Effect of DigitalCombined Decongestive Therapy in Patients with Breast Cancer-Related Lymphedema: Afollow-up study

Abstract

Objectives: This study present the feasibility of digital combined decongestive therapy in breast cancer-related lymphedema. At the same time, our study aims to reveal the short and long-term effects of digital combined decongestive therapy.Background: Breast cancer patients are at high risk for the development of breast cancer-related lymphedema due to axillary lymph node dissection and radiotherapy. Breast cancer-related lymphedema may occur immediately after treatment or may occur years later. Breast cancer-related lymphedema treatment involves intensive combined decongestive therapy followed by long-term maintenance. Digital implementation of combined decongestive therapy is a method that aims to demonstrate its potential to provide a cost-effective, safe and at the same time measurable tool for breast cancer-related lymphedema patients.Methods: The study population consisted of breast cancer patients who were admitted to the outpatient clinic due to upper extremity lymphedema. The circumferences of the extremities were measured by a trained physiotherapist, by marking reference points at 4-cm intervals from the ulnar styloid to the axillary region, using a standard tape measure. In first face-to-face session, patients received a basic introduction to skin care and risk reduction training. In this session, self-bandaging technique and self-manual lymphatic drainage technique was demonstrated while the caregiver videotaped it. At the same time, decongestive and breathing exercises were taught to the patient and caregiver. After the first face-to-face session, treatment was supervised with the help of electronic information and telecommunication technologies for 4 weeks. Following the intensive treatment phase, maintenance therapy commenced, which included the implementation of compression stockings. Breast cancer-related lymphedema patients were re-evaluated for follow-up after 12 weeks.Results: Total of 29 breast cancer-related lymphedema patients were included in the study (mean age=54.17±11.10 years). The mean pre-treatment extremity volume was 2998.06±930.61 mL. After digital combined decongestive therapy, the mean extremity volume was 2792.78±870.86 mL. There was a significant positive change in extremity volume in the patients after treatment (p<0.001). The mean extremity volume at follow-up was 2692.63±693.81 mL. There was also a significant positive change in the extremity volumes of the patients in the follow-up compared to the post-treatment (p<0.05).Conclusions: Our results revealed that digital combined decongestive therapy was effective in extremity volume reduction for breast cancer-related lymphedema. Following maintenance therapy, there was also a noticeable reduction in extremity volume. In conclusion, digital combined decongestive therapy was found to be a usable method for patients who cannot participate in face-to-face therapy due to financial or transportation reasons. Keywords: breast cancer-related lymphedema, combined decongestive therapy, caregiver, self-management