A systematic review of post-breast cancer lymphoedema and its treatment with natural medicine
Zygmont, Jesica Graciela Massaro
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In this minithesis a systematic review of all of the available contemporary literature on post-breast cancer lymphoedema was undertaken. The purpose of this systematic review was to search for, collate, synthesize and thereby provide the reader with a comprehensive, evidence-based account of all the available research published between 1988 and 2008 on the treatment of post-breast cancer lymphoedema with natural medicine.Because the large number of articles published every year across a plethora of biomedical journals makes it incredibly difficult for practitioners to keep up-to-date within their specialized areas, systematic reviews are particularly useful as they summarize high quality, contemporary scientific knowledge on a topic in one place (Antman, Lau, Kupelnik, Mosteller & Chalmers, 1992). One such topic on which many health practitioners have a paucity of information regarding management and risk reduction is lymphoedema (Radina, Armer, Culbertson & Dusold,2004) The primary objective of this research project was to assess the effects of natural medicine on post-breast cancer lymphoedema in regard to 1) life style improvement including any signs and symptoms related to the condition such as heaviness, tightness, pain, ache, itch, mobility of the affected arm, skin texture as well as psychological symptoms like distress;2) arm volume changes of the affected limb; 3) adverse effects; and 4) modification or cessation of treatment.Several online databases were searched for articles that contain the term lymphoedema, lymphedema, limb swelling or "linfedema" (Spanish and Portuguese); thereby including all possible spellings in English, Spanish and Portuguese. Relevant information was extracted and recorded in tabular format. The quality of each study was analysed using a checklist,which was drawn up by the primary researcher and study supervisor based on the CONSORT guidelines (Altman, 1996).To ensure quality, only randomized controlled trials, quasi-randomized controlled trials or clinical trials that met the inclusion or exclusion criteria, reporting benefits or adverse effects of natural medicines for the treatment of post-breast cancer lymphoedema were included. In addition,studies had to focus on natural medicine versus placebo or routine treatment or no treatment as types of intervention; and participants had to include women of all ages that had been diagnosed with post-breast cancer lymphoedema.The relevant data from included studies was entered into Review Manager 5 (Revman 5) software for meta-analysis. The primary studies included in this systematic review generally suffered from small sample sizes, varied somewhat in their operationalisation of outcomes and the format for presenting results, making meta-analysis very difficult. However, results suggest that sodium selenite taken orally and CYCLO 3 FORT also taken orally are effective in the reduction of limb volume. The results also suggested that aromatherapy using an intervention cream containing wheat germ oil and essential oils of fennel, sage, geranium, black pepper and juniper; and vitamin E plus pentoxifylline taken orally are not effective.Seeing as these results are drawn from single studies with heterogeneous outcome variables, they should be seen as tentative until they are confirmed by replication. Gaps in the literature regarding natural medicine as a treatment for post-breast cancer lymphoedema were identified, and recommendations for further research are proposed.