The Effect of Complex Decongestive Therapy on Post-Breast Surgery Quality of Life in Breast Cancer Patients With Unilateral Lymphedema and Its Predictive Factors

Abstract

Background: Complex decongestive therapy (CDT) is one of the most common treatments used in lymphedema. Effects of lymphedema treatment and its predictive factors were studied previously but its impact on quality of life (HRQOL) is still unknown. Objectives: This study, in addition to investigating CDT effects on HRQOL, examined factors that can influence it, to estimate the effect of treatment according to patient's condition in our setting. Patients and Methods:The present study was a quasi-experimental study on health-related HRQOL. A general data gathering form was used in 120 patients who developed lymphedema following breast cancer surgery and referred for treatment to Shiraz Motahari clinic in 2014. All patients' arm size was measured by "direct voltmeter" before the intervention to determine the grade of lymphedema. SF-36 questionnaire was used pre-and one month post-intervention to collect HRQOL data. Complete decongestive therapy (CDT) with or without Pump was used as the intervention. Results: Patients had higher scores after treatment in all subscales of quality of life (except for "role limitation due to physical problems"), but a statistically significant difference (P = 0.023) was observed only in the "mental health" subscale. The results showed significant changes in bodily pain after the intervention in patients less than 40 years old (P = 0.03), "general health" and "vitality" in single patients (P values equal to 0.013 and 0.02, respectively) and "mental health" in those with education "less than high school" (P = 0.018). In the case of household patients, only PF changed significantly after treatment (P = 0.027). Moreover, "role limitation due to physical problems" and "mental health" subscales changed significantly after treatment with CDT + Pump (P values equal to 0.004 and 0.003). Other groups represented no significant changes in other subscales. Besides, duration of lymph edema had no effect on improvement of HRQOL after treatment. Conclusions: Although this study showed that some factors can improve patients' feeling and HRQOL after treatment in our population, in many aspects no changes were observed. It is recommended to improve patients' HRQOL through more social and physiological support in our setting. Also, more follow-up duration after the intervention is recommended in future studies.

Quality-of-Life Outcomes in Surgical vs Nonsurgical Treatment of Breast Cancer–Related Lymphedema

“…A total of 35 articles related to quality of life following BCRL treatment were reviewed, of which 16 met inclusion criteria (Figure). 10,11,[17][18][19][20][21][22][23][24][25][26][27][28][29][30] Of note, no publications directly comparing HRQoL for VLNT and CDT were identified in this literature search.…”

“…Fourteen studies on CDT were included, and their results are summarized in Table 2. Eight were prospective cohort studies, and 6 were randomized clinical trials .…”

“…Fourteen studies on CDT were included, and their results are summarized in Table 2. Eight were prospective cohort studies, and 6 were randomized clinical trials . These studies included a total of 724 patients with BCRL, and 569 underwent CDT as the principal intervention.…”

“…Four studies on CDT reported improvement in all subscales of HRQoL, 10,19,27,30 while 3 studies reported no significant improvement in HRQoL. 11,20,23 The remainder of studies showed significant improvements in various subscales of HRQoL, including mental health, physical function, symptoms, and overall health. 21,22,[24][25][26]28,29 All but 2 studies 21,27 included clinician-measured outcomes in their analysis.…”

“…17,18 Reduction in arm volume was reported, although significance was only achieved in 1 study. 17 CDT Fourteen studies on CDT were included, 10,11,[19][20][21][22][23][24][25][26][27][28][29][30] and their results are summarized in Table 2. were prospective cohort studies, 1 0,1 1,1 9 -2 1, 2 5, 2 9, 3 0 and 6 were randomized clinical trials.…”