Arinaga Yoko, Piller Neil, Sato Fumiko, Ishida Takanori, Ohtake Tohru, Kikuchi Katsuko, Sato-Tadano Akiko, Tada Hiroshi, Miyashita Minoru
Lymphoedema Clinical Research Unit, Department of Surgery, Flinders University.
Department of Oncology Nursing, Tohoku University Graduate School of Medicine.
Tohoku J Exp Med. 2019 Feb;247(2):139-147. doi: 10.1620/tjem.247.139.
About 20% of patients with breast cancer are likely to develop breast cancer-related lymphedema (BCRL) following an axillary clearance, and BCRL can be refractory or irreversible to treatment. The aim of this pilot randomized controlled study was to evaluate the effectiveness of a 10-min holistic self-care program for patients with BCRL in Japan. The intervention group (n = 22) practiced the BCRL self-care program including 1) modified Japanese Radio Taiso (Rajio Taiso, national calisthenics in Japan), 2) gentle arm exercises combined with deep breathing, 3) central lymphatic drainage, and 4) skin care using a traditional lymphatic drainage technique daily for 6 months, while the control group (n = 21) received usual care from their hospitals. There was significant group*time interaction in the relative edema volume and relative volume change of the hand, with the intervention group having the better outcome. The intervention group showed significant improvement in transepidermal water loss as well as the mental health component summary score of the SF-8, most of BCRL-related symptoms, self-care time and score, frequencies of exercise, self-lymphatic drainage and skin care, and perceived adherence and effectiveness to self-care, although we were unable to exclude the possibility of the Hawthorne effect. Notably, even in the control group, the self-care was similarly increased, but the significant improvements were detected only in transepidermal water loss on the forearm and upper arm, pain and coldness. In conclusion, the patients who practiced the holistic BCRL self-care for 6 months have shown greater improvement.
约20%的乳腺癌患者在腋窝清扫术后可能会发生与乳腺癌相关的淋巴水肿（BCRL），且BCRL对治疗可能具有难治性或不可逆性。这项初步随机对照研究的目的是评估一项为期10分钟的整体自我护理计划对日本BCRL患者的有效性。干预组（n = 22）实施BCRL自我护理计划，包括1）改良的日本广播体操（广播体操，日本国民健身操），2）结合深呼吸的轻柔手臂运动，3）中央淋巴引流，以及4）每天使用传统淋巴引流技术进行皮肤护理，持续6个月，而对照组（n = 21）接受医院的常规护理。手部的相对水肿体积和相对体积变化存在显著的组*时间交互作用，干预组的结果更好。干预组在经表皮水分流失以及SF-8的心理健康成分总结评分、大多数BCRL相关症状、自我护理时间和评分、运动频率、自我淋巴引流和皮肤护理以及自我护理的感知依从性和有效性方面均有显著改善，尽管我们无法排除霍桑效应的可能性。值得注意的是，即使在对照组中，自我护理也同样增加，但仅在前臂和上臂的经表皮水分流失、疼痛和寒冷方面检测到显著改善。总之，实施为期6个月的整体BCRL自我护理的患者有更大改善。
