Use of compression garments by women with lymphoedema secondary to breast cancer treatment

E. Longhurst, E. S. Dylke & S. L. Kilbreath. Supportive Care in Cancer. 2018

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Use of compression garments by women with lymphoedema secondary to breast cancer treatment

Longhurst, E. S. Dylke & S. L. Kilbreath. Supportive Care in Cancer. 2018

Purpose This aim of this study was to determine the use of compression garments by women with lymphoedema secondary to breast cancer treatment and factors which underpin use.

Methods An online survey was distributed to the Survey and Review group of the Breast Cancer Network Australia. The survey included questions related to the participants’ demographics, breast cancer and lymphoedema medical history, prescription and use of compression garments and their beliefs about compression and lymphoedema. Data were analysed using principal component analysis and multivariable logistic regression.

Results Compression garments had been prescribed to 83% of 201 women with lymphoedema within the last 5 years, although 37 women had discontinued their use. Even when accounting for severity of swelling, type of garment(s) and advice given for use varied across participants. Use of compression garments was driven by women’s beliefs that they were vulnerable to progression of their disease and that compression would prevent its worsening. Common reasons given as to why women had discontinued their use included discomfort, and their lymphoedema was stable. Participant characteristics associated with discontinuance of compression garments included their belief that (i) the garments were not effective in managing their condition, (ii) experienced mild-moderate swelling and/or (iii) had experienced swelling for greater than 5 years.

Conclusion The prescription of compression garments for lymphoedema is highly varied and may be due to lack of underpinning evidence to inform treatment.

Main findings

  • The current study was undertaken to explore issues around use of compression garments by women with secondary lymphoedema arising from treatment of breast cancer.
  • The aims of this study, therefore, are to
    • Describe the use of compression garments by women living with lymphoedema.
    • Determine the beliefs that drive use of compression garments by women living with lymphoedema.
    • Determine factors that are associated with both use and discontinued use of compression garments by women living with lymphoedema.
  • An online survey of women who had used compression within the last five years.
  • Of the 215 women who completed the survey 178 reported having been prescribed a compression garment within the last 5 years.
  • Of the participants with lymphoedema, 140 (78.7%) reported that they were currently using a compression garment. The most common reasons reported for use of compression garments were ‘keeps my arm shape and lymphoedema stable’ (79.3%) and ‘I want to follow the advice of my health professional’ (61.4%). Whilst use of ready-made compression garments for upper limb lymphoedema was related to severity of disease (χ2 =6.9; P<0.03), ready-made compression garment use was not related to BMI (χ2 =2.8; P=0.24), even when severity was considered. Ready-made garments were more likely to be worn by women with mild (64.3%) or moderate (62.7%) severity whereas custom-made garments were worn by those with severe lymphoedema.
  • Instructions given by clinicians to patients on their garment use varied both between and within severity of lymphoedema.
  • Factor analysis identified two factors, perceived efficacy of compression garments managing lymphoedema and the participants’ fear of lymphoedema worsening.
  • Coping ability did not differ significantly depending on severity of lymphoedema.
  • Compression garments had been discontinued by 37 (21%) women. The most common reasons reported for discontinued use of compression garments were ‘[garment] felt uncomfortable’ (n=16), ‘lymphoedema stable’ (n=12), did not like the look of it (n=10) and made no difference (n=10). Six women had discontinued use of compression garments as the swelling had resolved.
  • Participants were therefore more likely to discontinue use of their compression garments if they
    • perceived that the garments were not effective in managing their condition,
    • experienced mild- moderate swelling and/or
    • had experienced swelling for greater than 5 years.

Age, BMI, dominant side affected and beliefs about lymphoedema did not contribute significantly as to whether or not women discontinued use of compression garments.

  • What is lacking is an evidence based approach to inform prescription of garments, both in terms of what type of garment is required, based on underlying pathology, as well as in terms of how long and often to wear the garments.