Evaluation of Sympathetic Skin Response and Its Relationship With Clinical Response to Complex Decongestive Therapy in Patients With Postmastectomy Lymphedema

Breast cancer-related lymphedema is a chronic condition that develops following breast cancer treatment and is traditionally considered to result from impaired lymphatic drainage and fluid accumulation. Recent evidence suggests that autonomic nervous system dysfunction may also contribute to the pathophysiology of lymphedema.

The aim of this prospective observational study was to evaluate sympathetic skin response (SSR), autonomic nervous system functions, and their relationship with clinical response to complex decongestive therapy (CDT) in patients with postmastectomy upper extremity lymphedema.

Thirty female patients aged 18-65 years with unilateral upper extremity lymphedema after breast cancer treatment and thirty healthy female controls were included. All participants underwent electrophysiological autonomic nervous system evaluation using SSR and R-R interval variability measurements. In addition, autonomic symptoms were assessed using the Composite Autonomic Symptom Score-31 (COMPASS-31).

Patients in the lymphedema group received a standardized CDT program for 3 weeks, 5 days per week, totaling 15 sessions. Clinical response to treatment was evaluated using changes in lymphedema volume measurements obtained before and after treatment.

Secondary clinical assessments included quality of life evaluation with LYMQOL-Arm, upper extremity functional assessment with QuickDASH, pain severity assessment using the Numeric Rating Scale (NRS), and neuropathic pain evaluation using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS).

The study aimed to determine whether autonomic dysfunction is present in breast cancer-related lymphedema and whether baseline SSR parameters are associated with clinical response to CDT.

Healthy Control Inclusion Criteria:

• Female volunteers aged between 18 and 65 years
• No history of breast cancer or lymphedema
• No neurological, metabolic, or systemic disease affecting autonomic nervous system function

Healthy Control Exclusion Criteria:

• History of breast cancer or lymphedema
• Polyneuropathy
• Diabetes mellitus
• Hypothyroidism
• Neurological disease
• Systemic diseases affecting autonomic nervous system function

Patient group;

Inclusion criteria

Inclusion criteria

• Female patients aged between 18 and 65 years
• Postmastectomy upper extremity lymphedema after breast cancer surgery
• Completion of breast cancer treatment protocols
• International Society of Lymphology (ISL) stage I-II lymphedema

Exclusion criteria

• Metastatic breast cancer
• Bilateral breast cancer history
• Bilateral upper extremity lymphedema
• Ongoing chemotherapy or radiotherapy
• Infection or allergic skin lesions on the upper extremities
• Medical conditions causing edema, including decompensated heart, lung, or renal failure
• Peripheral nervous system disease or polyneuropathy
• Chronic endocrine, metabolic, neurological, or systemic diseases affecting autonomic nervous system function, including diabetes mellitus, hypo/hyperthyroidism, uremia, heart failure, cardiac arrhythmia, and uncontrolled hypertension
• Presence of a cardiac pacemaker
• Inability to tolerate electrical stimulation