Rogan, S., Taeymans, J., Luginbuehl, H., Aebi, M., Mahnig, S., & Gebruers, N. (2016). Therapy modalities to reduce lymphoedema in female breast cancer patients: A systematic review and meta-analysis. Breast Cancer Research and Treatment, 159, 1–14. 

DOI Link

Purpose

STUDY PURPOSE: To assess the effects of compression bandages, sleevers, intermittent pneumatic compression, and active exercise on lymphedema related to breast cancer

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: CINAHL, Cochrane Collaboration, PEDro, WHO International Clinical Trials Registry, and a hand search of reference lists
 
INCLUSION CRITERIA: Randomized, controlled trials (RCTs) reporting mean and standard deviation (SD) or change in mean and SD, trials in the English or German language
 
EXCLUSION CRITERIA: Examination of the effects of drugs, nonbreast cancers, lower extremity lymphedema

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 1,907
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Cochrane risk of bias study evaluation. Studies had poor to moderate quality.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 60 (32 in systematic review, 9 in RCT meta-analysis, and 19 in pre/post meta-analysis)
  • TOTAL PATIENTS INCLUDED IN REVIEW = 1,340
  • SAMPLE RANGE ACROSS STUDIES: 14–141
  • KEY SAMPLE CHARACTERISTICS: All had breast cancer.

Phase of Care and Clinical Applications

PHASE OF CARE: Multiple phases of care

Results

The findings of the meta-analyses were:
 
From an analysis of four studies comparing various interventions, intermittent pneumatic compression (IPC) showed a standard mean difference (SMD) of –0.54 (p = 0.026). Exercise yielded a SMD of –0.49 (p = 0.011). The use of a sleeve did not show a significant effect. In studies reporting pre and post effects, compression bandaging showed a consistent benefit, sleeves showed a positive effect of varying strength, and results for IPC and exercise were inconsistent. The combination of exercise and bandaging showed the most favorable results.

Conclusions

The findings suggest that the use of compression bandaging and exercise in combination has the strongest beneficial effects for lymphedema management among women with breast cancer–related lymphedema. Bandaging had consistent positive effects, whereas other interventions as stand alone approaches yielded somewhat inconsistent results.

Limitations

  • Mostly low quality/high risk of bias studies
  • Low sample sizes

Nursing Implications

The findings suggest that the combination of active exercise and compression bandaging is more effective than other interventions for managing upper extremity lymphedema. This review did not include an examination of complete decongestive therapy along with other interventions, which has been shown to be effective as well. Nurses can educate patients about the use of compression bandaging and exercise for lymphedema management. The findings here suggest that compression sleeves do not aid in lymphedema reduction in the acute phase but may be helpful in the maintenance phase.

Legacy ID

6126