Meme kanseri ilişkili lenfödem tedavisinde komplet dekonjestif tedavi sonuçları ve tedavi başarısını etkileyen faktörler

Abstract

Amaç: Meme kanseri ilişkili lenfödem (MKİL) hastalarında komplet dekonjestif tedavi (KDT) etkinliğini ekstremite volum azalmasının yanısıra üst ekstremite fonksiyonel durumunun ve hastaların yaşam kalitesinin artması açısından incelenmesi amaçlandı. Yöntem: Retrospektif olarak tasarlanan çalışma MKİL tedavisinde KDT faz-1 uygulanmış kırk kadın hastadan oluşmaktadır. Evreleme hem Uluslararası lenfoloji topluluğu (ISL) önerilerine göre hem de lenfosintigrafi ile yapılmıştır. Hastaların tümü üç hafta boyunca haftada beş gün, manuel lenfatik drenaj, çok tabakalı bandajlama, gözetimli egzersiz, cilt bakımı ve hasta eğitiminden oluşan faz-1 KDT almıştır. Sonuç değerlendirme araçları çevre ölçümü ile hesaplanan volum hesabı, Görsel Analog Skala (VAS), Üst Ekstremite Fonksiyonel Indeksi-15 (UEFI-15), Yorgunluk Şiddet Ölçeği (FSS), Avrupa Kanser Araştırma ve Tedavi Organizasyonu Yaşam Kalitesi Anketini (EORTC QLQ-30) içermektedir. Ölçümler tedavi öncesi ve üç hafta sonra tedavi bitiminde kaşılaştırılmak üzere tekrarlanmıştır. Ek olarak tedavi başarısına etki edebilecek faktörler sorgulanmıştır. Bulgular: Kırk kişilik MKİL yakınması olan kadın hasta grubu 56.38±10.37 yıl yaş ortalamasina sahipti. Ödemli ekstremite hacminde azalma, fonksiyonel skorlarda artış, ağrı ve yorgunluk durumlarında anlamlı düşme saptandı. Tedavi başarısında bazı klinik ve demografik özellikler farklı sonuçlara sahipti. Sonuç: Çalışma MKİL yönetiminde KDT tedavi başarısına katkı sağlamakla birlikte bilinen risk faktörlerinin tedavi başarısı üzerindeki etkisini yansıtmaktadır. Ekstremite hacim ölçümleri, klinik ve demografik özelliklere göre ayrılan gruplar arasında değişiklik göstermezken, bazı fonksiyonel skorlar ve yaşam kalitesi ölçütleri fark göstermiştir. Sonuçlar MKİL’in multidisipliner yönetiminde eşlik eden hastalıklar, ilaç kullanımı, hastaların yaşam tarzı alışkanlıkları, sosyal, finansal ve psikolojik özelliklerinin de değerlendirme konusu olması gerekliliğini düşündürmektedir.

Keywords

• meme kanseri ilişkili lenfödem
• komplet dekonjestif tedavi
• yaşam kalitesi
• ekstremite hacimi
• lenfosintigrafi

Outcomes of complete decongestive therapy in breast cancer-related lymphedema and determinants of treatment success

Abstract

Aims: We aimed to evaluate the outcomes of complete decongestive therapy (CDT) among patients suffering from breast cancer-related lymphedema (BCRL) in the aspect of decrement of extremity volume and increment of functional status of upper extremity as well as patients’ quality of life (QoL). Methods: Retrospectively designed trial consists of forty women with BCRL who had received CDT phase-1. Staging was performed according to International society of lymphology (ISL) recommendations and lymphoscintigraphy both. All of the patients had received total of fifteen sessions, five sessions per week, for three weeks long, phase-one CDT which includes manual lymphatic drainage, multilayered compression bandage application, supervised exercise and skin care components. Outcome measures included extremity volumes calculated via frustum method based on circumferential measurements, Visual Analog Scale (VAS), Upper Extremity Functional Index-15 (UEFI-15), Fatigue Severity Scale (FSS), European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC-QLQ-C30). Assessments were performed at the beginning of the CDT and at the end of three weeks so as to be compared. Additionally features could have impact on treatment success were questioned. Results: Sample size of forty BCRL suffering women had mean age of 56.38±10.37. They had all significant reduction in edematous limb and gain in functional scores, decrement in fatigue and pain conditions. Some clinical and demographical properties showed differences in success of treatment. Conclusion: Along with contribution to the efficiency of CDT in management of BCRL the article represents roles of known risk factors on the success of treatment. While changes in volume measurements did not differ among groups based on clinical and demographical features, some items of QoL and functionality scales were different. Results thought the necessity of multidisciplinary management of BCRL in the aspects of comorbid diseases, medications, life style habits, social, financial and psychological status of the patients should be subjects.

Keywords

• Breast cancer-related lymphedema
• complete decongestive therapy
• quality of life
• extremity volume
• lymphoscintigraphy

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