Dhinakaran, M., Jain, K., Benjamin, K.E., Kaur, P., & Dhinakaran. (2014). Effect of complete decongestive therapy (CDT) in upper limb lymphedema in breast cancer patients. Indian Journal of Physiotherapy and Occupational Therapy, 8, 87–91. 

DOI Link

Study Purpose

To identify the long-term effect of complete decongestive therapy (CDT) to decrease lymphedema and enhance quality of life in patients after radical mastectomy with unilateral upper extremity lymphedema

Intervention Characteristics/Basic Study Process

Intensive phase of CDT for 10 days: Skin care, manual lymph drainage for 45 minutes (Vodder method), ComprezonTM low elastic compression stocking lymphedema arm sleeve with hand, shoulder cap and belt with a pressure of 23–32 mm Hg. Patients wore the garment 23 hours every day. Exercises twice a day up to 10 days: Active movement of the glenohumeral joint for five minutes; isometrics exercise, including the arm and shoulder, elbow, and wrist, 10 repetition each, with compression garments; and deep abdominal breathing exercise 3–5 times in between each isometric exercise. The same protocol was used in the home. Patients and their relatives were taught how to conduct self-care and self-management.
 
Maintenance phase: After a month with CDT isotonic exercise, including shoulder, elbow, and wrist muscles, for 50%–60% of 10 RM 8–10 times, two times a day, and stretching exercise, including stretching of the pectoralis major and minor latissimus dorsi. The patients were followed up with monthly for up to three months.

Sample Characteristics

  • N = 45   
  • AGE = 48.44 (SD = 6.5 years)
  • FEMALES: 100%
  • CURRENT TREATMENT: Immunotherapy
  • KEY DISEASE CHARACTERISTICS: Breast cancer survivors after radical mastectomy
  • OTHER KEY SAMPLE CHARACTERISTICS: History of unilateral post mastectomy lymphedema with more than 2 cm circumference than the normal side, aged older than 19 years, no neurological disorders, no untreated or unstable medical conditions, no edema in lower extremities

Setting

  • SITE: Single site   
  • SETTING TYPE: Outpatient    
  • LOCATION: India

Phase of Care and Clinical Applications

  • PHASE OF CARE: Late effects and survivorship
  • APPLICATIONS: Palliative care

Study Design

  • Pre-post design

Measurement Instruments/Methods

  • Modified truncated cone method
  • European Organization of Research and Treatment of Cancer Core Quality of Life (EORTC QLQ-C30) questionnaire
  • Upper limb lymphedema quality of life (ULL-QOL) questionnaire

Results

Volume of the affected limb was decreased by 80.22 (95% confidence interval [CI] [–96.71, –63.73]) from baseline to the third month (p < 0.0001). Mean change in quality of life at the second month as compared to baseline was significant (69.95, 95% CI [66.49, 73.42], p < 0.0001).

Conclusions

CDT may be effective in reducing the volume in the lymphedema limb and in enhancing breast cancer survivors’ quality of life.

Limitations

  • Small sample (< 100)
  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)
  • Measurement validity/reliability questionable
  • Findings not generalizable
  • Intervention expensive, impractical, or training needs
  • Single-site study

Nursing Implications

More rigorously designed studies are needed to examine the effectiveness of CDT in patients with lymphedema. Note that patients who underwent lumpectomy also developed lymphedema.