The important role of nighttime compression in breast cancer–related lymphedema treatment

This is the authors' abstract. We don't add key points for this paper.

Breast cancer– related lymphedema (BCRL) affects approximately 21% of women treated for breast cancer. The treatment of BCRL is burdensome for patients in terms of time, financial costs, and impact on their quality of life (QOL). However, treatment is imperative to prevent edema progression, which leads to increased limb volume, symptoms, and a change in the tissues from a fluiddominant edema to a fatdominant edema. At late stages, BCRL becomes refractory to conservative treatment, and the risk of cellulitis and hospitalization increases. This may result in a cycle of repetitive infections and increased chronic edema. It is, therefore, imperative to maximize the success of BCRL treatment to prevent progression while minimizing the impact on QOL resulting from the treatment itself. McNeely et al address this issue comprehensively with their multisite randomized controlled trial (RCT), which included 120 women in the maintenance phase of BCRL treatment. The primary objectives were to determine the efficacy of nighttime compression on arm volume maintenance and QOL outcomes. BCRL was defined as a minimum 200mL or 10% increase in arm volume over the unaffected arm. Participants were randomized to 3 groups: 1) standard care (SC) with a daytime compression sleeve alone (SC group), 2) SC plus nighttime multilayered compression bandaging (CB) for 12 weeks (CB group), and 3) SC plus a nighttime compression system garment (NCSG) for 12 weeks (NCSG group). The primary end point was the change in excess arm volume from the study baseline to 12 weeks, as measured via perometry. Secondary end points included QOL, bioimpedance analysis, sleep disturbance, and the selfefficacy of lymphedema management. Adherence to the assigned compression therapy regimen was selfreported. Participants were measured at weeks 6, 12 (the end of the RCT portion), 18, and 24. After the intervention, the addition of nighttime compression was found to be superior to SC for both absolute milliliter reductions (P = .006) and percentage reductions (P = .002) in excess arm lymphedema volume. There was no significant difference between the 3 groups in terms of QOL, selfefficacy, bioimpedance analysis, or sleep disturbance. Subgroup analyses indicated a significant difference in favor of the addition of nighttime compression for those with mild lymphedema. The rates of adherence to the application of nighttime compression were 95% ± 15% and 96% ± 11% in the CB and NCSG groups, respectively (P = .718). McNeely et al make a valuable contribution to the literature with this study. Nighttime compression is often overlooked for patients with BCRL yet can have a significant impact on BCRL management. This study nicely compared day sleeve management with a day sleeve plus multiplelayer bandaging, which is really the standard nighttime compression used to date, and it also compared the day sleeve plus compression system, which is a newer, attractive option for patients. These types of systems are available from several manufacturers, and they have options that are userfriendly and are much easier to apply than multiplelayer bandaging. Often, both daytime compression and nighttime compression are required to ensure maintenance of arm volume reduction. We applaud McNeely et al for offering a gauntlet or glove as an option alongside the day sleeve if there was swelling in a participant’s hand or fingers. These are often prescribed as standard or mandatory alongside compression sleeves, although they can be barriers to adherence to arm compression in this population. Giving the participant the option to omit hand compression in the absence of hand swelling likely improved adherence to daytime compression in this study, which was high. It has been found previously that hand swelling occurs only in a proportion of patients with BCRL, and it follows that hand compression should not be prescribed as standard alongside arm compression in the absence of hand swelling.