Vignes, S., Porcher, R., Arrault, M., & Dupuy, A. (2011). Factors influencing breast cancer-related lymphedema volume after intensive decongestive physiotherapy. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 19(7), 935–940.

To analyze factors associated with treatment failure and success in lymphedema

All patients underwent complete decongestive therapy (CDT) with manual drainage, multilayer low-stretch bandages and specific exercises and skin care as recommended in international consensus guidelines. Patients were followed at 6 and 12 months and then yearly.  At each patients were questioned about actual treatments used and responses were recorded

• The sample (N = 682) was comprised of female patients with lymphedema.
• Of the sample, 47.8% had mastectomy and 97.4% had radiation therapy.
• Median time to lymphedema onset was 22 months and duration was 32 months.
• All patients had initial lymphedema volume of more than 250 ml. 

The study used a descriptive design.

• Arm circumference was measured.
• Treatment failure was defined as a lymphedema volume increase of more than or equal to 50% of total reduction obtained during the first intensive CDT.
   

• Median lymphedema volume was 936 ml prior to therapy and 335 ml after CDT (p < 0.0001).
• Median duration of follow up was 28 months.
• Volume increased after initial intensive phase CDT throughout the first year.
• Analysis gave hazard ratios of: MLD alone = 1.91, p = 0.03; elastic sleeve alone = 0.65, p = 0.1; MLD and elastic sleeve = 1.09, p = 0.73; bandage and elastic sleeve = 0.53, p = 0.004; MLD, bandage, and elastic sleeve = 0.73, p = 0.14. 
• Lymphedema volume mainly reflected treatment compliance.
• MLD alone was associated with increased risk of failure and adding MLD did not reduce the risk of failure. 
• Being overweight was associated with increased risk of failure.
• Compression therapy with an elastic sleeve during the day and bandaging at night were the main means to stabilize lymphedema volume. 
• Body mass index was associated with higher risk of treatment failure.

MLD did not appear to reduce the risk of treatment failure for lymphedema. Compression therapy appears to be the main factor in stabilizing lymphedema volume.

• The study did not have a control group, blinding, or random assignment. 
• Measurement and methods were not well described.
• It is unclear if multiple people did measurement.
• Measurement validity and reliability were questionable.
• Patient self-report of compliance is not well described.
• How relevant data was coded for analysis is not described.

Findings add to the growing body of evidence pointing to the critical nature of patient compliance with compression sleeves and bandaging over time for ongoing effective management of lymphedema. Findings suggested that being overweight may also contribute to potential for treatment failure. Nursing measures to provide support for treatment adherence and weight control are important areas for patient care.  Interventions to facilitate adherence to compression therapy should be researched.