Role of physiotherapy and patient education in lymphedema control following breast cancer surgery
Role of physiotherapy and patient education in lymphedema control following breast cancer surgery
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DOI：
10.2147/tcrm.s77669
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发表时间：
2015-01-01
影响因子：
2.8
通讯作者：
Hsiao, Pei-Chi
中科院分区：
文献类型：
--
作者：
Lu, Shiang-Ru;Hong, Rong-Bin;Hsiao, Pei-Chi
简介：本回顾性队列研究评估了教育与物理治疗相结合是否可以降低乳腺癌相关性水肿（BCRL）的风险。方法：我们分析了2007年1月至2011年12月期间诊断为单侧乳腺癌并接受肿瘤切除术和腋窝淋巴结清扫术的1，217名女性。患者分为三组：A组（n=415），术后未接受教育或物理治疗; B组（n=672），术后0 - 7天接受BCRL教育计划; C组（n=130），术后0 - 7天接受BCRL教育计划，随后接受物理治疗计划。对所有患者进行监测，直至2013年10月，以确定是否发生BCRL。结果：随访期间，共188例（15.4%）患者发生水肿，其中A组77例（18.6%），B组101例（15.0%），C组10例（7.7%）（P=0.010）。从手术到水肿的中位时间为0.54年（四分位距=0.18-1.78）。BCRL的独立风险因素包括腋窝淋巴结浸润阳性、腋窝淋巴结清扫数量较多（>20个）以及接受过放射治疗，而接受教育计划和物理治疗是BCRL的保护因素（风险比=0.35，95%可信区间=0.18-0.67，P=0.002）。在术后第一周内开始患者教育，然后进行物理治疗，可有效降低BCRL的风险，乳腺癌
Introduction: This retrospective cohort study evaluated whether education in combination with physiotherapy can reduce the risk of breast cancer-related lymphedema (BCRL).Methods: We analyzed 1,217 women diagnosed with unilateral breast cancer between January 2007 and December 2011 who underwent tumor resection and axillary lymph node dissection. The patients were divided into three groups: Group A (n=415), who received neither education nor physiotherapy postsurgery; Group B (n=672), who received an educational program on BCRL between Days 0 and 7 postsurgery; and Group C (n=130), who received an educational program on BCRL between Days 0 and 7 postsurgery, followed by a physiotherapy program. All patients were monitored until October 2013 to determine whether BCRL developed. BCRL risk factors were evaluated using Cox proportional hazards models.Results: During the follow-up, 188 patients (15.4%) developed lymphedema, including 77 (18.6%) in Group A, 101 (15.0%) in Group B, and 10 (7.7%) in Group C (P=0.010). The median period from surgery to lymphedema was 0.54 years (interquartile range =0.18-1.78). The independent risk factors for BCRL included positive axillary lymph node invasion, a higher (>20) number of dissected axillary lymph nodes, and having undergone radiation therapy, whereas receiving an educational program followed by physiotherapy was a protective factor against BCRL (hazard ratio =0.35, 95% confidence interval =0.18-0.67, P=0.002).Conclusion: Patient education that begins within the first week postsurgery and is followed by physiotherapy is effective in reducing the risk of BCRL in women with breast cancer.