Scoping Review On The Application Of Traditional Chinese Nursing Techniques in The Treatment Of Breast Cancer-related Lymphedema

Abstract:

Objective

To provide a scoping review of the research on the application of traditional Chinese medicine nursing techniques in the treatment of breast cancer-related lymphedema, to provide a reference for the application of Chinese medicine nursing techniques to alleviate breast cancer-related lymphedema. Methods Nine Chinese and English databases were searched, with a search timeframe from the establishment of the database to November 2023. Results Seventeen articles were included in the literature to summarize the methods of intervention, frequency, duration, observation time, outcome indicators, and effective rate of TCM nursing techniques in breast cancer-related lymphedema. Conclusion Traditional Chinese nursing techniques demonstrate high diversity and effectiveness in the treatment of breast cancer-related lymphedema, showing good compatibility with other intervention methods, but their mechanism of action is not clear enough, and there is great heterogeneity in operation methods, intervention time, and intervention frequency, etc. In the future, we should carry out further research to standardize the interventions of TCM nursing techniques in treating breast cancer-related lymphedema, and to push for the introduction of authoritative guidelines for treating breast cancer-related lymphedema. In the future, further research should be conducted to standardize the interventions of TCM nursing techniques in the treatment of breast cancer-related lymphedema and to promote the introduction of authoritative guidelines in this field.

Keywords:traditional Chinese nursing technology; breast cancer related lymphedema; scoping review; massage; fumigation

 

 

 

TCM herbal Cistanche Supplements For treating breast cancer-related lymphedema

 

1. Background

According to the latest epidemiological data from the International Agency for Research on Cancer (IARC) in 2024, breast cancer has become the second most prevalent malignant tumor worldwide [1].

Breast Cancer-Related Lymphedema (BCRL) is one of the most common postoperative complications of breast cancer. It mainly occurs because surgery and treatment disrupt lymph nodes and lymphatic vessels, leading to obstruction of axillary lymphatic drainage pathways. As a result, protein-rich lymph fluid accumulates in the interstitial tissues, causing lymphedema [2].

Studies indicate that BCRL affects patients, families, and society in multiple ways, including physiological, psychological, and economic aspects [3-4].

Traditional Chinese Medicine (TCM) Nursing Techniques

Traditional Chinese medicine (TCM) nursing techniques are a set of care methods guided by TCM theories, implemented as a complement to conventional nursing practices. These techniques focus on individualized patient care and differentiation of various syndromes [5].

Research suggests that TCM nursing techniques can improve blood circulation, promote meridian flow, and effectively reduce the severity of lymphedema, providing a new approach for BCRL prevention [6-7].

Scoping Review Approach

A scoping review is a knowledge synthesis method based on evidence-based practice theory. It is used to identify evidence, summarize knowledge, and update research frameworks in a given field [8]. Compared to traditional reviews, scoping reviews are more systematic, involve broader searches, and provide higher-level evidence [9].

Thus, this study conducts a scoping review on the application of TCM nursing techniques in BCRL treatment, aiming to:

Summarize the current application of TCM nursing techniques in BCRL treatment.

Identify key evaluation indicators for TCM nursing in BCRL.

Assess the effectiveness of TCM nursing techniques in managing BCRL.

2. Materials and Methods

2.1 Research Questions

Based on the research team's focus and literature review, the following research questions were formulated:

What are the current applications of TCM nursing techniques in the treatment of BCRL?

What evaluation indicators are used to assess the effectiveness of TCM nursing for BCRL?

How effective are TCM nursing techniques in treating BCRL?

2.2 Search Strategy

The literature search was conducted across multiple international and Chinese databases, including:

PubMed, Web of Science, Embase, CINAHL, Cochrane Library (international databases)

CNKI, Wanfang, VIP (Weipu), and CBM (Chinese Biomedical Literature Database) (domestic databases)

The search strategy involved a combination of:

MeSH terms

Free-text keywords

Boolean logical operators

Search Terms

English keywords: Breast cancer, Breast carcinoma, Mammary cancer, Mammary carcinoma, Cancer of the breast, and keywords related to TCM nursing techniques.

 

2.3 Inclusion and Exclusion Criteria

Inclusion Criteria

Participants: Patients diagnosed with BCRL.

Intervention: Studies focusing on TCM nursing techniques for BCRL treatment, based on the TCM Nursing Techniques Manual issued by the National Administration of Traditional Chinese Medicine.

Study Type: Original quantitative studies.

Language: Published in Chinese or English.

Publication Date: From database inception to November 2023.

Exclusion Criteria

Full text unavailable.

Duplicate publications.

Conference papers, abstracts, guidelines, and review articles.

Studies that do not provide detailed descriptions of nursing methods.

2.4 Literature Screening and Data Extraction

Duplicate studies were removed, and two independent researchers screened the literature.

The selection process involved:

Initial screening: Reviewing titles and abstracts.

Full-text screening: Assessing articles based on inclusion and exclusion criteria.

Any disagreements were resolved through discussion with a third researcher, and all researchers received professional training.

Extracted Data

The extracted data included:

Author

Publication year

Study design

Sample size

Intervention methods

Intervention frequency

Intervention duration

Observation period

Outcome indicators

Effectiveness rate

 

3. Results

3.1 Literature Search Results

A total of 952 studies were initially retrieved.

After removing duplicates and irrelevant studies, 935 studies were excluded.

17 studies were finally included in the review [10-26].

15 studies were in Chinese [10-24].

2 studies were in English [25-26].

Study Types

15 studies were randomized controlled trials (RCTs).

2 studies were longitudinal studies.

Flowchart of Literature Screening

(See Figure 1 for the screening process).

Basic Characteristics of Included Studies

(See Table 1 for details).

 

 

Table 1. Basic Characteristics of Included Studies (n=17)

Study	Year	Study Design	Sample Size	Control Group	Intervention Methods	Observation Group	Intervention Frequency	Intervention Duration (days)	Observation Period (days)	Outcome Indicators	Effectiveness (%)
Wang Yajiao et al. [10]	2014	RCT	61	Elastic sleeve + wall climbing exercise	Chinese medicine cold compress	2 times/day	14	…	1)	87.10
An Hongli et al. [11]	2016	RCT	70	Chinese medicine fumigation	Chinese medicine fumigation + herbal soaking	2 times/day	21	…	2), 3)	94.28
Bi Jing et al. [12]	2017	Longitudinal Study	30	No control	Acupoint massage	1 time/day	…	…	7)	80.00
Lü Sujun et al. [13]	2017	RCT	60	Elastic sleeve + upper limb functional training	Chinese medicine fumigation + herbal washing	2 times/day	14	0	4), 6)	93.33
Cheng Si et al. [14]	2018	RCT	60	Microwave + upper limb moxibustion	Chinese medicine wet heat compress	2 times/day	10	0	2), 5), 6), 9)	93.33
Feng Qian et al. [15]	2018	RCT	93	Oral medication (aminophylline lozenges)	Acupuncture + cupping	1 time/day	28	120	3), 6), 7), 8), 11)	91.30
Chen Kailun et al. [16]	2018	RCT	60	Standard care (functional training)	Chinese medicine hot compress + acupoint massage	2 times/day	28	56	6), 9)	96.43
Liang Zhisheng et al. [17]	2019	RCT	60	Standard rehabilitation treatment	Chinese medicine hot compress + fumigation	2 times/day	14	0	5), 8), 10), 12)	…
Zhang Jufang et al. [18]	2020	RCT	98	Rehabilitation training + functional training + comprehensive training	Chinese medicine hot compress	1 time/day	30	0	10), 12)	…
Li Tingting et al. [19]	2020	Longitudinal Study	58	No control	Chinese medicine fumigation	2 times/day	20	…	6), 10)	…
Yang Zhifeng et al. [20]	2020	RCT	138	Western medicine symptomatic intervention	Moxibustion	0.5 times/day	14	240	4), 8), 10), 11), 15)	91.30
Yi Liying et al. [21]	2022	RCT	156	Acupoint massage	Acupoint massage + Chinese medicine fumigation	1 time/day	28	0	10), 13), 14)	94.87
Xu Xiaodong et al. [22]	2022	RCT	168	Standard treatment methods	Acupoint massage	1 time/day	30	0	2), 7), 12), 14)	92.86
Sun Huibin et al. [23]	2022	RCT	82	Oral diosmin tablets + acupoint massage	Chinese medicine wet heat compress + acupoint massage	1 time/day	28	0	5), 10), 15), 16)	95.12
Guo Huiqin et al. [24]	2022	RCT	60	Chinese medicine hydrotherapy	Chinese medicine wet heat compress + acupoint massage	1 time/day	28	0	10), 14)	…
Wang et al. [25]	2019	RCT	48	Pneumatic circulation therapy	Moxibustion	0.5 times/day	28	30	10), 13), 17)	…
Wang et al. [26]	2023	RCT	40	Pneumatic circulation therapy	Acupoint massage + moxibustion	2 times/week	28	0

 

 

Notes on Table 1

Outcome Indicators:

(1) Edema grading

(2) Edema efficacy indicators

(3) FCAT-B+4 scale (subjective symptom scale)

(4) Quality of life assessment

(5) TCM symptom efficacy indicators

(6) Edema measurement methods

(7) Arm circumference measurement methods

(8) Incidence of adverse reactions

(9) Upper limb swelling severity grading

(10) Upper arm circumference difference

(11) Recurrence rate

(12) Upper limb lymphatic flow

(13) Visual Analog Scale (VAS) for pain evaluation

(14) Upper Limb Disability Assessment Scale (DASH)

(15) TCM Syndrome Score

(16) Inflammatory factors

(17) Piper Fatigue Scale (RPFS)

(18) Arm volume

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2.2 Intervention Methods

In the treatment of Breast Cancer-Related Lymphedema (BCRL), a total of nine TCM nursing techniques demonstrated significant efficacy. These methods account for 50% of the 18 techniques outlined in the TCM Nursing Techniques Manual for Nursing Staff. The effective techniques include:

Chinese medicine cold compress [10]

Chinese medicine fumigation [11,13,17,19,21]

Chinese medicine soaking [11,13]

Acupoint massage [11-12,16,21-24,26]

Chinese medicine iontophoresis [12]

Chinese medicine wet heat compress [14,23-24]

Cupping therapy [15]

Chinese medicine hot ironing compress [16-18]

Suspended moxibustion [20,25-26]

Among these methods, Chinese medicine soaking is generally used in combination with Chinese medicine fumigation. After fumigation, when the temperature of the herbal solution decreases, it is used for soaking the affected area.

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2.3 Intervention Frequency and Duration

All included studies, except for one [12], described the frequency and duration of interventions. The frequency and duration varied across studies, but most interventions were administered once or twice daily, with a treatment duration of less than one month.

By Technique:

Acupoint massage:

5 studies [11,21-24] reported a frequency of 1 time/day.

1 study [16] reported a frequency of 2 times/day.

Treatment duration was relatively long, averaging 27.2 days.

Chinese medicine fumigation:

4 studies [11,13,17,19] reported a frequency of 2 times/day.

1 study [22] reported a frequency of 1 time/day.

Treatment duration was slightly shorter than that of acupoint massage, averaging 19.4 days.

Chinese medicine soaking (combined with fumigation):

2 studies [11,13] reported a frequency of 2 times/day.

Average treatment duration was 17.5 days.

Chinese medicine wet heat compress:

3 studies [12,21-22] reported a frequency of 1 time/day.

Treatment duration varied significantly:

2 studies [23-24] reported 28 days.

1 study [14] reported 10 days.

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2.4 Outcome Indicators of the Interventions

The studies assessed multiple outcomes, including arm swelling reduction, physiological function, TCM symptom scores, adverse reactions, and recurrence rates.

Key Outcome Assessments:

Arm Swelling Reduction:

Measured by arm volume, upper limb lymphatic flow, etc.

Physiological Function:

Assessment tools included FCAT-B+4 scale, shoulder joint range of motion, and upper limb mobility.

TCM Syndrome Score:

Symptoms were categorized as primary symptoms and secondary symptoms.

Primary symptoms (upper limb swelling, tingling, numbness, fatigue):

Graded as none, mild, moderate, or severe, scoring 0, 2, 4, and 6 points, respectively.

Secondary symptoms (poor appetite, shortness of breath, dark complexion, low energy, chest fullness, night sweats):

Graded as none, mild, moderate, or severe, scoring 0, 1, 2, and 3 points, respectively.

Tongue and pulse abnormalities were each assigned 1 point, and the total score was calculated.

Adverse Reactions:

Included rash, nausea, dizziness, and local ulceration.

Recurrence Rate:

Recurrence time and recurrence rate were measured.

Two studies [15,20] used recurrence rate as an observation indicator, both reporting lower recurrence rates in the intervention group compared to the control group.