Is lymphedema common after breast cancer?

On average, 20-30% of patients are affected by breast cancer-related lymphedema following removal of the axillary lymph nodes. In many breast cancer operations, lymph nodes are removed together with the breast tumor to prevent metastases. Removal of the lymph nodes during the operation interrupts the lymph vessels and lymphatic congestion can develop.

The lymph fluid can no longer be transported away from the region, and tissues of the arm or chest will swell because of the accumulation of fluid and lymphedema develops.

Approximately 50% of patients may develop lymphedema after standard axillary lymph node dissection. 

How to prevent lymphedema with early detection and compression?

Early detection is key when conquering a debilitating, lifelong disease like lymphedema. We now have clear evidence that shows early detection of the presence of lymphedema when combined with a swift treatment plan, can avoid the laborious treatment of later-stage lymphedema for most patients.

A recent study, published in December of 2022 in Lymphatic Research and Biology, clear clinical evidence is shown that the early use of the Bioimpedance screening surveillance and utilization of compression garments is an effective tool in lymphedema prevention. Use of mediven® harmony arm sleeves and gauntlets (a 20-30 mmHg mediven harmony arm sleeve and a 20-30 mmHg gauntlet or glove) assisted in preventing the progression of subclinical lymphedema in the largest randomized controlled trial focused on lymphedema prevention. Patients who immediately entered compression therapy treatment and were compliant with the protocol, significantly reduced their chances of late-stage lymphedema.

A Randomized Trial Evaluating Bioimpedance Spectroscopy Versus Tape Measurement for the Prevention of Lymphedema Following Treatment for Breast Cancer: Interim Analysis

Journal: Annals of Surgical Oncology

Publication Date: May 2019
Authors: Ridner et al.

BACKGROUND

Breast cancer-related lymphedema (BCRL) represents a major source of morbidity among breast cancer survivors. Increasing data support early detection of subclinical BCRL followed by early intervention. A randomized controlled trial is being conducted comparing lymphedema progression rates using volume measurements calculated from the circumference using a tape measure (TM) or bioimpedance spectroscopy (BIS).

METHODS

Patients were enrolled and randomized into either TM or BIS surveillance. Patients requiring early intervention were prescribed a mediven harmony compression sleeve and gauntlet for 4 weeks and then re-evaluated. The primary endpoint of the trial was the rate of progression to clinical lymphedema requiring complex decongestive physiotherapy (CDP). CDP was deemed necessary once the patient’s at-risk arm showed a 10% or greater increase in volume vs. the baseline measurement taken prior to surgery. This prespecified interim analysis was performed when at least 500 trial participants had ≥ 12 months of follow-up. 

RESULTS

Out of 508 patients, 109 triggered pre-threshold interventions; 68 TM and 41 BIS. Of the 68 TM, 10 (14.7%) progressed to CDP and of the 41 in the BIS group, 2 (4.9%) progressed to CDP. Patients in the TM group triggered when they had a volume change in the at-risk arm that was between ~ 5 and ~ 10% above presurgical baselines (without a similar change in the non-at-risk arm). The prevention intervention trigger point for patients in the BIS group were when patients had a BIS change of ~ 6.5 BIS L-Dex units to detect sub- clinical lymphedema. Once triggered, patients underwent 4 weeks of wearing a class 2 (23–32 mmHg) compression sleeve and gauntlet therapy for 12 h per day (medi).

A total of 508 patients were included in this analysis, with 109 (21.9%) patients triggering pre-threshold interventions pre-threshold being a change in at-risk arm volume of less than 10%. Compared with TM, BIS had a lower rate of trigger (15.8% vs. 28.5%, p < 0.001) and longer times to trigger (9.5 vs. 2.8 months, p = 0.002). Using mediven harmony 20-30 mmHg, twelve triggering patients progressed to CDP (10 in the TM group [14.7%] and 2 in the BIS group [4.9%]), representing a 67% relative reduction and a 9.8% absolute reduction (p = 0.130).

CONCLUSIONS

Interim results demonstrated that post-treatment surveillance with BIS reduced the absolute rates of progression of BCRL requiring CDP by approximately 10%, a clinically meaningful improvement. These results support the concept of post-treatment surveillance with BIS to detect subclinical BCRL and initiate early intervention. For the full article, visit https://doi.org/10.1245/s10434-019-07344-5

What compression arm sleeves are best for early-stage lymphedema?

The severity of lymphedema determines the applied pressure required, the stiffness or containment level of the material, and the style of the product. Early-stage lymphedema typically has relatively low edema or swelling levels. Also, in most cases, this will be a patient’s initial treatment and first time wearing a compression therapy garment. This entry-level garment must provide a positive patient experience, so it is more easily adapted into a patient’s lifestyle routine. Introductory arm sleeves are usually at a 20-30 mmHg compression level but can be prescribed by doctors and therapists at higher levels (30-40 mmHg). These garments apply pressure to the arm, hand, or both to promote lymph fluid movement and typically have a soft texture and are highly elastic for application purposes. Effective compression therapy is when the correct amount of compression is applied to the arm with consistent patient compliance.

The therapeutic need of the patient is at the forefront of concern when determining the correct compression garment for a condition. The style of garment will also be indicated to determine the necessary limb coverage and suspension needs. Lastly, the stiffness or elasticity level will be determined by the current swelling level status. The more edema that is present, the stiffer the material will need to be to contain the limb size.

Additional factors, such as patient lifestyle, limb size, and dexterity will help determine the right product selection.  The medi lymphedema portfolio of compression solutions has a selection of arm garments to best meet the needs of every patient. From ready-to-wear to custom options, and from elastic to inelastic varieties, medi has the right compression solution for lymphedema.

Ready-to-wear solutions:

Breast cancer related lymphedema Harmony armsleeve lifestyle image medi USA

The mediven® harmony arm sleeve fabric is soft to the touch, easy to apply and now clinically effective as an important tool in the fight of early intervention.

Matched to the mediven arm sleeve, the mediven harmony compression gauntlet/handpiece without fingers with thumb base offers ultimate wearing comfort for maximum mobility and flexibility.

harmony compression armsleeve for lymphedema with seperate hand gauntlet on woman on bench with other women
Breast Cancer Related Lymphedema mediven harmony seamless glove caramel close-up

Matched to the mediven arm sleeve, the mediven harmony compression gauntlet/handpiece without fingers with thumb base offers maximum wearing comfort with breathable, latex-free material with seamless technology for maximum mobility and flexibility.

Introductory arm sleeve for early-stage lymphedema with a custom-like fit available in 8 sizes and 2 lengths.

female wearing mediven comfort compression armsleeve magenta for breast cancer related lymphedema
circaid juxtafit compression wrap armsleeve portrait female

The easy and adjustable inelastic upper extremity garment in both an arm and handpiece has limited stretch when the circumference of the limb changes with the movement of the body. A perfect solution for those who need independent adjustability.

With both ready-to-wear and custom options (in 16 sizes and 2 lengths!) the circaid profile foam sleeve provides a comfortable solution at night or for those with sensitivity issues.

nightime compression garment circaid profile on women

Custom solutions:

women in mediven flat-knit compression armsleeve

For patients with upper limb lymphedema in stages 1 and 2, mediven mondi 350 arm is the perfect choice for those requiring an extra soft material for sensitive skin.

The mediven 550 arm provides a custom option for moderate to severe lymphedema and lipedema, with a robust material that provides the ultimate containment level, with an added flexure zone in the elbow for improved comfort.

women in mediven flat-knit compression armsleeve blue

Depending on your condition and lifestyle, your physician or therapist can recommend a compression garment that is best for you.

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