Erickson V S, Pearson M L, Ganz P A, Adams J, Kahn K L
V. S. Erickson, RAND Health, Santa Monica, CA, USA.
J Natl Cancer Inst. 2001 Jan 17;93(2):96-111. doi: 10.1093/jnci/93.2.96.
The improvement in the life expectancy of women with breast cancer raises important questions about how to improve the quality of life for women sustaining complications of breast cancer treatment. In particular, attention to common problems, such as arm edema, is of critical importance. We reviewed published breast cancer guidelines and literature identified via MEDLINE(R) searches in an effort to summarize the research literature pertinent to management of breast cancer-related arm edema, including incidence, prevalence, and timing; risk factors; morbidity; prevention; diagnosis; and efficacy of nonpharmacologic and pharmacologic interventions. We found that arm edema is a common complication of breast cancer therapy that can result in substantial functional impairment and psychological morbidity. The risk of arm edema increases when axillary dissection and axillary radiation therapy are used. Recommendations for preventive measures, such as avoidance of trauma, are available, but these measures have not been well studied. Nonpharmacologic treatments, such as massage and exercise, have been shown to be effective therapies for lymphedema, but the effect of pharmacologic interventions remains uncertain. Comparing results across studies is complicated by the fact that the definitions of interventions and measures of outcomes and risk stratification vary substantially among studies. As arm edema becomes more prevalent with the increasing survival of breast cancer patients, further research is needed to evaluate the efficacy of preventive strategies and therapeutic interventions.
乳腺癌女性预期寿命的提高引发了一些重要问题，即如何提高承受乳腺癌治疗并发症的女性的生活质量。特别是，关注常见问题，如手臂水肿，至关重要。我们回顾了已发表的乳腺癌指南以及通过医学文献数据库检索确定的文献，以总结与乳腺癌相关手臂水肿管理相关的研究文献，包括发病率、患病率和发生时间；危险因素；发病率；预防；诊断；以及非药物和药物干预的疗效。我们发现手臂水肿是乳腺癌治疗的常见并发症，可导致严重的功能障碍和心理疾病。当采用腋窝淋巴结清扫术和腋窝放射治疗时，手臂水肿的风险会增加。虽然有关于预防措施的建议，如避免创伤，但这些措施尚未得到充分研究。非药物治疗，如按摩和运动，已被证明是治疗淋巴水肿的有效方法，但药物干预的效果仍不确定。由于各研究中干预措施的定义、结局测量方法和风险分层差异很大，因此比较不同研究的结果很复杂。随着乳腺癌患者生存率的提高，手臂水肿变得更加普遍，需要进一步研究以评估预防策略和治疗干预的疗效。
