New non-drug technologies for lymphedema associated with breast cancer: a review

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Abstract

     

INTRODUCTION. Breast Cancer-Related Lymphedema (BCRL) is the most common complication after radical treatment of breast cancer (BC). Currently, there are no molecular therapeutic targets whose pharmacologic action could prevent edema, making it necessary to study the efficacy of non-pharmacologic techniques.

AIM. To study the effectiveness of non-medication technologies in BCRL to develop recommendations for practical application based on the analysis of systematic reviews and meta-analyses of randomized controlled trials (RCTs).

MATERIALS AND METHODS. The search was conducted in the Physiotherapy Evidence-Based Database (PEDro, 2002–2024) using the keywords: “lymphedema”, “upper limbs”, “breast cancer”. A total of 203 sources were selected as of March 2024.

RESULTS AND DISCUSSION. Numerous studies have found that the use of early postoperative physical exercise with a gradual expansion of the load in patients at risk of developing BCRL is a safe and effective method of rehabilitation. The effectiveness of early preventive use of manual lymphatic drainage (MLD) in 4 RCTs was studied in a Cochrane review. However, the clinical effectiveness of early prophylactic use of MLD to prevent BCRL remains insufficiently proven. In contrast, prophylactic use of compression sleeves has been shown to reduce and delay the onset of arm lymphedema in women at high risk of developing BCRL during the first year after breast cancer surgery. Studies have also confirmed the effectiveness of an early Prospective Surveillance Model using bioimpedance spectroscopy for early detection and immediate treatment of BCRL. It has been proven that in order to reduce the volume of a limb with BCRL, it is necessary to prescribe an intensive phase of complex decongestive therapy (CDT) for at least 3 weeks. Studies have also proven the effectiveness of using a standard or improved intermittent pneumatic compression device in the rehabilitation phases, including at home.

CONCLUSION. To reduce the risk of development and progression of BCRL, modern exercise therapy techniques should be used to increase physical activity in order to control body weight, and educational techniques for self-massage and self-application of compression bandages should be actively used. The “golden” standard for conservative treatment of BCRL remains CDT, which is based on MLD. At the same time, the wider use and development of new methods of hardware lymphatic drainage that imitate MLD, which is a highly resourceful and costly method of treatment for BCRL, is justified. To confirm the clinical effectiveness of improved hardware pneumocompression, additional RCTs assessing long-term treatment results are required.

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About the authors

Tatiana V. Apkhanova

National Medical Research Center for Rehabilitation and Balneology

Author for correspondence.
Email: apkhanovatv@nmicrk.ru
ORCID iD: 0000-0003-3852-2050

Dr.Sci. (Med.), Chief Researcher, Department of Physiotherapy and Reflexology, National Medical Research Center for Rehabilitation and Balneology

Russian Federation, Moscow

Tatiana V. Konchugova

National Medical Research Center for Rehabilitation and Balneology

Email: umc-rnc@mail.ru
ORCID iD: 0000-0003-0991-8988

Dr.Sci. (Med.), Professor, Chief Researcher, Department of Physiotherapy and Reflexology, National Medical Research Center for Rehabilitation and Balneology

Russian Federation, Moscow

Detelina B. Kulchitskaya

National Medical Research Center for Rehabilitation and Balneology

Email: apkhanovatv@nmicrk.ru
ORCID iD: 0000-0002-7785-9767

Dr.Sci. (Med.), Professor, Chief Researcher, Department of Rhysiotherapy and Reflexology, National Medical Research Center for Rehabilitation and Balneology

Russian Federation, Moscow

Olga V. Yurova

National Medical Research Center for Rehabilitation and Balneology

Email: apkhanovatv@nmicrk.ru
ORCID iD: 0000-0001-7626-5521

Dr.Sci. (Med.), Professor, Deputy Director for Science and Professional Education, National Medical Research Center for Rehabilitation and Balneology

Russian Federation, Moscow

Elena M. Styazhkina

National Medical Research Center for Rehabilitation and Balneology

Email: apkhanovatv@nmicrk.ru
ORCID iD: 0000-0003-4612-5119

Ph.D., Cand. Sci. (Med.), Associate Professor, Leading Researcher of the Department of Orthopedics, Biomechanics, Kinesiotherapy and Manual Therapy

Russian Federation, Moscow

Tatyana V. Marfina

National Medical Research Center for Rehabilitation and Balneology

Email: apkhanovatv@nmicrk.ru
ORCID iD: 0000-0002-2553-1946

Researcher, Department of Physiotherapy and Reflexology, National Medical Research Center for Rehabilitation and Balneology

Russian Federation, Moscow

Lev G. Agasarov

National Medical Research Center for Rehabilitation and Balneology

Email: apkhanovatv@nmicrk.ru
ORCID iD: 0000-0001-5218-1163

Dr.Sci. (Med.), Professor, Chief Researcher, Department of Physiotherapy and Reflexology, National Medical Research Center for Rehabilitation and Balneology

Russian Federation, Moscow

Valeriia A. Vasileva

National Medical Research Center for Rehabilitation and Balneology

Email: apkhanovatv@nmicrk.ru
ORCID iD: 0000-0002-6526-4512

Cand. Sci. (Med.), Senior Researcher, of Somatic Rehabilitation, Active Longevity and Reproductive Health Department, National Medical Research Center for Rehabilitation and Balneology.

Russian Federation, Moscow

Elena S. Berezkina

National Medical Research Center for Rehabilitation and Balneology

Email: apkhanovatv@nmicrk.ru
ORCID iD: 0009-0006-7416-3381

Ph.D. (Biol.), Researcher, Department of Biomedical Technologies, National Medical Research Center for Rehabilitation and Balneology.

Russian Federation, Moscow

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2. Fig. 1. Distribution of evidence of RCTs on medical rehabilitation for BCRL by PEDro score, number of studies

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3. Fig. 2. Scheme of treatment methods for BCRL

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Copyright (c) 2024 Apkhanova T.V., Konchugova T.V., Kulchitskaya D.B., Yurova O.V., Styazhkina E.M., Marfina T.V., Agasarov L.G., Vasileva V.A., Berezkina E.S.

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