Unilateral Meme Kanseri Tedavisi ile İlişkili Üst Ekstremite Lenfödeminde Kompleks Boşaltıcı Fizyoterapinin Duyusal Parametreler Üzerine Etkisinin İncelenmesi

Abstract

The aim of this study was to investigate the effect of complex decongestive physiotherapy (CDP) on sensory parameters in women with unilateral breast cancer-related lymphedema. A total of 29 women with unilateral breast cancer-related stage-2 lymphedema were included in the study. All evaluations were performed bilaterally. Circumference measurements were applied at the ulnar styloid and at each 5-cm segment until the axilla. Based on these measurements, arm volumes were determined using the frustum truncated cone formula. Additionally, the circumference measurement and ultrasonographic evaluations (epidermis, dermis and subcutaneous fat thicknesses) were applied at the same level, 10 cm distal to the midpoint of the medial and lateral epicondyle. Semmes-Weinstein monofilaments (SWM), static and moving two-point discrimination, vibration, pressure pain threshold (PPT), tactile localization and thermal sensation tests were evaluated from the same region. Besides, the Cold Intolerance Symptom Severity Questionnaire (CISS) and the Lymphedema Functioning Disability and Health Questionnaire (LYMPH-ICF-UL) were administered. After the initial evaluation, the CDP phase-1 program (5 days a week, for a total of 3 weeks) was applied to all patients. All evaluations were repeated at the end of the treatment period. Before treatment, volumetric, circumferential and ultrasonographic measurements were significantly higher in the affected extremity compared to the unaffected extremity (p<0.05). After CDP, volumetric, circumferential and ultrasonographic (except epidermis) measurements decreased significantly (p<0.05). Before CDP, SWM, static and moving two-point discrimination, PPT, and tactile localization values were significantly higher on the affected side compared to the unaffected side (p<0.05). When pre- and post-treatment values were compared, the SWM, static and moving two-point discrimination, PPT and tactile localization values decreased significantly on the affected side (p<0.05). While CISS scores were similiar after the treatment (p>0.05), the Lymph-ICF-UL scores increased significantly (p<0.05). While breast cancer-related lymphedema seems to reduce light touch, static and moving two-point discrimination, PPT and tactile localization, it was observed that CDP may improve these sensory perceptions. Being aware that lymphedema may reduce sensory perceptions, it is important to treat patients with CDP not only to reduce edema, but also to improve sensory functions.