Harris, S.R., Schmitz, K.H., Campbell, K.L., & McNeely, M.L. (2012). Clinical practice guidelines for breast cancer rehabilitation: Syntheses of guideline recommendations and qualitative appraisals. Cancer, 118(8 Suppl.), 2312–2324.doi: 10.1002/cncr.27461
To identify and review clinical practice guidelines (CPGs) related to the assessment and management of physical impairment outcomes of breast cancer and the interventions used to treat the disease. The patient population was patients with breast cancer.
Relevant health science databases were searched to identify evidence-based CPGs. The CPGs were evaluated using the AGREE II Instrument. The recommendations for updating current guidelines and for future guidelines were developed. Nineteen guidelines were included. Databases used were MEDLINE®, Google, Google Scholar, Physiotherapy Evidence Database (PEDro), Grey Matters and Intuit, CINAHL®, and Embase (OvidSP). Keywords were breast cancer, rehabilitation, and guidelines. CPGs were included if they focused on breast cancer-related upper-extremity physical impairments, upper-extremity or breast lymphedema, pain, fatigue, chemotherapy-induced peripheral neuropathy (CIPN), cardiotoxicity, or bone health. CPGs also had to be evidence-based recommendations related to weight management in breast cancer, published between 2001–2011 in a peer-reviewed journals or endorsed by a national or multinational government agency or health professional provider group, and available in English. CDPs were excluded if they pertained specifically to metastatic breast cancer.
Volume measurements using an opto-electric volumeter (perometer) and bioimpedance spectroscopy are recommended to be used in place of arm circumference measures. The use of compression garments is recommended in the management of lymphedema, but only limited evidence support compression bandaging with manual lymph drainage based on the reviewed guidelines.
High-quality evidence is insufficient to make clinical recommendations in the form of guidelines. There is an urgent need for updating the guidelines on lymphedema. Recommendations include physical therapy beginning the first day after surgery and active stretching exercises after removal of drains. Progressive resistive exercises with light weights within four to six weeks after surgery is also recommended. There is insufficient evidence regarding use of laser treatment and electrical stimulation, and there are published precautions for their use in people with neoplasms. Compression garments and bandaging and complete decongestive therapy are currently recommended.
The AGREE II Instrument fails to assess the quality of evidence supporting the guideline’s recommendations.
The findings from this review have highlighted the importance of conducting more rigorously designed studies related to lymphedema assessment ,measurement, and management. Nurse scientists can play a key role in this needed area.