Why do patients with breast cancer treatment develop lymphedema?
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?
A recent study published in May of 2019 in the Annals of Surgical Oncology demonstrates clear clinical evidence 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 assisted in preventing the progression of subclinical lymphedema in the largest randomized controlled trial focused on lymphedema prevention.
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.
As soon as we contract our muscles to walk, they squeeze our veins together. This pumps the blood up and out of our 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 control trial is being conducted comparing lymphedema progression rates using volume measurements calculated from the circumference using a tape measure (TM) or bioimpedance spectroscopy (BIS).
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.
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).
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 products are best for breast cancer-related lymphedema?
Depending on your condition and lifestyle, your physician or therapist can recommend a compression garment that is best for you.
mediven harmony products have been called the perfect balance between effective containment (strong) and wearing comfort (soft) for upper limb compression. harmony is a unique fabric that is soft to touch, clinically effective, and easy to apply. The precision fit and unique elbow ellipses (one in the crease and one on the point of the elbow) provide accurate compression therapy with freedom of movement, encouraging compliance and ultimately allowing patients to “feel better”.
harmony arm sleeves
This effective, round-knitted arm sleeve for primary and secondary stage 1 lymphedema has a double ellipse for freedom of movement, a comfortable top band with napped silicone coating, high containment with an innovative supple knit, and a soft fabric structure with Lanolin that stimulates the tissue for a massaging effect.
harmony gauntlet/ hand piece
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.
Matched to the mediven arm sleeve, the mediven harmony compression glove offers maximum wearing comfort with breathable, latex-free material and a new version with seamless technology in the finger borders and between the digits (fingers and base of the thumb) for maximum mobility and flexibility.
For other breast cancer-related compression solutions from medi, view our arm sleeve collection: