Comparison efficacy and safety of acupuncture and moxibustion therapies in breast cancer-related lymphedema: A systematic review and network meta-analysis.

OBJECTIVE: Although several acupuncture and moxibustion therapies have been tested in managing breast cancer-related lymphedema (BCRL), there is little consensus regarding the best options for treating this condition. This systematic review and network meta-analysis compared the efficacy of various acupuncture and/or moxibustion therapies for BCRL. METHODS: Seven databases and two clinical registration centers were searched from their inception to December 1st, 2023. The Cochrane Collaboration risk-of-bias assessment tool evaluated the quality of included RCTs. A pairwise meta-analysis was performed in STATA 16.0, while a network meta-analysis was performed in R 4.2.2. RESULTS: 18 studies were included in this analysis. Our results showed that acupuncture and moxibustion methods had great advantages in improving BCRL of patients with breast cancer. In particular, needle-warming moxibustion (NWM) could be the optimal acupuncture and moxibustion method for improving clinical effectiveness and reducing the degree of swelling of affected limbs. CONCLUSION: Our findings suggest that NWM has great potential in treating BCRL. It may reduce arm circumference, lower swelling levels, and improve clinical effectiveness. Nevertheless, more multi-center, high-quality, and large sample RCTs will be needed in the future.

Comparison of the effects of different functional exercise sequences on lymphedema in breast cancer: protocol for an exploratory randomised controlled cross-over trial.

INTRODUCTION: Breast cancer-related lymphedema (BCRL) is a common postoperative complication of breast cancer. It develops in a chronic and vicious cycle. Once lymphedema occurs, it cannot be cured and bring serious physiological, psychological, social and economic burden to patients. Upper limb functional exercises are an effective and convenient intervention for managing lymphedema. However, the optimal exercise sequence remains unclear. Therefore, we aim to compare the effects of exercise sequences under the guidance of commonly used exercise sequences and lymphatic flow theory. METHODS: An exploratory randomised controlled cross-over trial will be conducted. 32 patients with BCRL are randomly allocated into two groups (group A and group B). Group A patients will perform functional exercise from wrist joint to shoulder joint, and the exercise direction of group B is opposite to that of group A, that is, from shoulder joint to wrist joint end. Exercise time is once a day, each 20-30 min, for 2 weeks. After 2 weeks of washout period, A and B groups of exchange exercise sequences (exercise frequency and duration unchanged). The primary outcome is upper limb circumference, and secondary outcomes are upper limb function and lymphedema symptoms. ETHICS AND DISSEMINATION: This study protocol is presented in accordance with the Standard Protocol Items: Recommendations for Interventional Trials guidelines. All participants will sign a written informed consent. The research ethics regional committee of Shanghai Seventh People's Hospital has approved the study. Regardless of the outcome of this study, the results will be published in open-access journals to ensure public access. TRIAL REGISTRATION NUMBER: ChiCTR2200066463.

Initiating and Maintaining Complete Decongestive Therapy Self-Management of Lymphedema Among Breast Cancer Survivors: Descriptive Qualitative Study.

PURPOSE: This study aimed to identify determinants that promote the initiation and maintenance of complete decongestive therapy (CDT) as well as effective strategies for mitigating barriers to self-management of lymphedema among breast cancer survivors. METHODS: A descriptive and qualitative design was used. In-depth interviews were conducted with 13 breast cancer survivors who were managing breast cancer-related lymphedema. Interviews were transcribed verbatim. An iterative descriptive data analysis method was employed to examine the data, compare codes, challenge interpretations, and inductively identify themes. RESULTS: A realization that lymphedema requires daily self-management was the primary determinant leading breast cancer survivors to initiate CDT self-management. The determinants for maintaining daily CDT self-management included the perceived effectiveness of CDT, being willing to assume accountability, and perceived efficacy to undertake CDT. Developing strategies to integrate CDT regimens into daily life is key to maintaining CDT self-management of lymphedema. Three core concepts mediate initiation and maintenance of CDT self-management: understanding lymphedema as a chronic condition that can be managed with CDT self-management, being worried about lymphedema exacerbation, and having support from patient peers and family. CONCLUSIONS: Interventions should be tailored to promote the initiation and maintenance of CDT self-management. While clinicians provided knowledge-based and clinical skills-based information, patient peers provided daily life examples, and real-life implementation strategies for CDT self-management. Ongoing patient-provider and patient-peer communication functioned as effective support for maintaining CDT self-management. Reliable and realistic methods of symptom self-assessment are important for maintaining CDT at home.

Breast Cancer-related Lymphedema: Recent Updates on Clinical Efficacy of Therapies and Bioengineering Approaches for a Personalized Therapy.

BACKGROUND: Post-mastectomy lymphedema is a chronic progressive disease characterized by a significant reduction in quality of life and a range of complications. AIM: To this date, no single treatment method provides pathological correction of the mechanisms associated with tissue reorganization observed in later-stage breast cancer-related lymphedema (BCRL). METHODS: To define a personalized approach to the management of patients with iatrogenic lymphedema, we performed a systematic review of literature without a comprehensive meta-analysis to outline existing molecular- genetic patterns, overview current treatment methods and their efficacy, and highlight the specific tissue-associated changes in BCRL conditions and other bio-engineering approaches to develop personalized therapy. RESULTS: Our results show that several tissue-specific and pathological molecular markers may be found, yet current research does not aim to define them. CONCLUSION: As such, currently, a strong foundation for further research into molecular-genetic changes in lymphedema tissue exists, and further research should focus on finding specific targets for personalized treatment through bio-engineering approaches.

Long-term Experience on Breast Cancer-related Lymphedema in the Coastal Area of Fukushima, Japan After the 2011 Triple Disaster.

BACKGROUND/AIM: Disasters can jeopardize breast cancer care and Japan's triple disaster in 2011 (earthquake, tsunami, and nuclear accident) is no exception. However, detailed information is lacking regarding the care of breast cancer related lymphedema (BCRL) following the disaster. We aimed to explore the process by which local patients become aware of BCRL, the problems faced, and the support they require. We also aimed to clarify the effects of the 2011 disaster on experiences related to lymphedema in the target population. PATIENTS AND METHODS: Patients who developed BCRL after breast cancer treatment were recruited from Iwaki city, a municipality located in the southern coastal region of Fukushima (N=16). In-depth, semi-structured, face-to-face interviews were conducted, and the obtained data were appraised using thematic analysis. RESULTS: Five themes related to BCRL were identified: 1) the process of becoming aware of BCRL, 2) troubles or worries/concerns due to BCRL, 3) information sources regarding BCRL management, 4) strategies to cope with BCRL, and 5) the adverse impacts of the 2011 disaster on BCRL management. CONCLUSION: Except for the disaster context, the themes are in line with those of previous studies conducted in the non-disaster context. Nonetheless, there were limited but non-negligible adverse effects of the 2011 disaster on long-term local BCRL management. The findings of this study demonstrate the necessity for individualizing coping strategies against BCRL among healthcare professionals in the Fukushima coastal area and beyond.

Effectiveness of manual lymphatic drainage in intensive phase I therapy of breast cancer-related lymphedema-a retrospective analysis.

BACKGROUND: The standard therapy for lymphedema of any origin is complex physical decongestive therapy (CDT). It comprises manual lymph drainage (MLD), compression therapy (CT), exercise therapy (ET), skincare, and patient education. Additionally, intermittent pneumatic compression (IPC) can be applied. However, the contribution of MLD to decongestion is repeatedly questioned. PATIENTS AND METHODS: This study re-analyzes a previous study during a 3-week decongestion period, comparing two different types of compression bandaging at the weekend. Sixty-one patients with unilateral breast cancer-related lymphedema were included. The patients received the same therapy (CDT + IPC) except for the different weekend compression bandaging. MLD was performed twice a day on weekdays. The volume of the affected arm was measured on days 1, 5, 8, 12, 15, 19, and 22. For the analysis, the data of both study groups were pooled. RESULTS: During the week, the patients showed a significant volume reduction (- 155.23 mL (week 1), - 101.02 mL (week 2), - 61.69 mL (week 3), respectively; p < 0.001 each) with a high effect size. On the weekends without MLD, they showed a slight, but also significant increase (12.08 mL (weekend 1), 8.36 mL (weekend 2), 4.33 mL (weekend 3), respectively; p < 0.001 each) with a medium effect size. CONCLUSIONS: We showed a strong effect of MLD on volume reduction. Differences from other studies are the larger study population and the more intensive application of MLD. If applied intensively, MLD is strongly decongestive during a 3-week decongestion therapy for breast cancer-related lymphedema.

Eficacia de la fisioterapia para mejorar la calidad de vida y el dolor en el tratamiento del linfedema postmastectomía. Una revisión sistemática / Efficacy of physiotherapy to improve quality of life and pain in the treatment of postmastectomy lymphedema. A systematic review

Objetivo Comparar la evidencia de los diferentes tratamientos para el linfedema y los posibles dolores miofasciales postmastectomía, para conseguir la máxima calidad de vida de los pacientes. Estrategia de búsqueda y selección de estudios Se realizó una búsqueda en las bases de datos PubMed, Phisiotherapy Evidence Database (PEDro) y Web of Science (WOS) durante marzo y abril del año 2022. Se tuvo en cuenta que los pacientes hubiesen sido intervenidos quirúrgicamente por cáncer de mama (CaMama), mayores de 18 años y que los estudios fuesen ensayos clínicos; resultando un total de 10 artículos seleccionados. Se evaluó la calidad metodológica y factor de impacto de cada uno de ellos. Síntesis de resultados Las variables analizadas fueron reducción del linfedema, calidad de vida y abordaje del dolor. El tratamiento a través de drenaje linfático manual (DLM) presentó mejorías en todos los artículos que hacían referencia a la reducción del linfedema, tanto de forma individual como de forma aislada; en cambio, respecto a los dolores miofasciales el tratamiento de liberación miofascial mostró mejoras tanto en la calidad emocional como en la disminución del dolor, siendo más efectivo en esta última variable. Conclusiones Los tratamientos que mejoran la calidad de vida y dolor de los pacientes que han sufrido una intervención quirúrgica debido al CaMama, además de reducir el linfedema son DLM, facilitación neuromuscular propioceptiva (FNP), liberación miofascial y programas de ejercicios y entrenamientos. La limitación principal respecto a los tratamientos, es que no existe ningún programa de intervención específico (AU)

Objective To compare the evidence of the different treatments for lymphedema and possible postmastectomy myofascial pain, to achieve the highest quality of life for patients. Search strategy and selection of studies A search was carried out in the PubMed, Physiotherapy Evidence Database (PEDro) and Web of Science (WOS) databases during March and April 2022. It was taken into account that the patients had undergone surgery surgically for breast cancer, that they were over 18 years of age and that the studies were clinical trials; resulting in a total of 10 selected articles. The methodological quality and impact factor of each of them were evaluated. Summary of results The variables analyzed were reduction of lymphedema, quality of life and pain management. Treatment through manual lymphatic drainage (MLD) presented improvements in all the articles that made reference to the reduction of lymphedema, both individually and in isolation; On the other hand, regarding myofascial pain, myofascial release treatment showed improvements in both emotional quality and pain reduction, being more effective in this last variable. Conclusions The treatments that improve the quality of life and pain of patients who have undergone surgery due to breast cancer, in addition to reducing lymphedema, are manual lymphatic drainage, proprioceptive neuromuscular facilitation, myofascial release, and exercise and training programs. The main limitation regarding treatments is that there is no specific intervention program (AU)

Can Acupuncture be a Part of the Treatment for Breast Cancer-Related Lymphedema? A Systematic Review of the Safety and Proposed Model for Care.

Acupuncture is a potential therapy for breast cancer-related lymphedema (BCRL). Despite a recent meta-analysis on efficacy, data on acupuncture safety in BCRL are lacking. Current clinical guidelines recommend avoiding needling in the upper extremity affected by lymph node dissection. We undertook a systematic review focusing on acupuncture safety and treatment protocols in clinical trials for BCRL. Literature searches were conducted in PubMed, Ovid, CINAHL, and Cochrane library. Eight clinical trials on acupuncture for BCRL were analyzed. The Standards of Acupuncture intervention (STRICTA 2010) and Cochrane risk of bias (RoB2 2019) were applied to assess methods for acupuncture interventions within Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Quantity and severity of adverse events (AE) were reviewed. A total of 189 subjects participated in 8 clinical trials with 2965 acupuncture treatments. No serious adverse events (SAE) were reported regardless of treatment laterality or protocol, with only a single grade 2 skin infection in 2,965 total treatments (0.034%), including 1,165 bilateral and 225 ipsilateral treatments. Our comprehensive review of clinical trials of acupuncture for BCRL demonstrated no significant adverse events in 2,965 treatments, including 1,390 in the affected limb. An approach for routine integration of acupuncture into BCRL maintenance therapy is proposed.

Effectiveness of a Nonpneumatic Active Compression Device in Older Adults with Breast Cancer-Related Lymphedema: A Subanalysis of a Randomized Crossover Trial.

Background: A recently completed clinical trial compared a novel nonpneumatic compression device (NPCD) with a traditional advanced pneumatic compression device (APCD) for the treatment of breast cancer-related lymphedema (BCRL); the study revealed that the NPCD produced superior clinical and quality-of-life (QOL) outcomes. In this subanalysis, we sought to examine these results within the subset of trial subjects aged ≥65 years. Methods: A randomized crossover head-to-head trial was conducted to compare the NPCD with a commercially available APCD. Patients were randomly assigned to one or the other device for 28 days of use, followed by a 4-week washout period before a comparable 28-day utilization of the alternate device. Limb edema, adherence to daily device use, and QOL measures were collected at day 0 and 28 of each period. Results: A total of 14 subjects were aged ≥65. During NPCD use, subjects experienced a mean decrease in limb edema of 100.3% (p = 0.0082) as well as improvements in mean overall and subscale scores of the Lymphedema Quality of Life Questionnaire (LYMQOL). By comparison, during APCD use limb edema decreased by a mean of 2.9% (p = 0.8899) with no significant changes in any LYMQOL scores. Mean adherence was significantly higher during NPCD use (96.6%) than during APCD use (58.3%, p < 0.0001). Conclusions: The novel NPCD produced superior clinical and QOL outcomes in older subjects with BCRL. ClinicalTrials.gov ID: NCT04908254.

Indirect partial volumetry in breast cancer-related lymphoedema: Distribution of oedema and clinical-diagnostic implications / Volumetría parcial indirecta en linfedema relacionado con cáncer de mama: distribución del edema e implicaciones clínico-diagnósticas

Introduction and objectives: Currently, the assessment of lymphoedema related to breast cancer (BCRL) is performed through the global perimeter volumetry. We implemented an additional system with partial measures (hand, forearm, and upper arm) that allows us to approximate the segmental distribution of oedema. We used this measurement tool to determine the oedema distribution and its evolution, as well as its possible impact on clinical assessment. Methods: We carried out a retrospective observational study of the patients referred to our service with suspected BCRL. Inclusion criteria: Unilateral breast cancer, availability of global and partial digital medical record, and follow-up for a minimum of 24 months. Of the 210 selected patients, 190 were considered affected (≥10% excess volume). We analysed at three time points (initial, final, and peak involvement) the oedema distribution and segmental predominance and its relationship with the evolutionary course and the severity of the process. We subsequently examined, at the initial timepoint, the concordance of the global assessment with the partial assessment for the clinical classification of the 210 patients in the initial sample. Results: The BCRL oedema was characteristically irregular, with the forearm being the most affected segment and the hand the least affected (RM ANOVA: p<0.001). The irregularity was related to its severity (χ2: p<0.001) and the evolutionary course (Student t-test: p<0.005 for the hand). Overall, disagreement of 46.67% was observed between the clinical classification of the global and partial assessment. Conclusions: This work supports the need to add partial volumetry to the commonly used global assessment.(AU)

Introducción y objetivos: Actualmente la volumetría perimetral global se utiliza para valorar el linfedema relacionado con cáncer de mama (LRCM). Nosotros implementamos un sistema adicional que permite aproximarse a la distribución segmentaria del edema mediante tres indicadores parciales: mano, antebrazo y brazo. Utilizamos esta herramienta para conocer la distribución del edema, su evolución y su posible repercusión en la valoración clínica. Metodología: Se realizó un estudio observacional retrospectivo de los pacientes remitidos a nuestro servicio con sospecha de LRCM. Criterios de inclusión: Cáncer de mama unilateral, con registros volumétricos en la historia clínica digital y 24 meses de seguimiento mínimo. De los 210 pacientes seleccionados, en 190 pacientes afectos (≥10% de exceso de volumen) se analizaron en tres momentos de medición (inicial, final y máxima afectación) la distribución del edema, su predominio segmentario y la relación con la evolución y la gravedad del proceso. Posteriormente se examinó la concordancia de los indicadores globales con los parciales en la valoración clínica de los 210 pacientes de la muestra inicial. Resultados: El LRCM fue característicamente irregular, siendo el antebrazo el segmento predominante y la mano el menos afecto (MR ANOVA: p<0,001). La irregularidad se relacionó con la gravedad del proceso (chi cuadrado: p<0,001) y su evolución (t de Student: p<0,005 para la mano). Además, se apreció, en conjunto, una discordancia en la valoración clínica del índice global con los índices parciales del 46,67% (W de Kendall=0,467). Conclusión: El estudio apoya la necesidad de añadir volumetría parcial a la valoración global habitualmente utilizada.(AU)

Development of Pressure Sensors to Help Support Community Lymphedema Monitoring: A Scoping Review.

Breast cancer-related lymphedema is a condition occurring after a partial or full mastectomy, where there is a buildup of interstitial fluid in the body, particularly in the upper limb. There is a lack of at-home sensors that can help monitor the progression of lymphedema. The purpose of this scoping review is to gather relevant information on sensors for remote lymphedema monitoring. A literature search of Medline, PubMed, Scopus, Web of Science, and BMC databases yielded 96 studies. A total of six studies were selected for data extraction. Data were extracted from each study and organized into tables for analysis. A total of six different devices were mentioned in the six studies included in the scoping review, divided into wearable and nonwearable sensors. Nonwearable sensors were more likely to be adaptable for remote sensing as they were further along in development and commercially available on the market. Nonwearable sensors are more developed than wearable sensors for the purpose of remote lymphedema monitoring. This review advocates further development and validation of sensors for lymphedema management, particularly for remote monitoring and health assessments.

Complex physical therapy employing self-adjusting garment (ReadyWrap®) in breast cancer-related lymphedema cases in Brazilian women: a protocol for a randomized controlled trial.

BACKGROUND: Lymphedema is a common complication following breast cancer treatment. The aim of this study is to evaluate the effectiveness of a self-adjusting compression garment (ReadyWrap®) in reducing (phase 1) and maintaining (phase 2) upper limb volume in women presenting breast cancer-related lymphedema. METHODS: This study will comprise a randomized, controlled, single-blind clinical trial concerning women with breast cancer-related lymphedema undergoing treatment at a public cancer treatment reference hospital in the city of Rio de Janeiro, Brazil. The intervention will be carried out by adapting self-dressing versus the standard treatment of compressive bandaging (phase 1) and compressive mesh (phase 2). Both groups will be assessed at the beginning and end of intensive treatment and followed up for up to 12 months to evaluate immediate and late outcomes. Assessments will be carried out by physical upper limb examination (inspection, palpation, volume, dynamometry, and thermography) and questionnaires application to assess patient's quality of life pertaining to the health, functionality, and symptoms of the affected upper limb, as well adverse effects and adherence to treatment. Data will be analyzed descriptively and analytically through univariate and multiple linear regressions. P values < 0.05 will be considered statistically significant. DISCUSSION: This study will evaluate the effectiveness of a self-adjustable garment (ReadyWrap®) in the treatment of lymphedema secondary to breast cancer in Brazilian women compared to the gold standard treatment for limb volume reduction (phase 1) and maintenance (phase 2) phases comprising, respectively, a compressive bandaging and a compressive mesh. The outcome results will provide data based on both quantitative responses and self-reported participant outcomes. The study will also assess the cost-effectiveness of the ReadyWrap® treatment versus standard care. Finally, we expect to reaffirm one more product/therapy as a treatment for this extremely complex and impactful condition following the data analysis. TRIAL REGISTRATION: NCT04934098 [Clinical trials phase 1]. Registered on June 22, 2021. NCT04881604 [Clinical trials phase 2]. Registered on May 11, 2021.

Exploring the potential role of health resort medicine in the management of breast cancer-related lymphedema: a viable alternative for innovative rehabilitation opportunities?

Lymphedema is a chronic and progressive disorder of the lymphatic system that impairs the return of lymphatic fluid. Breast cancer treatment can cause breast cancer-related lymphedema (BCRL), with axillary lymph node dissection and regional lymph node radiation being established risk factors. BCRL can cause severe morbidity, disability, and reduced quality of life. Early detection and treatment are essential to prevent the disease from progressing and causing complications. According to the International Society of Lymphology, complex decongestive therapy (CDT) is the most effective conservative treatment for lymphedema. Aquatic exercise is a safe and effective form of therapeutic CDT exercise that can improve joint range of motion, reduce pain, and positively impact limb volume. Additionally, health resort medicine and thermal mineral-rich waters may provide synergistic benefits for therapeutic exercise programs. Therefore, we believe that consideration should be given to whether the spa setting could represent a viable alternative for the rehabilitation of BCRL patients.

Complete Decongestive Therapy Effect on Breast Cancer Related to Lymphedema: A Systemic Review and Meta-Analysis of Randomized Controlled Trials.

PURPOSE: To review and analyze critically the available evidence for Complete Decongestive Therapy Effect on Breast Cancer Related to Lymphedema. DATA SOURCES: Publications were retrieved from the major database search engines, included  Google scholar, EBSCO host, and PubMed database. The search terms including: "Complete decongestive therapy (CDT)", "breast cancer", "Breast cancer related to lymphedema (BCRL)" "breast surgery" and "mastectomy". STUDY SELECTION: The studies were initially selected based on keywords associated with inclusion criteria. Then, articles were chosen based on their titles. Then, based on the fill text and design, randomized control with a comprehensive description of the outcomes. The authors analyzed 3,181 articles, of which 15 randomized controlled trials met inclusion criteria with no publication date constraint. DATA EXTRACTION: Each article's authors, nations, participants, outcomes variables, measuring instruments, intervention technique and follow-up, outcomes, and results were retrieved. After reaching consensus among authors, study quality was evaluated using the Jadad scale, and risk of bias was determined using the Cochrane Rob2 tool. DATA SYNTHESIS: The levels of evidence were of excellent quality. The retrieved articles were of "high" methodological caliber. The major outcome variables were in QOL, pain, ROM and edema. The effect size of CDT on QOL was 2.347 (95% CI: -1.41, 6.11) (p=0.22). Pain was -0.068 (95% CI: -35.21) (p=0.64). ROM was 0.324 (95% CI: -0.44,0.09) (p=0.41) and edema was -2.9 (95% -1.53,1.11) (p=0.76). CONCLUSIONS: The CDT is still recommended as the primary therapy for BCRL and is regarded the most practical and cost-effective treatment for BCRL. This result recommends patients to perform CDT to improve their QOL, ROM, and to lessen pain and edema volume. To improve the body of evidence supporting the effectiveness of the CDT on BCRL, additional trials with bigger sample sizes, longer follow-ups, blindness outcomes, and patient compliance evaluations are required.

Effectiveness of physical exercise programmes in reducing complications associated with secondary lymphoedema to breast cancer: a protocol for an overview of systematic reviews.

INTRODUCTION: Breast cancer-related lymphoedema (BCRL) is one of the most underestimated and debilitating complications associated with the treatment that women with breast cancer receive. Several systematic reviews (SRs) of different physical exercise programmes have been published, presenting disperse and contradictory clinical results. Therefore, there is a need for access to the best available and summarised evidence to capture and evaluate all the physical exercise programmes that focus on reducing BCRL. OBJECTIVE: To evaluate the effectiveness of different physical exercise programmes in reducing the volume of lymphoedema, pain intensity and improving quality of life. METHOD AND ANALYSIS: The protocol of this overview is reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols, and its methodology is based on Cochrane Handbook for Systematic Reviews of Interventions. Only those SRs involving physical exercise by patients with BCRL will be included, whether on its own or combined with other exercises or other physical therapy interventions.The outcomes of interest to be considered will be lymphoedema volume, quality of life, pain intensity, grip strength, range of motion, upper limb function and any adverse event. The MEDLINE/PubMed, Lilacs, Cochrane Library, PEDro and Embase databases will be searched for reports published from database inception to April 2023.Two researchers will perform study selection, data extraction and risk of bias assessment independently. Any discrepancy will be resolved by consensus, or ultimately, by a third-party reviewer. We will use Grading of Recommendations Assessment, Development and Evaluation System to assess the overall quality of the body of evidence. ETHICS AND DISSEMINATION: The results of this overview will be published in peer-reviewed scholarly journals and the scientific dissemination will take place in national or international conferences. This study does not require approval from an ethics committee, as it does not directly collect information from patients. PROSPERO REGISTRATION NUMBER: CRD42022334433.

The effect of complex decongestive physiotherapy applied with different compression pressures on skin and subcutaneous tissue thickness in individuals with breast cancer-related lymphedema: a double-blinded randomized comparison trial.

PURPOSE: The aim of this study was to evaluate the effect of compression bandage applied with different pressures on the skin and subcutaneous thickness in individuals with breast cancer-related lymphedema (BCRL). METHODS: 21 individuals with stage 2 unilateral BCRL participated in the study. Individuals were randomly allocated into two groups as low-pressure bandage (20-30 mmHg) (n: 11) and high-pressure bandage (45-55 mmHg) (n: 10). Skin and subcutaneous tissue thickness, extremity volume, sleep quality, treatment benefit, and comfort were evaluated by ultrasound from 6 reference points (as hand dorsum, wrist volar, forearm volar, arm volar, forearm dorsum, and arm dorsum), volumetric measurement, Pittsburgh Sleep Quality Index, Patient Benefit Index-Lymphedema, and visual analog scale, respectively. Complex decongestive physiotherapy was applied to both groups. Compression bandage was applied according to their group. Individuals were evaluated at the baseline, 1st session, 10th session, 20th session, and at 3-month follow-up. RESULTS: Skin thickness decreased significantly in the volar reference points of the extremity in the high-pressure bandage group (p = 0.004, p = 0.031, and p = 0.003). Subcutaneous tissue thickness significantly decreased at all reference points in the high-pressure bandage group (p < 0.05). In the low-pressure bandage group, skin thickness only decreased in the forearm dorsum and the arm dorsum (p = 0.002, p = 0.035) and subcutaneous tissue thickness changed for all points (p < 0.05) except for hand and arm dorsum (p = 0.064, p = 0.236). Edema decreased in a shorter time in the high-pressure bandage group (p < 0.001). No significant differences were found in sleep quality, treatment benefit, and comfort for both groups (p = 0.316, p = 0.300, and p = 0.557, respectively). CONCLUSION: High pressure was more effective in reducing subcutaneous tissue thickness in the dorsum of hand and arm. The usage of high-pressure can be recommended especially in cases which have edema in the dorsum of hand and arm which is difficult to resolve. Also, high-pressure bandage can provide faster edema resolution and can be used in rapid volume reduction as desired. Treatment outcomes may improve with high-pressure bandage without any impairment in comfort, sleep quality, and treatment benefit. TRIAL REGISTRATION NUMBER AND DATE: NCT05660590, 12/26/2022 retrospectively registered.

Recent Advances in Therapeutic Modalities Against Breast Cancer-Related Lymphedema: Future Epigenetic Landscape.

Background: Lymphedema is a significant postsurgical complication observed in the majority of breast cancer patients. These multifactorial etiopathogenesis have a significant role in the development of novel diagnostic/prognostic biomarkers and the development of novel therapies. This review aims to ascertain the epigenetic alterations that lead to breast cancer-related lymphedema (BCRL), multiple pathobiological events, and the underlying genetic predisposing factors, signaling cascades pertinent to the lapses in effective prognosis/diagnosis, and finally to develop a suitable therapeutic regimen. Methods and Results: We have performed a literature search in public databases such as PubMed, Medline, Google Scholar, National Library of Medicine and screened several published reports. Search words such as epigenetics to induce BCRL, prognosis/diagnosis, primary lymphedema, secondary lymphedema, genetic predisposing factors for BRCL, conventional therapies, and surgery were used in these databases. This review described several epigenetic-based predisposing factors and the pathophysiological consequences of BCRL, which affect the overall quality of life, and the interplay of these events could foster the progression of lymphedema in breast cancer survivors. Prognosis/diagnostic and therapy lapses for treating BCRL are highly challenging due to genetic and anatomical variations, alteration in the lymphatic vessel contractions, and variable expression of several factors such as vascular endothelial growth factor (VEGF)-E and vascular endothelial growth factor receptor (VEGFR) in breast cancer survivors. Conclusion: We compared the efficacy of various conventional therapies for treating BCRL as a multidisciplinary approach. Further substantial research is required to decipher underlying signaling epigenetic pathways to develop chromatin-modifying therapies pertinent to the multiple etiopathogenesis to explore the correlation between the disease pathophysiology and novel therapeutic modalities to treat BCRL.

Efectividad de la fisioterapia multimodal acuática mediante ejercicio terapéutico, autodrenaje manual y medidas de autocuidado en el linfedema de miembro superior en mujeres supervivientes de cáncer de mama. Ensayo clínico aleatorizado / Effectiveness of aquatic multimodal physiotherapy through therapeutic exercise, manual self-drainage and self-care measures in upper limb lymphedema in female breast cancer survivors. Randomized clinical trial

Introducción El linfedema secundario al cáncer de mama es una patología crónica. La fisioterapia descongestiva compleja (FDC) es el tratamiento conservador de elección, consta de una fase intensiva para disminuir el volumen de la extremidad, y una fase de mantenimiento para fomentar el autocontrol de la patología. El objetivo es evaluar si la fisioterapia multimodal acuática (FMA) compuesta por ejercicio terapéutico, auto drenaje manual y medidas de autocuidado de miembro superior mantiene o reduce el volumen del linfedema en fase de mantenimiento y si esta es más efectiva que la fisioterapia multimodal de miembro superior en sala. Metodología Se ha realizado un ensayo clínico aleatorizado comparando dos grupos, experimental n:43 que realizó una pauta de ejercicios en el medio acuático y control n:47 que realizó la misma pauta de ejercicios en sala. Ambos grupos efectuaron 20 sesiones de 45 min, dos o tres días por semana. Se evaluaron como variables principales los cambios en el volumen del linfedema, mediante circometría y la calidad de vida de las participantes, mediante la escala FACT-B + 4. Resultados No se encontraron diferencias estadísticamente significativas entre las intervenciones realizadas, ambas mejoran el volumen a las 20 sesiones (p = 0,7855), pero si entre la frecuencia del tratamiento y el tiempo postintervención (p<0,01). Se encontraron mejoras en las variables de calidad de vida; «estado físico general del paciente», «ambiente familiar y social», «estado emocional», «capacidad de funcionamiento personal» y «preocupaciones de las pacientes» (p < 0,01). Conclusión La FMA de miembro superior parece mejorar la calidad de vida de las mujeres supervivientes con linfedema de miembro superior en fase de mantenimiento. La FMA no muestra un beneficio añadido a la fisioterapia multimodal en sala (AU)

Introduction Lymphedema secondary to breast cancer is a chronic pathology. Complex decongestive physiotherapy is the conservative treatment of choice, it consists of an intensive phase to minimize the volume of the limb, and a maintenance phase to promote self-control of the pathology. The objective is to evaluate if aquatic multimodal physiotherapy (AMP) composed of therapeutic exercise, manual self-drainage and upper limb self-care measures maintains or reduces the volume of lymphedema in the maintenance phase and if it is more effective than upper limb multimodal physiotherapy in-room. Methodology A randomized clinical trial has been carried out comparing two groups, experimental N:43 that performed a pattern of exercises in an aquatic environment and control N:47 that performed the same pattern of exercises in-room. Both groups carried out 20 sessions of 45min, 2 or 3 days per week. The main variables were the changes in the volume of the lymphedema, by means of circometry, and the quality of life of the participants, by means of the FACT-B + 4 scale. Results No statistically significant differences were found between the interventions carried out, both improve the volume at 20 sessions (p = 0.7855), the interaction between the frequency of treatment and the time after intervention was (p-value: < 0.01). Improvements were found in quality of life variables; «general physical state of the patient», «family and social environment», «emotional state», «personal functioning capacity» and «patient concerns» (p-value: < 0.01). Conclusion Upper limb AMP seems to improve the quality of life of surviving women with upper limb lymphedema in the maintenance phase. AMP does not show an added benefit to room multimodal physiotherapy (AU)