OPTIMAL COMPRESSION THERAPY DOSAGE IN BREAST CANCER–RELATED LYMPHEDEMA: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS

Abstract

Background: Breast cancer survivors can experience chronic, debilitating swelling of an arm or both arms as a result of treatment. The standard treatment for this condition, known as breast cancer-related lymphedema (BCRL), includes the use of specialized “compression garments. There is variability in the prescription and use of compression therapy to alleviate the swelling and related symptoms. It is important to determine the best compression strategies to improve symptom management. Objective: The goal of this study was to systematically synthesize the available evidence from randomized controlled trials to determine the compression therapy dosages and to analyze the strategies that best alleviate edema in the arm(s) of women with BCRL. Methods: We conducted this study in accordance with the PRISMA guidelines and the protocol registered in PROSPERO (CRD420261353843). Using defined search strategies, we systematically searched MEDLINE, CENTRAL, EMBASE, and CINAHL, to identify relevant randomized controlled trials. We included studies that reported the use of compression therapy for the treatment of adult patients with BCRL and described the dosage of the therapy. Two reviewers independently extracted data and assessed risk of bias using the Cochrane tool. Results: Most of the RCTs included in this synthesis reported reductions in volume and symptoms of BCRL with the use of compression therapy. One study reported that low-pressure (20-30 mmHg) compression bandages improved symptoms and adherence when compared to high-pressure (44-58 mmHg) compression bandages. Another study reported that the use of low-pressure (27-32 mmHg) class I compression sleeves contributed to the arrest of lymphedema progression over a 12 month period. Lastly, a study using an advanced pneumatic compression device in home health care settings reported greater symptom improvement and edema reduction compared to standard home care devices. Conclusion: Clinically, lower compression therapy is more effective and better tolerated than high compression therapy. While randomized control trials are lacking, it is recommended that BCRL compression therapy be individualized and that treatment begin early. In order to establish evidence based guidelines, large multicenter randomized control trials are needed.