DISCUSSION
cancers, obese, Breast Cancer, melanoma, fatigue, breast cancer, lymphoedema, cancer, overweight breast cancer, weight gain, overweight, overweight (OR 2), Lymphoedema, sentinelWeight Gain
CANCERS, OBESE, BREAST CANCER, MELANOMA, BREAST CANCER, LYMPHOEDEMA, CANCER, ARM SWELLING, DISEASE, RECRUITMENT, EFFECTS OF CHEMOTHERAPY, LYMPHOEDEMA, COMPLICATIONS
External Compression Garment application to the arm has been used as treatment for established arm LE for decadesFollowing theThe PLACE trial was designed to test the efficacy of such a strategy. Essentially, the reduction in lymphoedema with a compression garment should be considered as a percent of the control rate in a high risk population. Within 12 months using the sleeve, 17% of patients developed lymphoedema compared to 26% with best supportive care and 30% participants developed lymphoedema at 2 years in the intervention group. There was no evidence of benefit from surveillance and early application of a compression sleeve in subclinical LE in preventing clinical LE. Neither was a benefit of early intervention found either in terms of preventing lymphoedema progression to moderate LE or its infective complications.It could be argued that early intervention may treat subclinical / mild clinical lymphoedema and therefore after 1 year in the intervention group we should see a difference compared with the control group which could disappear after the compression garment is discontinued. However, this was not the result found (see Figure One limitation of the study is that we did not have an accurate record of adherence by participants to wearing the garment in the intervention group, despite the provision of diaries. Another limitation may be the different rate of loss to follow‐up by 24 months in the 2 groups (21% in the controls and 13% in the intervention group).In this study, no benefit of early intervention was found either in terms of preventing lymphoedema progression to moderate LE or its infective complications. In the BEA study, high BMI was also associated with progression of lymphoedema after application of a compression sleeve.However, it should be recognised that although those who developed lymphoedema were followed up in the study, the treatment of their lymphoedema was provided by lymphoedema therapists outside the study and not standardised.These findings will potentially apply to other cancers requiring axillary clearance (ie melanoma) causing lymphoedema following surgery.Although PLACE patient recruitment was lower than planned, the similar rate of lymphoedema development in both trial arms indicates that there is no preventative effect of Compression Sleeves on Lymphoedema development compared to standard conservative management, particularly in overweight and obese patients. Notably, the small differences in lymphoedema rates was largely seen in the women with a normal BMI. Women with a normal BMI represent a minority of the cancer population. We had previously reported that in 271 nonrandomised BEA patients developed LE in 24% patients by 24 months despite sleeve application. Older Age, BMI > 30 and the number of metastatic nodes at axillary clearance predicted progression to Lymphoedema in those BEA patients.A small controlled trial randomised 45 women (23 in the compression group and 22 to the control) to light compression sleeves (15–21 mmHg) worn daily immediately after breast cancer surgery, yet two years later,Following theIn the ALMANAC Trial of those patients developing 4–9% arm swelling by 6 months postsurgery, 30% improved spontaneously with standard management.The lack of evidence of the effects of surveillance or compression sleeves on preventing LE raises doubts about the National Lymphoedema Network guideline recommendations.Higher Lymphoedema risks for both overweight (OR 2) and obese (OR 3) patients after both sentinelWeight Gain after Breast Cancer Surgery is common and due to the effects of chemotherapy and radiotherapy causing fatigue and steroid therapy during chemotherapy. Exercise and diet regimes reduce weight gain on adjuvant endocrine therapy but not chemotherapyWeight loss has been found to reduce lymphoedema in a pilot study of overweight breast cancer survivors.Two recent studies have shown upper ‐body exercise reduces lymphoedema flare‐ups and symptoms, possibly due to increased muscle function and vascular flow.However the exercise interventions used in these studies above did not affect body weightThe purpose of any screening intervention to prevent disease is to identify patients who will benefit from an intervention and prevent the disease being screened for subsequently developing. Early Intervention with compression sleeves did not prevent lymphoedema development.The lack of preventative interventions suggests that screening for lymphoedema should not be recommended for all patients after axillary node clearance.