About 20% of patients with breast cancer are likely to develop breast cancer-related lymphedema (BCRL) following an axillary clearance, and BCRL can be refractory or irreversible to treatment.
The aim of this pilot randomized controlled study was to evaluate the effectiveness of a 10-min holistic self-care program for patients with BCRL in Japan.
The intervention group (n = 22) practised the BCRL self-care program including1) modified Japanese Radio Taiso (Rajio Taiso, national calisthenics in Japan), 2) gentle arm exercises combined with deep breathing, 3) central lymphatic drainage, and 4) skin care using a traditional lymphatic drainage technique daily for 6 months, while the control group (n = 21) received usual care from their hospitals.
There was significant group*time interaction in the relative edema volume and relative volume change of the hand, with the intervention group having the better outcome. The intervention group showed significant improvement in transepidermal water loss as well as the mental health component summary score of the SF-8, most of BCRL-related symptoms, self-care time and score, frequencies of exercise, self-lymphatic drainage and skin care, and perceived adherence and effectiveness to self-care, although we were unable to exclude the possibility of the Hawthorne effect. Notably, even in the control group, the self-care was similarly increased, but the significant improvements were detected only in transepidermal water loss on the forearm and upper arm, pain and coldness.
In conclusion, the patients who practiced the holistic BCRL self-care for 6 months have shown greater improvement.
Moseley A.
L., Piller N. B., Carati C. J. (2005): The effect of gentle arm exercise and
deep breathing on secondary arm lymphedema, Lymphology, 38(3), 136–145.
3)中心リンパクリアランス(シャワー又は入浴中1日1回、1分程度)
首,肩,上腕から鎖骨窩リンパ本幹に向かって軽擦法を行ってもらいました。
4)スキンケア+SLD(入浴直後、3分程度)
入浴直後皮膚の水分が蒸散しないうちに実施し,患側の肩,上腕,前腕,手の順に鎖骨窩リンパ本幹に向かってロート製薬株式会社のディーアールエックス® AD パーフェクトバリア® ボディミルクを塗布しながら軽擦を行ってもらいました。各部位一度ずつ撫でる程度で保湿が主な目的です。第Ⅰ相試験ではスウィートアーモンドオイルとグレープフルーツオイルを使ったのですが、赤くなるなどの皮膚反応を起こす対象者がいたため、本試験では、アトピー性皮膚炎で安全性と効果を検証された本剤を使用しました。リンパ浮腫は皮膚の問題であると言っている研究者もいるように、皮膚バリア機能が低下した対象者に配慮し、保湿剤を選びました。
TEWL(Transepidermal water loss)は皮膚水分蒸散量で、皮膚のバリア機能の指標として使われます。日機装サーモのH4500という信頼性妥当性を検証された機械で測定しました。リンパ浮腫の方は皮膚のトラブルが発生しやすく、2割が蜂窩織炎を経験し、その半数は反復性で、皮膚バリア機能はとても重要です。
ARINAGA, Yoko, et al. The 10-Min Holistic Self-Care for Patients with Breast Cancer-Related Lymphedema: Pilot Randomized Controlled Study. The Tohoku journal of experimental medicine, 2019, 247.2: 139-147.
Arinaga, Y., Sato, F., Piller, N., Kakamu, T., Kikuchi, K., Ohtake, T., Sakuyama, A., Yotsumoto, F., Hori, T. &Sato, N. A 10 Minute self-care program may reduce breast cancer-related lymphedema: a six-month prospective longitudinal comparative study. The Journal of Lymphology. 49, 93-106. 2016.
Arinaga, Y., Piller, N. &Sato, F. How can we know the true magnitude of any breast cancer-related lymphoedema if we do not know which is the true dominant arm? Journal of Lymphoedema. 11, 27-34. 2016.