The improvement in the life expectancy of women with
breast cancer raises important questions about how to improve
the quality of life for women sustaining complications
of breast cancer treatment. In particular, attention to common
problems, such as arm edema, is of critical importance.
We reviewed published breast cancer guidelines and literature
identified via MEDLINE® searches in an effort to summarize
the research literature pertinent to management of
breast cancer-related arm edema, including incidence,
prevalence, and timing; risk factors; morbidity; prevention;
diagnosis; and efficacy of nonpharmacologic and pharmacologic
interventions. We found that arm edema is a common
complication of breast cancer therapy that can result in substantial
functional impairment and psychological morbidity.
The risk of arm edema increases when axillary dissection
and axillary radiation therapy are used. Recommendations
for preventive measures, such as avoidance of trauma, are
available, but these measures have not been well studied.
Nonpharmacologic treatments, such as massage and exercise,
have been shown to be effective therapies for lymphedema,
but the effect of pharmacologic interventions remains
uncertain. Comparing results across studies is
complicated by the fact that the definitions of interventions
and measures of outcomes and risk stratification vary substantially
among studies. As arm edema becomes more
prevalent with the increasing survival of breast cancer patients,
further research is needed to evaluate the efficacy of
preventive strategies and therapeutic interventions. [J Natl
Cancer Inst 2001;93:96–111]