Occupational Therapy, Capital District Health Authority, NS Rehabilitation Center, 1341 Summer Street, Halifax, NS, B3H 4KY, Canada.
Support Care Cancer. 2012 May;20(5):1031-6. doi: 10.1007/s00520-011-1178-9. Epub 2011 May 8.
Lymphedema as a result of curative surgery for breast cancer can lead to long-term morbidity. Decongestive lymphatic therapy (DLT) is recognized as an optimal management strategy for patients with moderate symptomatologies, but there is little data in regard to the most effective means of providing compression therapy within a DLT protocol. We conducted a randomized trial of two forms of compression therapy within the initial treatment phase of a DLT protocol for breast cancer-related lymphedema.
Subjects were required to have mild-moderate lymphedema (10-40% volume difference) acquired as a result of curative breast cancer surgery and were randomized to compression bandaging or garments within the initial treatment phase of a DLT protocol. Primary endpoint was change in affected limb volume assessed via volumetry, and secondary endpoints were symptom control and upper extremity function assessed via visual analogue scales and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, respectively. Endpoints were assessed at day 10 of treatment and at 3 months and compared to baseline.
Twenty-one subjects were available for analysis. The group receiving bandaging experienced greater median volume reductions at 10 days (70 vs. 5 mL; p = 0.387) and at 3 months (97.5 vs. 50 mL; p = 0.182). The bandaging group also experienced a greater increase in median DASH scores at 10 days (+20.9 vs. +5; p = 0.143) and at 3 months (+18.4 vs. +3.3; p = 0.065).
Within the initial treatment phase of a DLT protocol for acquired, breast cancer-related lymphedema, compression bandaging may lead to greater volume reduction but worse upper extremity functional status (higher DASH scores) as compared to compression garments.
乳腺癌根治术后导致的淋巴水肿会导致长期发病。 引流淋巴水肿治疗（DLT）被认为是中度症状患者的最佳管理策略，但在 DLT 方案中提供压缩治疗的最有效方法的数据很少。我们在乳腺癌相关淋巴水肿的 DLT 方案初始治疗阶段进行了两种压缩治疗形式的随机试验。
受试者必须患有轻度中度淋巴水肿（10-40%体积差异），是由根治性乳腺癌手术后获得的，并在 DLT 方案的初始治疗阶段随机分配至压缩绷带或服装。主要终点是通过体积测量评估受影响肢体体积的变化，次要终点是通过视觉模拟量表和上肢功能评估症状控制和上肢功能（手臂，肩部和手的残疾）（DASH）问卷分别。在治疗的第 10 天和 3 个月评估终点，并与基线进行比较。
21 名受试者可进行分析。接受绷带包扎的组在第 10 天（70 对 5 毫升；p = 0.387）和第 3 个月（97.5 对 50 毫升；p = 0.182）的中位数体积减少更大。绷带组在第 10 天（+20.9 对+5；p = 0.143）和第 3 个月（+18.4 对+3.3；p = 0.065）的中位数 DASH 评分也增加了更多。
在获得性乳腺癌相关淋巴水肿的 DLT 方案的初始治疗阶段，与压缩服装相比，压缩绷带包扎可能会导致更大的体积减少，但上肢功能状态（更高的 DASH 评分）更差。
