Case Control Study
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World J Clin Cases. Sep 6, 2022; 10(25): 8827-8836
Published online Sep 6, 2022. doi: 10.12998/wjcc.v10.i25.8827
Effectiveness of six-step complex decongestive therapy for treating upper limb lymphedema after breast cancer surgery
Hui-Zhen Zhang, Qiao-Ling Zhong, Hui-Ting Zhang, Qing-Hua Luo, Hai-Lin Tang, Li-Juan Zhang
Hui-Zhen Zhang, Qiao-Ling Zhong, Hui-Ting Zhang, Qing-Hua Luo, Hai-Lin Tang, Li-Juan Zhang, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
Author contributions: Zhang HZ and Zhong QL contributed equally to this work; Zhang HZ, Zhang LJ, and Zhong QL conceived and designed the research; Zhang HZ, Zhong QL and Luo QH collected the data and conducted the research; Zhang HZ, and Tang HL analyzed and interpreted the data; Zhang HZ and Zhong QL wrote the initial paper; Zhang LJ and Zhang HT revised the paper; Zhang LJ had primary responsibility for final content; all authors read and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of Sun Yat-sen University Cancer Center. All procedures performed in studies involving human participants were in accordance with the ethics standards of the institutional and national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethics standards.
Informed consent statement: Written informed consent was obtained from all individual participants included in this study.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement - Checklist of items, and the manuscript was prepared and revised according to the STROBE Statement - Checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Juan Zhang, BSc, Director, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, No. 651 Dongfeng Road East, Guangzhou 510060, China. zhanglij@sysucc.org.cn
Received: March 4, 2022
Peer-review started: March 4, 2022
First decision: April 19, 2022
Revised: May 27, 2022
Accepted: July 25, 2022
Article in press: July 25, 2022
Published online: September 6, 2022
Processing time: 174 Days and 18.8 Hours
ARTICLE HIGHLIGHTS
Research background

Patients with lymphedema following breast cancer surgery are likely to suffer from an abnormal appearance of the limb, susceptibility to fatigue, repeated limb infections, and limb dysfunction, which further seriously affects their quality of life. Active and effective treatment for upper limb lymphedema is very important for improving the health and quality of life of patients after breast cancer treatment. Complex decongestive therapy (CDT) is currently recommended as the standard treatment for lymphedema. CDT is a four-step detumescence therapy that can effectively treat upper limb lymphedema after breast cancer surgery, and is considered non-invasive, painless and without side effects. CDT typically involves manual lymphatic drainage, elastic bandage compression, limb function exercises, and personalized skin care. However, for the purposes of reducing scar formation and preventing axillary reticulum syndrome, this study added two steps to create a six-step comprehensive deswelling therapy combined with the use of a foam type granule bandage, which was applied in the treatment of upper extremity lymphedema pressure.

Research motivation

At present, there are few studies on the treatment of lymphedema after breast cancer surgery in China, and most of the relevant studies focus on the efficacy of single or composite methods. This study is based on the international standard four-step CDT with improvements, and the treatment mode is standardized and reasonable. The six-step CDT method was found to effectively treat upper limb lymphedema after breast cancer surgery, without trauma, pain, or side effects. At the same time, this study found for the first time that in the early stage of CDT, edema of the affected limb was temporarily aggravated, and the clinical nursing staff need to provide targeted education for patients in order to improve treatment compliance.

Research objectives

The six-step CDT developed in this study effectively alleviated upper limb lymphedema after breast cancer surgery, and the subjective symptoms of patients were reduced or disappeared. Moreover, patients’ self-care ability was improved, which will lead to improvements in the quality of life and treatment compliance among patients. Lymphedema is a chronic and long-term process that requires patients to adhere to the treatment for the curative effect to be stabilized. However, in real life, patients often cannot adhere to the treatment for a long period, and the symptoms of lymphedema may return or be aggravated. At the same time, treatment fatigue is possible, and then treatment compliance gradually decreases. Therefore, good treatment methods and obvious treatment effects can further improve patient compliance. Lymphedema therapists have further investigated methods to improve treatment compliance and the follow-up rate of patients with lymphedema.

Research methods

No six-step approaches to CDT for the treatment of upper limb lymphedema pressure have been reported in the literature, and most related studies have focused on the treatment effect of each individual method. This study adopted six-step CDT for the pressure treatment of upper limb lymphedema, which was found to effectively treat upper limb lymphedema and improve the quality of life of patients, which is worthy of discussion and further research. The results of this study provide a basis for the prevention and treatment of lymphedema in a specialist nursing clinic, and provide a talent basis for the study class of lymphedema specialist nurses, which can be used as a reference for future generations.

Research results

The newly introduced six-step CDT can improve the symptoms of upper limb lymphedema after breast cancer surgery and takes full advantage of the ability of nurses to treat lymphedema. Thus, it is a practice that should be referenced and promoted. Lymphedema treatment is a long process, and our future research will expand upon this study by increasing the sample size, extending the follow-up time, and observing the curative effect of therapy, in order to develop better treatment methods for lymphedema.

Research conclusions

This study put forward a new theory regarding scar care and the effect of a foam rolled bandage combined with the use of an air pressure wave therapeutic instrument. The new method included two new steps in addition to those of the international standard four-step treatment.

Research perspectives

In the future, multi-center studies are needed that include a larger sample size, compare lymphedema at different stages over a longer follow-up time, apply additional relevant scales for quality of life and treatment compliance, and improve the observation indicators, so that more powerful clinical evidence can be obtained.