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Page 2 of 14 Al Onazi et al. Plast Aesthet Res 2020;7:23 I http://dx.doi.org/10.20517/2347-9264.2019.74

Conclusion: The findings suggest less than optimal adherence to daytime compression sleeve use. Further
research is needed to explore the relative benefit of daytime compression, optimal wear times, and implementable
strategies to improve adherence.

Keywords: Lymphedema, breast cancer, compression therapy, adherence

INTRODUCTION
Lymphedema, a significant swelling of the arm that occurs on the side of the breast cancer, is one of the
[1,2]
more frequent complications following surgical interventions for breast cancer . It is a lifelong condition
that tends to worsen over time [1,3,4] . Recent data suggest that approximately 21% of women who undergo
[1]
treatment for breast cancer are diagnosed with lymphedema . Of these cases, approximately half will
[2,5]
develop chronic progressive lymphedema, a more severe presentation of ongoing and complex swelling .
[6,7]
At present, there are no known curative treatments, either surgical or pharmacological, for lymphedema .
Conservative treatments are prescribed to reduce and maintain limb size, restore function, reduce pain, and
improve the appearance of the limb [6,8,9] . Decongestive lymphatic therapy, often prescribed to reduce the
[9]
lymphedema volume, is an intensive treatment program usually delivered in a clinical or hospital setting .
This program is followed by a maintenance phase which aims to promote life-long control of lymphedema
through use of self-management strategies [9,10] . Currently, daytime compression sleeves represent the
[6]
standard of care and are the primary strategy in lymphedema maintenance .
We conducted a trial examining the efficacy of the addition of nighttime compression to standard care,
[11]
involving daytime use of a compression sleeve, on arm lymphedema volume (LYNC trial) . The LYNC
trial was a parallel three-arm, multicenter randomized fast-track trial involving three sites in Canada: (1)
the Cross Cancer Institute in Edmonton; (2) Tom Baker Cancer Centre in Calgary; and (3) University of
[11]
British Columbia in Vancouver . One hundred twenty women enrolled in the trial and were randomly
assigned to one of three groups: (1) standard care (daytime use of a compression sleeve alone); (2) standard
care plus nighttime compression through self-administered or assisted compression bandaging; and (3)
[11]
standard care plus nighttime compression through use of a nighttime compression system garment .
At the end of the randomized controlled trial portion of the study, participants in the two comparison
groups were provided with a nighttime compression system garment and followed the night regimen for an
[11]
additional three months .

During the LYNC study, all participants were asked to follow standard care recommendations that involved
wearing their daytime compression sleeve daily for a minimum of 12 h. We monitored adherence to use of
daytime compression among participants and found that, while overall adherence (based on hours worn
per week) was 81%, only 58% of participants adhered to the recommendations of seven days per week and
12 h per day. In contrast, mean adherence to nighttime compression during the trial was 100% both during
the intervention and follow-up periods of the randomized controlled trial. As adherence to use of daytime
[12]
compression is seen as a critical factor in long-term lymphedema control , we aimed to explore the
reasons participants reported less than optimal adherence to use of their daytime compression. Thus, the
objective of this follow-up study was to explore the barriers and facilitators to use of a daytime compression
sleeve.

METHODS
Study design
The study used a multi-methods approach involving quantitative and qualitative survey data. In this design,
we conducted both a survey and five focus group sessions to collect information from participants on their
perspectives and experiences with use of daytime compression.