Du Xinwen, Li Yuan, Fu Lan, Chen Huaying, Zhang Xiaoxia, Shui Yuping, Zhang Aihua, Feng Xianqiong, Fu Mei Rosemary
Department of Hematology, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China.
Department of Nursing, West China Second University Hospital/West China School of Nursing, Sichuan University, Chengdu, China.
Front Oncol. 2022 Oct 24;12:1015387. doi: 10.3389/fonc.2022.1015387. eCollection 2022.
Many breast cancer survivors face long-term postoperative challenges as a result of developing lymphedema symptoms and chronic lymphedema. (TOLF) program is an intervention based on physiological-cognitive-behavioral principles that teaches patients self-management strategies to activate lymphatic system and promote lymph flow to decrease lymphatic pain, reduce the risk and severity of lymphedema.
The purpose of this pilot clinical trial was to evaluate the use of TOLF program as an early intervention on improving lymphedema symptom experience (i.e., symptom number, symptom severity, symptom distress, and the impact of symptoms on patients' activities of daily living) and optimizing lymph fluid levels (measured by the arm volume differences) among breast cancer survivors.
This study is a parallel, randomized clinical trial. A total of 92 breast cancer patients were randomly assigned to either the TOLF intervention group or the control group focusing on promoting arm mobility. Data were collected at baseline and end of the trial at the 3-month post intervention. The Breast Cancer and Lymphedema Symptom Experience Index was used to measure lymphedema symptom experience. Anthropometric measurements were used for circumferential arm measurements. Generalized linear mixed-effects models were used to evaluate the trial outcomes.
Significant improvements of lymphedema symptom experience were found in patients in the TOLF intervention group in comparison with patients in control group: the number of lymphedema symptoms (<0.001) and the severity of lymphedema symptoms (<0.001) as well as the impact of symptoms on patients' daily living function (<0.001). Patients in both groups showed improvements in all study outcomes over the 3 months, whereas those in the TOLF group gained greater benefits in reducing the number and severity of lymphedema symptoms. Moreover, the TOLF group had significantly fewer patients with ≥5% arm volume differences ([5/45] vs [13/43], =0.035) at the study endpoint.
Findings of the study demonstrated positive outcomes of relieving lymphedema symptom experience, optimizing arm circumference and halting the progression of lymphedema status in breast cancer survivors receiving TOLF intervention during early postoperative time. Given its feasibility, acceptability, and effectiveness, this program may be incorporated in routine breast cancer care.
http://www.chictr.org.cn/index.aspx, identifier ChiCTR1800016713.
许多乳腺癌幸存者因出现淋巴水肿症状和慢性淋巴水肿而面临长期的术后挑战。淋巴水肿生活方式训练（TOLF）项目是一种基于生理 - 认知 - 行为原则的干预措施，它教导患者自我管理策略，以激活淋巴系统并促进淋巴液流动，从而减轻淋巴疼痛，降低淋巴水肿的风险和严重程度。
这项初步临床试验的目的是评估TOLF项目作为一种早期干预措施，对改善乳腺癌幸存者的淋巴水肿症状体验（即症状数量、症状严重程度、症状困扰以及症状对患者日常生活活动的影响）和优化淋巴液水平（通过手臂体积差异测量）的效果。
本研究是一项平行随机临床试验。总共92名乳腺癌患者被随机分配到TOLF干预组或侧重于促进手臂活动的对照组。在基线以及干预后3个月的试验结束时收集数据。使用乳腺癌和淋巴水肿症状体验指数来测量淋巴水肿症状体验。人体测量学测量用于手臂周长测量。使用广义线性混合效应模型来评估试验结果。
与对照组患者相比，TOLF干预组患者的淋巴水肿症状体验有显著改善：淋巴水肿症状数量（<0.001）、淋巴水肿症状严重程度（<0.001）以及症状对患者日常生活功能的影响（<0.001）。两组患者在3个月内所有研究结果均有改善，而TOLF组在减少淋巴水肿症状数量和严重程度方面获益更大。此外，在研究终点时，TOLF组手臂体积差异≥5%的患者明显更少（[5/45] 对比 [13/43]，P = 0.035）。
研究结果表明，在术后早期接受TOLF干预的乳腺癌幸存者中，该干预措施在缓解淋巴水肿症状体验、优化手臂周长以及阻止淋巴水肿状态进展方面取得了积极成果。鉴于其可行性、可接受性和有效性，该项目可纳入常规乳腺癌护理中。
