Adjustable Compression Wrap Versus Compression Bandage Reduce to Breast Cancer-related Lymphedema

Compressive Therapy by Adjustable Compression Garment (Ready Wrap®) in Breast Cancer-related Lymphedema: Randomized Clinical Trial

This is a randomized clinical trial with women with lymphedema secondary to breast cancer. The intervention will consist of the use of self-adjusting clothing versus compressive bandaging (routine treatment of the institution). Self-adjusting clothing is expected to be more effective for the treatment of lymphedema reduction, when compared to standard treatment, in addition to promoting a better quality of life and functionality.

Study Overview

• Status: Recruiting
• Conditions: Breast Neoplasms; Lymphedema of Upper Arm; Breast Cancer Related Lymphedema; Lymphedema, Secondary
• Intervention / Treatment: Device: Adjustable Compression Wrap; Device: Compression Bandage

Detailed Description

This is a randomized clinical trial, simple blind, which aims to evaluate the effectiveness of the use of self-adjusting compression garments (Read Wrap®) in reducing the volume of the upper limb of women with lymphedema secondary to breast cancer. It will be carried out in a referral hospital for the treatment of breast cancer in Brazil, with inclusion scheduled for June 2021 and follow-up of up to 1 year. All volunteers must have lymphedema in the upper limb after surgical treatment for breast cancer for more than 6 months, indicating phase 1 of compressive therapy. According to the sample calculation, 72 women will be needed to be randomly randomized in a 1: 1 ratio among the experimental intervention group (n = 36) and the standard intervention group (n = 36). The intervention consists of compressive therapy in the volume reduction phase for lymphedema secondary to breast cancer. The Experimental Intervention Group will receive an adjustable compaction wrap (Read Wrap®) while the standard Intervention Group will be submitted to compressive bandaging and will be followed up on an outpatient basis, as per institutional routine, twice a week, for 30 days. The institutional protocol for the lymphedema reduction phase will be respected, in which the orthosis is used at home for as long as possible, with time off just for bathing and sleeping, in addition, skincare and therapeutic exercises for upper limbs must be performed daily. An orientation booklet and home exercises of the institutional routine will be delivered. During the first 30 days of treatment, all study participants will be accompanied by a telephone channel that will be made available for questions, guidance, and communications of adverse events, in addition to a therapeutic diary that will be delivered at the first consultation and collected after this period, destined to notify relevant information that considers the use of compressive therapy, such as facilities, difficulties and time of use, symptoms related to the arm and adverse effects that may arise, and to monitor adherence to exercises. The suspension of treatment before the anticipated end of therapy will occur when adverse effects are observed, such as an increase in limb volume greater than 10% from the last measurement, signs of dermatitis, associated skin, or allergy. The case will be evaluated by the physiotherapy team and, when necessary, by the medical team and the treated procedures will be adopted.

Data collection will take place through the analysis of physical and electronic data, medical records, interviews, and physical examination. The interviews will be conducted through questionnaires produced by the researchers, in addition to validated questionnaires for the Brazilian population. The evaluations will take place in the outpatient clinic of the physiotherapy service of the hospital on the 1st, 7th, and 30th day of the intervention for immediate evaluation, and will be followed up to 1 year later, to verify the measures of long-term results. The analysis of the data will be descriptive and comparative of the intervention groups, about the selected variables and the main results, through the analysis of measures of central tendency, dispersion, and frequency distribution. The evaluation of the result will be carried out by intention of treatment, using linear and simple, and multiple logistic regression. For all analyzes, a 95% confidence interval will be considered.

• Study Type: Interventional
• Enrollment (Estimated): 72
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Anke Bergmann, PhD; Phone Number: 55 21 32076551; Email: abergmann@inca.gov.br
• Study Contact Backup: Name: Raul Denner Duarte; Phone Number: 55 86 999857875; Email: rauldenner@outlook.com

Study Locations

• Brazil
  • Rio De Janeiro, Brazil, 20231050
    • Recruiting
    • Anke Bergmann
    • Contact: Anke Bergmann, PhD; Phone Number: 55 21 32076551; Email: abergmann@inca.gov.br
    • Principal Investigator: Anke Bergmann, PhD
    • Contact: Raul Denner; Phone Number: 55 86 999857875; Email: rauldenner@outlook.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Women

  1. Age over 18 years
  2. Undergo surgical treatment for breast cancer
  3. Diagnosed with lymphedema in the upper limb stabilized for a period ≥6 months
  4. Indicated the second phase of compressive therapy / treatment of lymphedema

Exclusion Criteria:

• Women with:

  1. Bilateral lymphedema;
  2. Lymphedema since the preoperative period;
  3. Presence of phlogistic signs in the limb with lymphedema;
  4. Treatment of lymphedema (phase 1) in the last three months;
  5. Previous history of allergic reaction to the material used for compressive therapy;
  6. Active regional or remote disease;
  7. In chemotherapy or radiation therapy;
  8. Functional changes in the upper limbs prior to the diagnosis of breast cancer;
  9. Heart disease and decompensated systemic arterial hypertension; psychiatric, mental, neurological disorders or cognitive deficits that make it impossible to answer the questionnaires.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Adjustable compression wrap; Daily use of the Adjustable Compression Wrap on the upper limb with breast cancer-related lymphedema during phase 1 compression therapy.	Device: Adjustable Compression Wrap; The material will be delivered, adapted, and oriented for the daily use of the adjustable compression wrap (Ready Wrap®). The wrap allows for easy use because it is the pre-molded system in inelastic material with self-adjusting compressible components according to the size and shape of the upper limb. Due to its compression properties, it can be used as a therapy to control lymphedema. The material composition is: 61% Nylon, 33% Polyurethane, 6% Elastane (Spandex)). The institutional protocol for the control of the lymphedema phase will be respected, in which the orthosis is used at home for the longest period possible, with the only removal for bathing and sleeping; in addition, skincare and therapeutic exercises for the upper limbs should be performed daily.
Active Comparator: Compression Bandage; Daily use of compression bandage on the upper limb with breast cancer-related lymphedema during phase 1 compression therapy.	Device: Compression Bandage; Evaluation, skincare, compression bandaging, and guidance on therapeutic exercises for upper limbs. The material used for binding is tubular mesh, foam, elastic compression bandage. Therapy will be followed according to the institutional protocol for the lymphedema reduction phase, in which it will be reassessed twice a week for 30 days.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Arm volume	The main outcome is the change in the volume of the upper limb with lymphedema, which will be assessed through the perimeter of the circumference of the limb, and indirectly estimated the volume of the limb using the cone trunk formula.	Assessment of arm volume will be on the before (1st day), 30 days, 6 months and 1 year after enrollment.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Tissue characteristics (fibrosis) of the upper limb with lymphedema	Ultrasonography is used, a non-invasive method of capturing images of tissues through the emission of ultrasonic waves, through the evaluation of images obtained by the portable device, it will be possible to characterize the alteration of the dermoepidermal complex and the tissue. subcutaneous tissue of the upper limb with lymphedema. The report will be provided by a professional with experience in using the kinesiological ultrasound method.	The evaluation of the tissue characteristics of the arm will be before (1st day), 30 days, 6 months and 1 year after enrollment.
Tissue temperature of the upper limb with lymphedema	The tempertature of the arm will be assessed by means of thermography. Thermography is a safe, non-invasive imaging method that determines the distribution of body surface temperatures according to the physiological and pathological condition of the tissues. Inflammation, metabolic changes in the subcutaneous tissue and changes in blood supply result in changes in the temperature gradient of the affected area. In this way, the different stages of lymphedema will be related to different patterns of temperature distribution. The body surface temperatures will be recorded by means of a thermal camera and will be taken in the orthostatic position, from the anterior and posterior portions of the limb, at a distance of 2m. Later, these thermometric images will be analyzed using proprietary software. The standard measurement used will be in degrees celsius (ºC).	The tissue temperature of the arm will be before (1st day), 30 days, 6 months and 1 year after enrollment.
Health-related quality of life	Health-related quality of life will be assessed using 'European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30' (EORTC QLQ-C30). It is an instrument validated for our population, which scores from 0 to 100, the higher the value the better the quality of life will be.	The evaluation of the Health-related quality of life will be before (1st day), 30 days, 6 months and 1 year after enrollment.
Upper limb functionality	The functionality of the upper limbs will be assessed by the 'Disabilities of the Arm, Shoulder and Hand Questionnaire' (DASH). It is a validated instrument for our population, consisting of 30 questions that assess the ability to perform certain activities in the last week, regardless of the upper limb used. The score ranges from 0 to 100, the higher the worse the functionality.	The evaluation of the Upper limb functionality will be before (1st day), 30 days, 6 months and 1 year after enrollment.
Handgrip strength	Hand grip strength will be assessed by the dynamometer for 3 attempts, being considered the best of the 3.	The handgrip strength assessment will be before (1st day), 30 days, 6 months and 1 year after enrollment.

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Treatment costs	Expenses with material, professional, travel and food for each participant will be researched and noted on a form for later analysis.	Total cost of each therapy within 12 months of follow-up.
Adverse events	Guided by self-reporting and professional evaluation according to the Common Terminology Criteria for Adverse Events (CTCAE).	Daily documents during the first 30 days of the intervention. And at 6 and 12 months follow-up.

Collaborators and Investigators

• Sponsor: Instituto Nacional de Cancer, Brazil
• Investigators: Principal Investigator: Anke Bergmann, PhD, National Cancer Institute (INCA-BRAZIL)

Study record dates

Study Major Dates

• Study Start (Actual): July 1, 2021
• Primary Completion (Estimated): October 30, 2023
• Study Completion (Estimated): December 31, 2023

Study Registration Dates

• First Submitted: June 14, 2021
• First Submitted That Met QC Criteria: June 14, 2021
• First Posted (Actual): June 22, 2021

Study Record Updates

• Last Update Posted (Actual): September 28, 2023
• Last Update Submitted That Met QC Criteria: September 26, 2023
• Last Verified: September 1, 2023

More Information

Terms related to this study

• Keywords: breast cancer; lymphedema; compression bandages
• Additional Relevant MeSH Terms: Pathologic Processes; Skin Diseases; Neoplasms; Lymphatic Diseases; Neoplasms by Site; Postoperative Complications; Breast Diseases; Breast Neoplasms; Lymphedema; Breast Cancer Lymphedema
• Other Study ID Numbers: Stage 1 Compression Therapy

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes
• product manufactured in and exported from the U.S.: Yes