Ask an answerable question (PICO)：
After lymph node removal surgery, a common complication for breast cancer patients is arm lymphedema. Compression therapy can help prevent lymphedema, as the pressure needs to be continuous for the effect to be maintained. Compression garments are more convenient and easier to wear; however, they need to be purchased out-of-pocket and are relatively expensive. Patients are often skeptical about the effectiveness of compression garments, leading to clinical questions.
The Method and Analysis of Literature Review：
PICO-P: breast cancer cases combined with lymphadenectomy, I: Compression garments and rehabilitation exercises, C: Rehabilitation exercises, O: the occurrence of arm lymphedema. The Cochrane Library, PubMed, Embase, Clinical key and CEPS were used to search for synonyms based on keywords using mesh term, and the Boolean logic technique of "AND" and "OR" was utilized for literature search. The study types were set as SR and RCT, and studies containing surgery, drugs and other physiotherapy were eliminated. The research type was set as SR and RCT, and studies containing surgery, drugs, and other physiotherapy were excluded. Articles not related to the topic were deleted, and those without full text, those without context, and those with different interventions and timing were deducted, and finally two RCTs (2017 and 2021) were included in the literature review.
Critical Appraisal：
The 2020 version of the CASP tool was used for evaluation, with most studies rated as having good quality and a low risk of bias. The evidence level was based on the Oxford Centre for Evidence-Based Medicine 2011 levels of evidence, which is Level 2. Both studies implemented compression garments immediately after surgery. Limb volume was measured using the truncated cone formula for lymphedema. The first study by Ochalek et al. (2017) included 45 women with unilateral breast cancer who had undergone axillary lymph node surgery, with an average age ranging from 52.9 to 64 years. The study found that wearing compression garments led to a significant difference starting from the third month, suggesting that early use of compression garments could alleviate early lymphedema. The second study by Nadal Castells et al. (2021) included 65 women with a mean age of 57.4 years who had primary breast cancer and had undergone axillary lymph node surgery. The study found that early use of compression garments within three months after surgery could reduce the incidence of edema. However, it could not demonstrate that exercise could reduce the incidence of lymphedema.
Clinical Application of Evidence：
Using the seven steps of evidence-based nursing for clinical application and result analysis, a convenience sampling method was employed. The study period was from November 1, 2022, to October 31, 2023. The study included female patients aged 40 to 70 who underwent surgical treatment for early-stage breast cancer.The experimental group consisted of 10 patients who received both compression garments and rehabilitation exercises, while the control group included 10 patients who received only rehabilitation exercises. The degree and changes in lymphedema were assessed using limb measurement techniques and the truncated cone formula for lymphedema calculation. The study aimed to compare whether the intervention with compression garments could reduce arm lymphedema in early-stage breast cancer patients who had undergone axillary lymph node removal surgery.
Evaluation of Effectiveness：
According to this empirical statistical analysis, the incidence of lymphedema in the control group, who did not use compression garments, was 20%. All cases were assessed as grade 1 lymphedema. In the first month, both the Z value and p value were 0.001, indicating a significant difference. This trend persisted until the 12th month, with no increase in the number of cases experiencing lymphedema in either group. Through further investigation, cases experiencing lymphedema were found to have undergone chemotherapy at least three times postoperatively, had a BMI greater than 24 kg/m2, and were over 60 years old, indicating high-risk factors. These findings are consistent with those of the study by Ochalek et al. (2017). After twelve months, the Z value was 1.874 and the p value was less than 0.05, demonstrating the sustained efficacy of the intervention.
Conclusions and Recommendations：
Using compression garments immediately after surgery and wearing them daily for at least one year can effectively treat arm lymphedema and provide significant benefits and convenience for both patients and nursing care. This approach can alleviate symptoms such as arm lymphedema, local fluid accumulation, and pain. The results confirm the importance and effectiveness of using compression garments post-surgery. It is hoped that these findings will provide valuable clinical guidance.
