Evaluation of Sympathetic Skin Response and Its Relationship With Clinical Response to Complex Decongestive Therapy in Patients With Postmastectomy Lymphedema (BCRL-SSR)

May 20, 2026 updated by: Sehri Baris, Gaziler Physical Medicine and Rehabilitation Education and Research Hospital

This prospective observational single-center study aimed to evaluate sympathetic skin response (SSR) in patients with postmastectomy upper extremity lymphedema and to investigate the relationship between SSR parameters and clinical response to complex decongestive therapy (CDT).

Thirty female patients with breast cancer-related lymphedema and thirty healthy female controls were included in the study. All participants underwent autonomic nervous system assessment using SSR and R-R interval variability measurements and completed the Composite Autonomic Symptom Score-31 (COMPASS-31) questionnaire.

Patients in the lymphedema group received a standardized 3-week CDT program consisting of 15 treatment sessions. Clinical response to treatment was evaluated by calculating changes in lymphedema volume before and after treatment. Quality of life, upper extremity function, pain severity, and neuropathic pain symptoms were assessed using LYMQOL-Arm, QuickDASH, Numeric Rating Scale (NRS), and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS).

Study Overview

Status

Completed

Conditions

Detailed Description

Breast cancer-related lymphedema is a chronic condition that develops following breast cancer treatment and is traditionally considered to result from impaired lymphatic drainage and fluid accumulation. Recent evidence suggests that autonomic nervous system dysfunction may also contribute to the pathophysiology of lymphedema.

The aim of this prospective observational study was to evaluate sympathetic skin response (SSR), autonomic nervous system functions, and their relationship with clinical response to complex decongestive therapy (CDT) in patients with postmastectomy upper extremity lymphedema.

Thirty female patients aged 18-65 years with unilateral upper extremity lymphedema after breast cancer treatment and thirty healthy female controls were included. All participants underwent electrophysiological autonomic nervous system evaluation using SSR and R-R interval variability measurements. In addition, autonomic symptoms were assessed using the Composite Autonomic Symptom Score-31 (COMPASS-31).

Patients in the lymphedema group received a standardized CDT program for 3 weeks, 5 days per week, totaling 15 sessions. Clinical response to treatment was evaluated using changes in lymphedema volume measurements obtained before and after treatment.

Secondary clinical assessments included quality of life evaluation with LYMQOL-Arm, upper extremity functional assessment with QuickDASH, pain severity assessment using the Numeric Rating Scale (NRS), and neuropathic pain evaluation using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS).

The study aimed to determine whether autonomic dysfunction is present in breast cancer-related lymphedema and whether baseline SSR parameters are associated with clinical response to CDT.

Study Type

Observational

Enrollment (Actual)

60

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Turkey (Türkiye)
    • Ankara
      • Ankara, Ankara, Turkey (Türkiye), 06800
        • Gaziler Physical Medicine and Rehabilitation Training and Research Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Sampling Method

Non-Probability Sample

Study Population

The study population consisted of female patients aged 18-65 years with unilateral postmastectomy upper extremity lymphedema following breast cancer treatment and age-matched healthy female volunteers. Patients had completed breast cancer treatment protocols and had ISL stage I-II lymphedema. Healthy controls had no history of breast cancer, lymphedema, neurological disease, metabolic disorder, or systemic condition affecting autonomic nervous system function.

Description

Healthy Control Inclusion Criteria:

  • Female volunteers aged between 18 and 65 years
  • No history of breast cancer or lymphedema
  • No neurological, metabolic, or systemic disease affecting autonomic nervous system function

Healthy Control Exclusion Criteria:

  • History of breast cancer or lymphedema
  • Polyneuropathy
  • Diabetes mellitus
  • Hypothyroidism
  • Neurological disease
  • Systemic diseases affecting autonomic nervous system function

Patient group;

Inclusion Criteria:

Inclusion Criteria:

  • Female patients aged between 18 and 65 years
  • Postmastectomy upper extremity lymphedema after breast cancer surgery
  • Completion of breast cancer treatment protocols
  • International Society of Lymphology (ISL) stage I-II lymphedema

Exclusion Criteria:

  • Metastatic breast cancer
  • Bilateral breast cancer history
  • Bilateral upper extremity lymphedema
  • Ongoing chemotherapy or radiotherapy
  • Infection or allergic skin lesions on the upper extremities
  • Medical conditions causing edema, including decompensated heart, lung, or renal failure
  • Peripheral nervous system disease or polyneuropathy
  • Chronic endocrine, metabolic, neurological, or systemic diseases affecting autonomic nervous system function, including diabetes mellitus, hypo/hyperthyroidism, uremia, heart failure, cardiac arrhythmia, and uncontrolled hypertension
  • Presence of a cardiac pacemaker
  • Inability to tolerate electrical stimulation

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Lymphedema volume difference and sympathetic skin response (SSR) parameters
Time Frame: Baseline and after 3 weeks of complex decongestive therapy
Upper extremity lymphedema volume difference and sympathetic skin response (SSR) parameters were evaluated before and after complex decongestive therapy. Limb volume was calculated using circumferential measurements obtained at 4-cm intervals with the truncated cone formula. SSR recordings were obtained using surface electrodes and median nerve stimulation. Peak-to-peak amplitude and latency values were analyzed.
Baseline and after 3 weeks of complex decongestive therapy

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
R-R interval variability (RRIV)
Time Frame: Baseline and after 3 weeks of complex decongestive therapy
Cardiac autonomic function was evaluated using R-R interval variability measurements during resting and deep breathing conditions.
Baseline and after 3 weeks of complex decongestive therapy
COMPASS-31 score
Time Frame: Baseline and after 3 weeks of complex decongestive therapy
Autonomic symptoms were evaluated using the Composite Autonomic Symptom Score-31 questionnaire.
Baseline and after 3 weeks of complex decongestive therapy
LYMQOL-Arm score
Time Frame: Baseline and after 3 weeks of complex decongestive therapy
Quality of life related to upper extremity lymphedema was evaluated using the LYMQOL-Arm questionnaire.
Baseline and after 3 weeks of complex decongestive therapy
QuickDASH score
Time Frame: Baseline and after 3 weeks of complex decongestive therapy
Upper extremity functional status was assessed using the QuickDASH questionnaire.
Baseline and after 3 weeks of complex decongestive therapy
Numeric Rating Scale (NRS)
Time Frame: Baseline and after 3 weeks of complex decongestive therapy
Pain severity was evaluated using the Numeric Rating Scale.
Baseline and after 3 weeks of complex decongestive therapy
Leeds Assessment of Neuropathic Symptoms and Signs (LANSS)
Time Frame: Baseline and after 3 weeks of complex decongestive therapy
Neuropathic pain symptoms were evaluated using the LANSS questionnaire.
Baseline and after 3 weeks of complex decongestive therapy

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Gaziler Physical Medicine and Rehabilitation Education and Research Hospital

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 25, 2025

Primary Completion (Actual)

February 12, 2026

Study Completion (Actual)

February 12, 2026

Study Registration Dates

First Submitted

May 7, 2026

First Submitted That Met QC Criteria

May 7, 2026

First Posted (Actual)

May 13, 2026

Study Record Updates

Last Update Posted (Actual)

May 22, 2026

Last Update Submitted That Met QC Criteria

May 20, 2026

Last Verified

May 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • BCRL-SSR-2026

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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