed a basic training course on lymphedema treatment and management. About 75% of patients seen by practitioners had secondary lymphedema, 47% with breast cancer-related lymphedema. On average 72%, practitioners provide a “comprehensive” lymphedema services. The average number of lymphedema practitioners per service is 2.67. The perceived barriers reported included an inadequate number of certified therapists (100%), difficulties with transportation and lack of financial support (each =72%), and limited space for lymphedema practice/management (89%). Conclusion: The results suggest that lymphedema practitioners provide a reasonable, but not the optimal, services for lymphedema patients. The service provision is still limited and inequities. Therefore, more staffing is required to promote awareness of the condition and related services, improve referral and care coordination, and enhancing geographical and multidisciplinary coordination of the service.

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Simplifying evidence-based management of breast cancer-related lymphedema

Cited by 6 publications

References 105 publications

Clinical effectiveness of decongestive treatments on excess arm volume and patient-centered outcomes in women with early breast cancer-related arm lymphedema: a systematic review

Clinical effectiveness of decongestive treatments on excess arm volume and patient-centered outcomes in women with early breast cancer-related arm lymphedema: a systematic review

Breast cancer-related lymphedema and quality of life: A qualitative analysis over years of survivorship

Lymphedema Rehabilitation: Provision and Practice Patterns among Service Providers: National Survey

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