Effectiveness of compression sleeve in preventing breast cancer-related lymphoedema

Abstract

Breast cancer-related lymphoedema (BCRL) is one of the most feared complications following breast cancer treatment. The burden of BCRL is high in India, with more than 162,000 women diagnosed with breast cancer annually. Strategies that prevent the condition from developing are needed; for those women at-risk of its development, strategies that enable early detection and monitoring of its impact are required. Three gaps that informed these strategies were identified and addressed in this thesis to reduce the burden of BCRL. First, detection of lymphoedema in India using bioimpedance spectroscopy (BIS) was compromised as the device available in India used an alternative electrode placement and had yet to be validated against established protocols. A study was, therefore, conducted to examine the interchangeability of two electrode placement protocols. Secondly, to inform which self-reported questionnaire (SRQ) should be translated into Indian languages, a comprehensive systematic review of the lymphoedema-specific SRQs was conducted to identify which of the available ones demonstrates good measurement properties. Thirdly, an adequately powered randomized controlled trial on the efficacy of the prophylactic use of compression sleeves to prevent lymphoedema in women at high risk of lymphoedema was investigated. The first study demonstrated that the equipotential and sternal notch electrode placement protocols are interchangeable in BCRL assessment. The second study showed that the Lymph-ICF-UL and LYMQOL-leg SRQs had good quality evidence supporting their content validity, reliability and construct validity. The third study demonstrated that prophylactic use of compression sleeve delayed and reduced the arm swelling in the first year following surgery. In conclusion, this thesis provides critical evidence to advance the management of the enormous burden of BCRL in the Indian context and other similar resource-limited settings.