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S. Rogan1,2,3, J. Taeymans1,3, S. Sidler1, T. Sturzenegger1, H. Luginbuehl1
1Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Bern, Switzerland, 2Akademie für Integrative Physiotherapie und Trainingslehre, AfiPT, Grenzach-Wyhlen, Germany, 3Vrije Universiteit Brussel, Faculty of Physical Education and Physiotherapy, Brussels, Belgium
Background: The prevalence of lymphedema after breast cancer surgery varies between 6%-80%. Physiotherapists advise affected women to reduce their risk of developing secondary lymphedema. Basically, they recommend avoiding activities which could lead to an increase in lymphatic load or could impair the already reduced transport capacity of the lymph vessels. Among such recommendations is avoidance of tissue damage with following inflammatory response. Up to date the question whether tissue damage can trigger secondary lymphedema is controversially discussed.
Purpose: We conducted a systematic literature review of studies in the field of lymphology, which investigated the influence of tissue damage (such as “hospital skin puncture” (injection), blood draws, cuff compression, burns, trauma, insect bites) of the affected arm and trunk quadrant on the development of secondary lymphedema in women after breast cancer surgery and/ or radiation.
Methods: CINAHL (EBSCOhost), Cochrane Central Register of Controlled Trials, Embase, Physiotherapy Evidence Database (PEDro) and PubMed databases were searched for literature published from 2005 to June 2020. All retrieved studies were screened for title and abstract by two independent reviewers reaching consensus through discussion in case of disagreement. The same researchers independently assessed the full-text articles for eligibility based on a priori set inclusion and exclusion criteria. The methodological quality was appraised using the CASP checklists while the study characteristics were screened and extracted by the two reviewers independently. The study protocol was registered at PROSPERO (CRD42017043224).
Results: A total of 432 articles were identified. After screening of the titles and removing the duplicates, 99 articles remained. Following the reading of the abstracts, 33 articles entered the full text review. From those, 27 articles were excluded. Finally, six studies involving 2392 participants met the inclusion criteria. These studies showed a low to medium methodological quality. This systematic review showed but very poor evidence that the investigated risk factors were associated with an increased risk for lymphedema development. Only the risk factor “hospital skin puncture” (injection) represented a significant risk of developing secondary lymphedema in women after breast cancer surgery.
Conclusion(s): Due to the low number of included studies, the lack of their methodological quality and their high risk of bias, it is difficult to draw recommendations for affected women. Only "hospital skin puncture” (injection) may be related to an increased development of secondary lymphedema in women after breast cancer surgery. The current systematic literature review corroborates the clinical implication that health-care professionals should perform skin punctures on the contralateral upper extremity of women after breast cancer surgery. This present work also revealed a lack in literature on this topic. Therefore, further high-quality epidemiological studies should be performed.
Implications: The lymphedema prophylaxis recommendation “skin puncture avoidance on the affected upper extremity” for women after breast cancer surgery seems important, i.e. is confirmed by the present systematic literature review.
Funding, acknowledgements: No funding
Keywords: Breast Cancer Lymphedema, Wounds and Injury, Injections
Topic: Oncology, HIV & palliative care
Did this work require ethics approval? No
Institution: N/A
Committee: N/A
Reason: We performed a Systematic Review, therefore N/A
All authors, affiliations and abstracts have been published as submitted.
