The Complete Decongestive Therapy to Treat Lymphedema in Post-Breast Cancer Surgery and Its Relationships with Patients Psychological and Physical Characteristics: A Pilot Study

摘要

Background. More than 20% of women treated for breast cancer are at risk for developing lymphedema, a chronic condition that causes swelling, pain, altered appearance and reduced mobility. Complete Decongestive Therapy (CDT) is considered the gold standard to treat lymphedema. Objective. To measure lymphedema features and psychological variables in 10 post-breast cancer surgery patients at baseline, and 1, 6, and 12 months after CDT. Results. Lymphedema appeared between 0 and 6 years after breast cancer surgery. After 4 weeks in CDT treatment, the median degree of reduction was 38.73% (range, 7.45-58.39), and six months after, 49.57% (range, 11.91-82.50). Comparing patients that have had an extra reduction in arm circumferences at T3 (group 1) and patients that did not (group 2), we found: patients in group 1 showed at baseline a better psychological functioning (health-related quality of life domains, anxiety, depression, body-image vulnerability, appearance stereotyping), and higher scores in curability and severity respect to the comparison group. 12 months after the CDT, among patients of the group 1, the lymphedema is perceived as less severe and more curable compared to their perception at baseline, and dysfunctional investment in one's appearance and anxiety scores decreased, emotional wellbeing improved. Patients in the group 2 perceived lymphedema as much more curable, but also much more severe that at baseline. Both, anxiety and dysfunctional investment in one's appearance scores increased. Conclusions. Too often, conventional rehabilitation may not optimally match clinical resources to patients' needs, and if our results will be confirmed, screening and independent treatment for psychological distress will be required in patients to prevent poor CDT responses.