Lymphedema can cause swelling, discomfort and body image issues for patients with breast cancer, but nighttime compression may help reduce the effects of the complication.
Wearing a compression bandage or compression system garment at night may improve arm lymphedema in patients with breast cancer, according to study results.
Lymphedema, which occurs in 21% of women, is swelling that occurs in the arm on the side that a patient underwent surgery for breast cancer. Margaret L. McNeely, physical therapist and professor at the University of Alberta in Canada, explained in an interview with CURE® that lymphedema can be progressive in some patients, which means it can worsen over time, causing discomfort, and increasing the risk of infection or cellulitis in the arm.
McNeely, who was lead author of the study, added that it can impede on a patient’s daily functions because the arm can become so swollen and that some women have trouble finding clothes that fit them correctly. It can also cause body image issues; she said some women describe it as having arms that don’t match — as if having one arm from someone else’s body.
“There’s that aspect of (lymphedema) that it’s always there and it’s a constant reminder that they had cancer. Unfortunately, it’s a chronic condition that never goes away,” McNeely added.
She and other researchers sought to discover how to alleviate this discomfort and reduce lymphedema swelling in patients with breast cancer. Their study, which was published in the journal Cancer, evaluated 120 women who were split into three groups: standard care (daytime use of a compression sleeve alone; 39 patients), standard care plus multilayered compression bandaging at night (44 patients) and standard care plus nighttime compression system garments (37 patients).
At the end of the study period, 118 patients competed the trial and 114 completed the 24-week follow up.
Results demonstrated that wearing compression at night, whether it be compression bandaging or a compression system garment, was more effective than only wearing compression during the day. McNeely explained that for some individuals the arm swells more during the night, so the compression can help to treat the lymphedema as they sleep. For others, the compression provides a means to support the lymphatic system, so that more fluid is removed when the individuals is resting. This allows the system to ‘catch up’ a bit at night.
“Especially for the women who had the milder versions of lymphedema, we saw some amazing results,” she added.
McNeely mentioned that the improvement in swelling is subtle, so it takes longer to see, but those women enrolled in the trial who did see benefit were very thankful. She added that for many of the women, over time, the garment became so comfortable for them to wear at night that they often felt uncomfortable if they didn’t wear it when sleeping. Many felt it was very easy to apply and more comfortable to wear than a daytime garment.
Interestingly, quality of life was improved across all three groups, which McNeely said “was a bit of a surprise” to her and the other researchers. “We had anticipated we would see more improvement in quality of life in the groups that had the nighttime compression, but we saw an improvement across all groups, which ended up then not being statistically significant.”
They hypothesized that this might have been because often adherence to daytime compression is poor, but in this study, it was “excellent,” so even those wearing only daytime compression some saw a slight improvement in their condition.
McNeely concluded that earlier introduction to nighttime compression may benefit women.
“We need to change our approach so that we actually introduce nighttime compression earlier when the arm swelling is less severe. In these early cases, we may be able to reduce the swelling to a subclinical level, where you can barely see the swelling.” In that way, McNeely said that earlier use of compression for these patients may help them better control the condition in the long run.
“(When we introduce) it earlier, we don’t keep the woman on the same pathway that’s allowing their condition to slowly get worse, or to fluctuate, that kind of arthritis-type pattern where it flares up, and then it settles, then it flares up again. “If we can keep the swelling nicely in control, and keep the limb healthy, the individual may be better able to take part in other activities that will further benefit their lymphedema and overall wellness, such as exercising.”
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