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Wang L, Zhen M, Liao L, Li H, Yan H, Wiley JA, Lu Q, Chen X, Yv J, Ding B. Effects of dietary habits and catheterization type on breast cancer-related lymphedema: a retrospective cohort study. BMC Cancer 2024; 24:1264. [PMID: 39394086 PMCID: PMC11468185 DOI: 10.1186/s12885-024-13025-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Accepted: 10/03/2024] [Indexed: 10/13/2024] Open
Abstract
BACKGROUND Understanding the factors that contribute to variability in breast cancer-related lymphedema (BCRL) is an important first step in developing targeted interventions to improve quality of life in breast cancer patients. Although previous research studies have has identified many risk factors for BCRL, dietary habits and catheterization type have rarely been studied until the present. AIM This study aims to explore the effects of nursing factors such as dietary habits and catheterization type on breast cancer-related lymphedema (BCRL). METHODS This retrospective cohort study included 1,476 breast cancer patients who underwent surgery between January 1, 2012, and September 1, 2020. Lymphedema was assessed with a validated self-report questionnaire. All research data were obtained from medical records and a follow-up database. Multivariate Cox regression was conducted to explore the effects of dietary habits and catheterization type on BCRL. RESULTS The results showed an increased risk for BCRL among breast cancer patients who followed a high-fat diet prehospitalization (HR = 2.47; 95% CI = 1.55-3.94; P < 0.001), indwelling totally implantable venous access ports (TIVAPs) compared with indwelling needles (HR = 0.56; 95% CI = 0.35-0.90;P = 0.017) or indwelling peripherally inserted central catheters (PICCs) (HR = 0.69; 95% CI = 0.45-1.05; P = 0.086). CONCLUSION High-fat diet pre-hospitalization was an independent risk factor for lymphedema. The TIVAPs did not exert a protective effect on lymphedema compared with the PICC and indwelling needle. This study finding offers new insights to develop targeted interventions to decrease the incidence of lymphedema.
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Affiliation(s)
- Ling Wang
- Nursing Department, The Third Xiangya Hospital, Central South University, 138 Tong Zi Po Road, Changsha, Hunan, 410013, China
- Department of Thyroid Breast Surgery, The Third Xiangya hospital, Central South University, 138 Tong Zi Po Road, Changsha, Hunan, 410013, China
| | - Meixin Zhen
- Xiangya Nursing School, Central South University, Changsha, China
| | - Lulu Liao
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Li
- Nursing Department, The Third Xiangya Hospital, Central South University, 138 Tong Zi Po Road, Changsha, Hunan, 410013, China.
- Department of Thyroid Breast Surgery, The Third Xiangya hospital, Central South University, 138 Tong Zi Po Road, Changsha, Hunan, 410013, China.
| | - Huang Yan
- Nursing Department, The Third Xiangya Hospital, Central South University, 138 Tong Zi Po Road, Changsha, Hunan, 410013, China
| | - James A Wiley
- Family and Community Health and Institute of Health Policy Studies, University of California San Francisco, San Francisco, USA
| | - Qing Lu
- Xiangya Nursing School, Central South University, Changsha, China
| | - Xuemei Chen
- Nursing Department, The Third Xiangya Hospital, Central South University, 138 Tong Zi Po Road, Changsha, Hunan, 410013, China
- Department of Thyroid Breast Surgery, The Third Xiangya hospital, Central South University, 138 Tong Zi Po Road, Changsha, Hunan, 410013, China
| | - Jun Yv
- Nursing Department, The Third Xiangya Hospital, Central South University, 138 Tong Zi Po Road, Changsha, Hunan, 410013, China
- Department of Thyroid Breast Surgery, The Third Xiangya hospital, Central South University, 138 Tong Zi Po Road, Changsha, Hunan, 410013, China
| | - Boni Ding
- Department of Thyroid Breast Surgery, The Third Xiangya hospital, Central South University, 138 Tong Zi Po Road, Changsha, Hunan, 410013, China
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Brown S, Tadros AB, Montagna G, Bell T, Crowley F, Gallagher EJ, Dayan JH. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may reduce the risk of developing cancer-related lymphedema following axillary lymph node dissection (ALND). Front Pharmacol 2024; 15:1457363. [PMID: 39318780 PMCID: PMC11420520 DOI: 10.3389/fphar.2024.1457363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Accepted: 08/22/2024] [Indexed: 09/26/2024] Open
Abstract
Purpose Patients undergoing axillary lymph node dissection (ALND) for breast cancer face a high risk of lymphedema, further increased by high body mass index (BMI) and insulin resistance. GLP-1 receptor agonists (GLP-1RAs) have the potential to reduce these risk factors, but their role in lymphedema has never been investigated. The purpose of this study was to determine if GLP-RAs can reduce the risk of lymphedema in patients undergoing ALND. Methods All patients who underwent ALND at a tertiary cancer center between 2010 and 2023 were reviewed. Patients with less than 2 years of follow-up from the time of ALND were excluded. Race, BMI, radiation, chemotherapy history, pre-existing diagnosis of diabetes, lymphedema development after ALND, and the use of GLP-1RAs were analyzed. Multivariate logistic regression analysis was performed to assess if there was a significant reduction in the risk of developing lymphedema after ALND. A sub-group analysis of non-diabetic patients was also performed. Results 3,830 patients who underwent ALND were included, 76 of which were treated with. GLP-1 RAs. The incidence of lymphedema in the GLP-1 RA cohort was 6.6% (5 patients). Compared to 28.5% (1,071 patients) in the non-GLP-1 RA cohort. On multivariate regression analysis, patients who were treated with GLP-1 RA were 86% less likely to develop lymphedema compared to the non-GLP-1 RA cohort (OR 0.14, 95% CI 0.04-0.32, p < 0.0001). A BMI of 25 kg/m 2 or greater was a statistically significant risk factor for developing lymphedema with an odds ratio of 1.34 (95% CI 1.16-1.56, p < 0.0001). Diabetes was associated with lymphedema development that closely approached statistical significance (OR 1.32, 95% CI 0.97-1.78, p = 0.06). A subgroup analysis solely on non-diabetic patients showed similar results. The odds of developing lymphedema were 84% lower for patients without diabetes treated with GLP1-RAs compared to those who did not receive GLP-1 RAs (OR 0.16, 95% CI 0.05-0.40, p < 0.0001). Conclusion GLP1-RAs appear to significantly reduce the risk of lymphedema in patientsundergoing ALND. The mechanism of action may be multifactorial and not limited to weight reduction and insulin resistance. Future prospective analysis is warranted to clarify the role of GLP-1RAs in reducing lymphedema risk.
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Affiliation(s)
- Stav Brown
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Audree B Tadros
- Department of Surgery, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Giacomo Montagna
- Department of Surgery, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Tajah Bell
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Fionnuala Crowley
- Division of Hematology and Medical Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Emily J Gallagher
- Department of Medicine, Division of Endocrinology, Diabetes and Bone Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Joseph H Dayan
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- The Institute for Advanced Reconstruction, Plastic and Reconstructive Surgery, Red Bank, Paramus, NJ, United States
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3
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Lodewijckx I, Matthys C, Verheijen J, Verscuren R, Devoogdt N, Van der Schueren B, Goffin K, Fourneau I, Thomis S. Potential therapeutic effect of a ketogenic diet for the treatment of lymphoedema: Results of an exploratory study. J Hum Nutr Diet 2024; 37:885-891. [PMID: 38837503 DOI: 10.1111/jhn.13330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/17/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Lymphoedema is a chronic and progressive disease characterised by excessive accumulation of lymph in the interstitial compartment, leading to tissue swelling and fibroadipose deposition. Lymphangiogenesis is partly regulated by ketone body oxidation, and a ketogenic diet (KD) has shown therapeutic efficacy in a preclinical mouse tail lymphoedema model. Therefore, we aimed to investigate the potential therapeutic effect of a KD in patients with secondary lymphoedema. METHODS Nine patients with unilateral stage 2 lymphoedema secondary to lymphadenectomy were included in this quasi-experimental exploratory study consisting of a short run-in phase to gradually induce ketosis, followed by a classic KD (CKD) and modified Atkins diet (MAD) phase during which patients consumed a CKD and MAD, respectively. Lymphatic function and oedema volume, the primary outcomes, were assessed at baseline and at the end of both the CKD and MAD phase. Secondary outcomes included health-related and lymphedema-specific quality of life (QoL). RESULTS Seven out of nine patients completed the study protocol. Lymphatic function was improved upon consumption of both a CKD (dermal backflow score [mean ± SD]: 7.29 ± 2.98 vs. 10.86 ± 2.19 at baseline; p = 0.03) and MAD (6.71 ± 2.06; p = 0.02), whereas oedema volume did not decrease during the course of the study (excess limb volume [mean ± SD]: 20.13 ± 10.25% at end of CKD and 24.07 ± 17.77% at end of MAD vs. 20.79 ± 12.96% at baseline; p > 0.99 and p > 0.30, respectively). No changes were observed in health-related, nor lymphoedema-specific QoL at the end of CKD and MAD. CONCLUSIONS The consumption of a KD improved lymphatic function and was associated with a clinically meaningful reduction in oedema volume in some patients (3/7 at end of CKD, 2/7 at end of MAD) with unilateral stage 2 secondary lymphoedema. These results highlight the potential of a KD to improve lymphatic function in patients with lymphoedema. However, further studies are required to substantiate our findings.
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Affiliation(s)
- Inge Lodewijckx
- Department of Chronic Diseases and Metabolism, Research Group for Clinical and Experimental Endocrinology, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, Research Group for Vascular Surgery, KU Leuven - University of Leuven, Leuven, Belgium
| | - Christophe Matthys
- Department of Chronic Diseases and Metabolism, Research Group for Clinical and Experimental Endocrinology, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Endocrinology, UZ Leuven - University Hospitals Leuven, Leuven, Belgium
| | - Joke Verheijen
- Department of Endocrinology, UZ Leuven - University Hospitals Leuven, Leuven, Belgium
- Center for Lymphedema, UZ Leuven - University Hospitals Leuven, Leuven, Belgium
| | - Raf Verscuren
- Department of Nuclear Medicine, UZ Leuven - University Hospitals Leuven, Leuven, Belgium
- Department of Nuclear Medicine, Regionaal Ziekenhuis Heilig Hart Tienen, Tienen, Belgium
| | - Nele Devoogdt
- Center for Lymphedema, UZ Leuven - University Hospitals Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven - University of Leuven, Leuven, Belgium
| | - Bart Van der Schueren
- Department of Chronic Diseases and Metabolism, Research Group for Clinical and Experimental Endocrinology, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Endocrinology, UZ Leuven - University Hospitals Leuven, Leuven, Belgium
| | - Karolien Goffin
- Department of Nuclear Medicine, UZ Leuven - University Hospitals Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department of Cardiovascular Sciences, Research Group for Vascular Surgery, KU Leuven - University of Leuven, Leuven, Belgium
- Center for Lymphedema, UZ Leuven - University Hospitals Leuven, Leuven, Belgium
| | - Sarah Thomis
- Department of Cardiovascular Sciences, Research Group for Vascular Surgery, KU Leuven - University of Leuven, Leuven, Belgium
- Center for Lymphedema, UZ Leuven - University Hospitals Leuven, Leuven, Belgium
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Harvie M, Livingstone K, McMulllan D, Pegington M, Lombardelli C, Adams J, Farragher M, Barrett E, Bundred N. BE-WEL trial (breast: evaluation of weight and exercise for lymphoedema) testing weight control and exercise programmes for women with breast cancer related lymphoedema: a feasibility trial. Breast Cancer Res Treat 2024; 207:203-212. [PMID: 38758461 PMCID: PMC11230950 DOI: 10.1007/s10549-024-07356-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/24/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE A combined body weight loss and upper body/arm exercise programme is a potential strategy for managing Breast cancer related lymphoedema (BCRL), but there is limited data on the best method for delivery or its potential efficacy. METHODS Fifty-seven women with overweight/obesity and BCRL were randomised to a 12 week supervised (n = 12) or home-based combined weight loss and upper body/arm exercise programme (n = 16), a home-based upper-body arm exercise only programme (n = 17) or standard care (n = 12). Primary outcomes were uptake, retention and changes in weight and change in Relative Arm Volume Increase (RAVI) using analysis of covariance (ANCOVA). RESULTS Sixteen percent of women invited joined the study and 49 completed the trial (85% retention). Reductions in weight occurred in the supervised and home-based weight control and exercise programmes; Mean (95% CI) change compared to standard care - 1.68 (- 4.36 to - 1.00), - 2.47(- 4.99 to - 0.04) Kg. Reductions in perometer assessed RAVI were seen in the supervised and home-based combined weight control and arm exercise groups and the weight stable home-based arm exercise only group: mean (95% CI) change compared to standard care - 2.4 (- 5.0 to + 0.4),- 1.8 (- 4.3 to + 0.7), - 2.5(- 4.9 to - 0.05)%. CONCLUSION Women with BCRL and overweight and obesity engaged in diet and exercise weight loss programmes. Both weight loss/arm exercise programmes led to modest changes in weight and BCRL. Comparable reductions in BCRL were reported in the weight stable group undertaking arm exercise only. The independent and combined effects of weight loss and exercise on BCRL need further study. TRIAL REGISTRATION ISRCTN86789850 https://doi.org/10.1186/ISRCTN86789850 , registered 2011.
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Affiliation(s)
- Michelle Harvie
- The Nightingale and Prevent Breast Cancer Centre, Manchester University Hospital Foundation NHS Trust, Manchester, UK.
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Wilmslow Road, Manchester, M20 4BX, UK.
| | - Karen Livingstone
- The Nightingale and Prevent Breast Cancer Centre, Manchester University Hospital Foundation NHS Trust, Manchester, UK
| | - Debbie McMulllan
- The Nightingale and Prevent Breast Cancer Centre, Manchester University Hospital Foundation NHS Trust, Manchester, UK
| | - Mary Pegington
- The Nightingale and Prevent Breast Cancer Centre, Manchester University Hospital Foundation NHS Trust, Manchester, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Wilmslow Road, Manchester, M20 4BX, UK
| | - Cheryl Lombardelli
- The Nightingale and Prevent Breast Cancer Centre, Manchester University Hospital Foundation NHS Trust, Manchester, UK
| | - Judith Adams
- Manchester Academic Health Science Centre and Radiology, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester, Manchester Royal Infirmary, Manchester, UK
| | - Maggie Farragher
- Trafford Community, Manchester University Hospital Foundation NHS Trust, Manchester, UK
| | - Emma Barrett
- Research and Innovation, Manchester University Hospital Foundation NHS Trust, Manchester, UK
| | - Nigel Bundred
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Wilmslow Road, Manchester, M20 4BX, UK
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5
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Ryding HG, Mitchell LJ, Rigby RR, Ball L, Hobby J, Williams LT. Effectiveness of dietetic care for cancer survivors in the primary care setting: A systematic review and meta-analysis of randomized controlled trials. J Cancer Surviv 2024:10.1007/s11764-024-01583-6. [PMID: 38710853 DOI: 10.1007/s11764-024-01583-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/01/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE Nutrition plays an important role in cancer survivorship. This systematic review and meta-analysis aim to critically assess and quantify the effectiveness of nutrition care interventions provided by dietitians to survivors who have completed treatment for cancer. METHODS A systematic review of randomized controlled trials (RCTs) published from January 2004 to November 2023 reporting the effectiveness of primary care dietetic interventions with adult cancer survivors was conducted. PubMed, Scopus, CINAHL, Embase, ProQuest and PsycINFO databases were searched for key terms. Meta-analyses were conducted where there were sufficient studies of the same cancer type and outcomes. RESULTS Twelve RCTs representing 1138 cancer survivors (519 breast cancer; 75 prostate cancer; 544 colorectal cancer) were included. Primary outcome measures included weight loss (n = 6), quality of life (n = 2), reducing lymphedema-related arm volume (n = 2), nutritional status (n = 1) and increasing fruit and vegetable intake (n = 1). Weight loss was observed in studies where this was the primary outcome. Results for quality of life varied. Meta-analyses of RCTs with breast cancer survivors showed that dietitian intervention achieved a mean of 3.7 kg greater intentional weight loss and 2.3% greater body fat decrease than control (p < 0.0001). CONCLUSIONS This study provides evidence for the effectiveness of primary care dietetic interventions by dietitians with cancer survivors, particularly with respect to intentional weight and fat loss in breast cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Dietitians can play a key role in managing weight and improving long term health outcomes and prognosis for cancer survivors beyond the acute care setting.
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Affiliation(s)
- Henriette G Ryding
- Griffith University, Brisbane, Australia
- Menzies Health Institute Queensland, Southport, QLD, Australia
| | - Lana J Mitchell
- Griffith University, Brisbane, Australia.
- Menzies Health Institute Queensland, Southport, QLD, Australia.
| | - Roshan R Rigby
- Griffith University, Brisbane, Australia
- Menzies Health Institute Queensland, Southport, QLD, Australia
| | - Lauren Ball
- Griffith University, Brisbane, Australia
- University of Queensland, Brisbane, Australia
| | | | - Lauren T Williams
- Griffith University, Brisbane, Australia
- Menzies Health Institute Queensland, Southport, QLD, Australia
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Crowley F, Brown S, Gallagher EJ, Dayan JH. GLP-1 receptor agonist as an effective treatment for breast cancer-related lymphedema: a case report. Front Oncol 2024; 14:1392375. [PMID: 38699640 PMCID: PMC11063291 DOI: 10.3389/fonc.2024.1392375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/02/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction Lymphedema is a major public health issue for many women undergoing breast cancer treatment. Although weight loss has been reported to be beneficial in the treatment of lymphedema, no studies to date have examined the use of GLP-1RAs for the treatment of secondary lymphedema. This case report describes a patient who experienced significant resolution of her breast cancer-related lymphedema after initiation of a GLP-1RA for weight loss. Main symptoms and/or important clinical findings Nine months postoperatively the patient developed arm swelling and disability. While on adjuvant chemo and hormonal therapy, her weight increased dramatically and peaked 4 years later. Corresponding to her weight gain was significant worsening of her symptoms. The main diagnoses therapeutic interventions and outcomes Due to adjuvant cancer-related weight gain and inability to lose weight with diet and exercise, she was referred for evaluation and diagnosed with lymphedema. The patient started treatment with a Glucagon-like peptide 1 receptor agonist and lost 24% of her body weight over the next 13 months. The improvement in her lymphedema mirrored her weight loss. Her limb volume difference dropped from 10.3% down to 3.4% and she no longer required a compression garment. Her imaging demonstrated return of lymphatic pumping and she experienced a significant improvement in quality of life, assessed by a validated lymphedema-specific patient reported outcome (PROM). She remains on hormonal therapy, no longer needs compression and is back to regular exercise without impairment. Conclusions GLP-1 RAs provide a potential medical option for many patients struggling with weight gain and lymphedema. We have observed by all objective measures a significant reduction in lymphedema and the elimination of compression in the case presented as a direct result of GLP-1 RA. This may also reduce a patient's BMI to the point where they become a good candidate for lymphovenous bypass or vascularized lymph node transplant when indicated.
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Affiliation(s)
- Fionnuala Crowley
- Division of Hematology and Medical Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Stav Brown
- Plastic and Reconstructive Surgery Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Emily J. Gallagher
- Division of Endocrinology, Diabetes and Bone Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Joseph H. Dayan
- Plastic and Reconstructive Surgery Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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Bundred NJ, Barrett E, Todd C, Morris J, Watterson D, Purushotham A, Riches K, Evans A, Skene A, Keeley V. Prevention of lymphoedema after axillary clearance by external compression sleeves PLACE randomised trial results. Effects of high BMI. Cancer Med 2023; 12:5506-5516. [PMID: 36507561 PMCID: PMC10028125 DOI: 10.1002/cam4.5378] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 09/13/2022] [Accepted: 10/09/2022] [Indexed: 12/14/2022] Open
Abstract
Around 25% of women undergoing Axillary Clearance (ANC) develop lymphedema (LE). Intervention with a compression garment is recommended to prevent LE but no randomised evidence exists to support this strategy. METHODS A randomised trial tested standard management versus application of graduated compression garments (20-24 mmHg) to affected arm, for 1 year. Women with node positive breast cancer (n = 1300) undergoing ANC consented to arm volume measurements and those developing a 4-9% relative arm volume increase (RAVI) (subclinical LE) within 9 months post-surgery were randomised. Primary outcome was proportion of patients developing LE (RAVI > 10%) by 24-months in each group. Secondary endpoints included Quality of life in each group. RESULTS In total 143 patients were randomised (74 no sleeve: 69 compression sleeve) between October 2010 and November 2015. The lymphoedema rate at 24 months in the 'no sleeve' group was at 41%, similar to the 'sleeve' group (30%: p = 0.32). Thirtytwo patients randomised to the 'no sleeve' group had a sleeve applied within 24 months. Body Mass Index (BMI) at randomisation predicted LE at any time point HR 1.04 (CI 1.01-1.08; p = 0.01). Patients with obesity (BMI > 30) had higher rates of LE in both groups (46%) compared to those with BMI < 30 (24%). No difference between patients was found in either group in changes in QoL. Compression sleeves applied after development of LE improved QoL scores (FACT-B p = 0.007:TOI p = 0.042). CONCLUSION Early intervention with External Compression garments does not prevent clinical LE, particularly in women with a high BMI > 30. The use of prophylactic garments in subclinical LE (RAVI < 9%) is unwarranted.
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Affiliation(s)
- Nigel J Bundred
- Manchester University NHS Foundation Trust, Manchester, UK
- University of Manchester, Manchester Academic Health Sciences Centre (MAHSC) Manchester, Manchester, UK
| | - Emma Barrett
- Manchester University NHS Foundation Trust, Manchester, UK
- University of Manchester, Manchester Academic Health Sciences Centre (MAHSC) Manchester, Manchester, UK
| | - Chriss Todd
- Manchester University NHS Foundation Trust, Manchester, UK
- University of Manchester, Manchester Academic Health Sciences Centre (MAHSC) Manchester, Manchester, UK
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Julie Morris
- Manchester University NHS Foundation Trust, Manchester, UK
- University of Manchester, Manchester Academic Health Sciences Centre (MAHSC) Manchester, Manchester, UK
| | - Donna Watterson
- Manchester University NHS Foundation Trust, Manchester, UK
- University of Manchester, Manchester Academic Health Sciences Centre (MAHSC) Manchester, Manchester, UK
| | | | - Katie Riches
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | | | - Anthony Skene
- Royal Bournemouth NHS Foundation Trust, Bournemouth, UK
| | - Vaughan Keeley
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- University of Nottingham Medical School, Nottingham, UK
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8
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Sano M, Hirakawa S, Sasaki T, Inuzuka K, Katahashi K, Kayama T, Yamanaka Y, Tsuyuki H, Endo Y, Naruse E, Yokoyama Y, Sato K, Yamauchi K, Takeuchi H, Unno N. Role of Subcutaneous Adipose Tissues in the Pathophysiology of Secondary Lymphedema. Lymphat Res Biol 2022; 20:593-599. [PMID: 35394362 DOI: 10.1089/lrb.2021.0054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background: Secondary lymphedema (LE) occurs due to the disruption of lymphatic circulation. Lymphatic fluid accumulation in subcutaneous tissues induces adipocyte proliferation. Obesity is an important risk factor for the occurrence and deterioration of LE. Although the relationship between LE and subcutaneous adipose tissue increase has been reported clinically, their pathophysiological relationship remains unknown. Thus, we aimed to verify whether subcutaneous adipose tissue increase is involved in the pathophysiology of secondary LE. Methods and Results: The hindlimb model of secondary LE was created using male Sprague-Dawley rats (control and LE groups; n = 5 each). Skin samples were obtained on postoperative day 168. Histological examination and quantitative real-time polymerase chain reaction analysis of inflammatory adipokines, tumor necrosis factor-alpha (Tnf-α), C-C chemokine ligand 2 (Ccl2), and interleukin-6 (Il-6) were performed. Limb volume and subcutaneous adipose tissues significantly increased in the LE group compared with those in the control. Macrophages aggregated in the augmented adipose tissues, around the adipocytes, and formed crown-like structures (CLSs). The number of CLSs significantly increased in the LE group. These macrophages expressed transforming growth factor-beta 1 (TGF-β1). Inflammatory adipokine secretion was not observed. Although Il-6 expression increased in the LE group, IL-6 was expressed in subcutaneous myofibroblasts but not in subcutaneous adipocytes. Conclusion: As TGF-β1 derived from subcutaneous myofibroblasts is involved in skin fibrosis during LE, TGF-β1 derived from adipose tissues may also play a similar role. Drug treatment for subcutaneous adipose tissue reduction may improve the skin condition in secondary LE and may be a new therapeutic strategy.
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Affiliation(s)
- Masaki Sano
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Satoshi Hirakawa
- Preeminent Medical Photonics Education and Research Center Institute for NanoSuit Research, Departments of Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takeshi Sasaki
- Anatomy and Neuroscience and Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazunori Inuzuka
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazuto Katahashi
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takafumi Kayama
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuta Yamanaka
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hajime Tsuyuki
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yusuke Endo
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Ena Naruse
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yurina Yokoyama
- Rehabilitation, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kohji Sato
- Anatomy and Neuroscience and Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Katsuya Yamauchi
- Rehabilitation, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroya Takeuchi
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naoki Unno
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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9
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Ahmadi M, Shahrokhi SN, Khavaninzadeh M, Alipour J. Development of a Mobile-Based Self-care Application for Patients with Breast Cancer-Related Lymphedema in Iran. Appl Clin Inform 2022; 13:935-948. [PMID: 36198310 PMCID: PMC9534597 DOI: 10.1055/s-0042-1757295] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/20/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Due to the chronic, progressive, and debilitating nature of breast cancer-related lymphedema (BCRL), it is necessary to observe and maintain self-care management accordingly. This study was conducted to develop a mobile application based on the Android operating system for self-care management of Iranian patients with BCRL. METHODS An applied developmental study was conducted in 2020. The users' information needs assessment as well as design, development, implementation, and evaluation of the mobile app for self-care management of patients with BCRL was done by searching the literature, reviewing the existing mobile applications, and surveying the users' needs. The mobile app was designed using the Android Studio environment and Java programming language in the Android operating system. The usability of the app was evaluated by 30 patients with BCRL using the questionnaire for user interface satisfaction-seventh version (QUIS 7). RESULTS The mobile app for BCRL included demographic information, clinical information, lifestyle and system functions (drug use, nutrition, exercise, smoking cessation, communication, and test time reminder). User usability evaluation of the app content and functions confirmed that it was appropriate and satisfactory for the self-management of women with BCRL. CONCLUSION The mobile app was appropriate in terms of the content, function, and quality for improving the patients' lifestyle and education and self-management of BCRL symptoms according to its usability evaluation from the end-users' (patients) perspective. It is suggested that studies should be performed to confirm the effectiveness and identify the clinical significance of the app.
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Affiliation(s)
- Maryam Ahmadi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Nafiseh Shahrokhi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Khavaninzadeh
- Department of General Surgery, School of Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Jahanpour Alipour
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Health Information Technology, School of Paramedical, Zahedan University of Medical Sciences, Zahedan, Iran
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10
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Raji Lahiji M, Vafa S, de Souza RJ, Zarrati M, Sajadian A, Razmpoosh E, Jaberzadeh S. Effect of Dietary-Based Lifestyle Modification Approaches on Anthropometric Indices and Dietary Intake Parameters in Women with Breast Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Adv Nutr 2022; 13:1974-1988. [PMID: 35641019 PMCID: PMC9526840 DOI: 10.1093/advances/nmac062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/26/2022] [Accepted: 05/26/2022] [Indexed: 01/28/2023] Open
Abstract
This systematic review and meta-analysis aimed to investigate the effect of dietary-based lifestyle modification interventions ("diet," or "diet + exercise," or "diet + exercise + behavioral" intervention) on the measures of anthropometric and dietary intake parameters in women with breas cancer (BC). Databases were searched until June 2021. Inclusion criteria were randomized controlled trials that enrolled only women with BC. Studies that used exercise or behavioral interventions alone were not included. Mean ± SD changes were extracted for each outcome, and pooled using a random-effects model; 7315 studies were identified. Fifty-one studies (n = 7743) were included. The median ± SD duration of treatment was 24 ± 16.65 wk. Dietary-based interventions significantly reduced body weight [45 studies (n = 7239), weighted mean difference (WMD) (95% CI): -2.6 (-3.2, -2.1) kg], BMI [31 studies (n = 5384); WMD (95% CI): -1.0 (-1.3, -0.7) kg/m2], lean body mass [15 studies (n = 1194); WMD (95% CI): -0.6(-0.7, -0.4) kg], fat mass [11 studies (n = 913); WMD (95% CI): -2.6 (-3.3, -1.8) kg], fat percentage [17 studies (n = 897); WMD (95% CI): -1.5 (-1.9, -1.3)%], hip circumference [9 studies (n = 489); WMD (95% CI): -2.43 (-3.34, -1.54) cm], and waist circumference [7 studies (n = 309); WMD (95% CI): 0.02 (-0.03, -0.005) cm]. Significant reductions in energy intakes [20 studies (n = 4608), WMD (95% CI): -162 (-220, 104) kcal/d] and fat intakes [7 studies (n = 4316), WMD (95% CI): -7.5 (-7.8, -7.2)% of energy/d], and an increase in fiber intakes [11 studies (n = 4241), WMD (95% CI): 2.4 (0.7, 4.1) g/d] were observed. No significant changes were seen in protein, carbohydrate, and fruit and vegetable intakes. Subgroup analyses showed that changes in anthropometric and dietary intake indices were significant in studies that enrolled patients with both obesity and normal weight, studies that used diet therapy in combination with exercise and behavioral therapy, and studies that started the intervention during the treatment period. Overall, a multimodal dietary-based lifestyle intervention had significant effects on anthropometric and dietary intake parameters in women with BC, specifically when started as early as the diagnosis. This meta-analysis was registered at PROSPERO as CRD42021291488.
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Affiliation(s)
- Mahsa Raji Lahiji
- Deparment of Integrative Oncology and Quality of Life, Breast Cancer Research Center, Motamed Cancer Institute, Academic Centre for Education, Culture, and Research, Tehran, Iran,Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Saeideh Vafa
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada,Population Health Research Institute, Hamilton, ON, Canada
| | - Mitra Zarrati
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Akram Sajadian
- Deparment of Integrative Oncology and Quality of Life, Breast Cancer Research Center, Motamed Cancer Institute, Academic Centre for Education, Culture, and Research, Tehran, Iran
| | | | - Shapour Jaberzadeh
- Non-invasive Brain Stimulation and Neuroplasticity Laboratory, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia
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11
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Di Meglio A, Martin E, Crane TE, Charles C, Barbier A, Raynard B, Mangin A, Tredan O, Bouleuc C, Cottu PH, Vanlemmens L, Segura-Djezzar C, Lesur A, Pistilli B, Joly F, Ginsbourger T, Coquet B, Pauporte I, Jacob G, Sirven A, Bonastre J, Ligibel JA, Michiels S, Vaz-Luis I. A phase III randomized trial of weight loss to reduce cancer-related fatigue among overweight and obese breast cancer patients: MEDEA Study design. Trials 2022; 23:193. [PMID: 35246219 PMCID: PMC8896231 DOI: 10.1186/s13063-022-06090-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/07/2022] [Indexed: 12/24/2022] Open
Abstract
Background Elevated body mass index (BMI) represents a risk factor for cancer-related fatigue (CRF). Weight loss interventions are feasible and safe in cancer survivors, leading to improved cardio-metabolic and quality of life (QOL) outcomes and modulating inflammatory biomarkers. Randomized data are lacking showing that a lifestyle intervention aimed at weight loss, combining improved diet, exercise, and motivational counseling, reduces CRF. Motivating to Exercise and Diet, and Educating to healthy behaviors After breast cancer (MEDEA) is a multi-center, randomized controlled trial evaluating the impact of weight loss on CRF in overweight or obese survivors of breast cancer. Herein, we described the MEDEA methodology. Methods Patients (N = 220) with stage I–III breast cancer and BMI ≥ 25 kg/m2, within 12 months of primary treatment, and able to walk ≥ 400 m are eligible to enroll. Participants are randomized 1:1 to health education alone vs. a personalized telephone-based weight loss intervention plus health education. Both arms receive a health education program focusing on healthy living. Patients in the intervention arm are paired with an individual lifestyle coach, who delivers the intervention through 24 semi-structured telephone calls over 1 year. Intervention goals include weight loss ≥ 10% of baseline, caloric restriction of 500–1000 Kcal/day, and increased physical activity (PA) to 150 (initial phase) and 225–300 min/week (maintenance phase). The intervention is based on the social cognitive theory and is adapted from the Breast Cancer Weight Loss trial (BWEL, A011401). The primary endpoint is the difference in self-reported CRF (EORTC QLQ-C30) between arms. Secondary endpoints include the following: QOL (EORTC QLQ-C30, -BR45, -FA12), anxiety, and depression (HADS); weight and BMI, dietary habits and quality, PA, and sleep; health care costs (hospital-admissions, all-drug consumption, sick leaves) and cost-effectiveness (cost per quality-adjusted life-year); and patient motivation and satisfaction. The primary analysis of MEDEA will compare self-reported CRF at 12 months post-randomization between arms, with 80.0% power (two-sided α = 0.05) to detect a standardized effect size of 0.40. Discussion MEDEA will test the impact of a weight loss intervention on CRF among overweight or obese BC survivors, potentially providing additional management strategies and contributing to establish weight loss support as a new standard of clinical care. Trial registration ClinicalTrials.govNCT04304924
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Affiliation(s)
- Antonio Di Meglio
- INSERM Unit 981-Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France.,Gustave Roussy, Villejuif, France
| | | | | | | | | | | | | | | | | | | | | | | | - Anne Lesur
- Institut de cancérologie de Lorraine, Nancy, France
| | | | | | | | | | | | | | | | - Julia Bonastre
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Oncostat U1018, Inserm, University Paris-Saclay, Equipe labellisee Ligue Contre le Cancer, Villejuif, France
| | | | - Stefan Michiels
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Oncostat U1018, Inserm, University Paris-Saclay, Equipe labellisee Ligue Contre le Cancer, Villejuif, France
| | - Ines Vaz-Luis
- INSERM Unit 981-Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France. .,Gustave Roussy, Villejuif, France.
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12
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Boyages J, Cave AE, Naidoo D, Ee CCL. Weight Gain and Lymphedema After Breast Cancer Treatment: Avoiding the Catch-22? Lymphat Res Biol 2021; 20:409-416. [PMID: 34748426 DOI: 10.1089/lrb.2020.0048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Overweight and obesity are strongly implicated in breast cancer (BC) development and are also a risk factor for BC-related lymphedema (BCRL). Materials and Methods: An online cross-sectional survey was conducted between November 2017 and January 2018. Analyses were restricted to women with localized BC, who provided information about BCRL (n = 238). Most women were not experiencing BCRL (55.46%). Results: Mean self-reported weight at diagnosis was 68.55 kg for women without BCRL and 74.43 kg for women with BCRL (p = 0.0021). In this study, 50.9% with BCRL were overweight/obese at diagnosis (body mass index [BMI] ≥25) compared with 36.4% of women without BCRL (p = 0.003). For women without BCRL, 12.12% were classified as obese (BMI ≥30) versus 20.75% with BCRL. Women with BCRL were more likely to have gained >5% of body weight (p = 0.03), be currently overweight or obese (p = 0.004), and less active (48.11%) than they were at diagnosis than women without BCRL (33.33%) (p = 0.042). Having a structured exercise program, following a prescribed diet, and being accountable to someone else were identified as the main facilitators to successful weight loss and weight maintenance. Conclusions: Clinicians should consider obesity when personalizing axillary treatment and encourage lifestyle interventions and lymphedema screening after BC treatment.
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Affiliation(s)
- John Boyages
- ICON Cancer Centre, Sydney Adventist Hospital, Wahroonga, Australia.,Australian Lymphoedema Education Research and Treatment (ALERT), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Adele E Cave
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Dhevaksha Naidoo
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Carolyn C L Ee
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
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13
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Roberts SA, Gillespie TC, Shui AM, Brunelle CL, Daniell KM, Locascio JJ, Naoum GE, Taghian AG. Weight loss does not decrease risk of breast cancer-related arm lymphedema. Cancer 2021; 127:3939-3945. [PMID: 34314022 PMCID: PMC8516692 DOI: 10.1002/cncr.33819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/06/2021] [Accepted: 06/28/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The goal of this study was to determine the relationship between postoperative weight change and breast cancer-related lymphedema (BCRL). METHODS In this cohort study, 1161 women underwent unilateral breast surgery for breast cancer from 2005 to 2020 and were prospectively screened for BCRL. Arm volume measurements were obtained via an optoelectronic perometer preoperatively, postoperatively, and in the follow-up setting every 6 to 12 months. Mean follow-up from preoperative baseline was 49.1 months. The main outcome was BCRL, defined as a relative volume change of the ipsilateral arm of ≥10% at least 3 months after surgery. RESULTS A total of 92 patients (7.9%) developed BCRL. Net weight loss versus net weight gain from baseline to last follow-up was not protective against developing BCRL (hazard ratio, 1.38; 95% confidence interval, 0.89-2.13; P = .152). CONCLUSIONS Although weight loss may be recommended as part of an individualized lifestyle management program for overall health, weight loss alone may not decrease the risk of developing BCRL.
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Affiliation(s)
- Sacha A. Roberts
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston MA, 02114
| | - Tessa C. Gillespie
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston MA, 02114
| | - Amy M. Shui
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston MA, 02114
| | - Cheryl L. Brunelle
- Department of Physical and Occupational Therapy, Massachusetts General Hospital, Boston MA, 02114
| | - Kayla M. Daniell
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston MA, 02114
| | - Joseph J. Locascio
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston MA, 02114
| | - George E. Naoum
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston MA, 02114
| | - Alphonse G. Taghian
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston MA, 02114
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14
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Saneei Totmaj A, Haghighat S, Jaberzadeh S, Navaei M, Vafa S, Janani L, Emamat H, Salehi Z, Izad M, Zarrati M. The Effects of Synbiotic Supplementation on Serum Anti-Inflammatory Factors in the Survivors of Breast Cancer with Lymphedema following a Low Calorie Diet: A Randomized, Double-Blind, Clinical Trial. Nutr Cancer 2021; 74:869-881. [PMID: 34085881 DOI: 10.1080/01635581.2021.1933096] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIM Breast cancer-related lymphedema (BCRL) is a treatment-related inflammatory complication in breast cancer survivors (BCSs). This study was aimed to evaluate the effect of synbiotic supplementation on serum concentrations of IL-10, TGF-β, VEGF, adiponectin, and edema volume among overweight or obese BCSs with lymphedema following a low-calorie diet (LCD). METHOD In a randomized double-blind, controlled clinical trial, 88 obese and overweight BCSs women were randomized to synbiotic supplement (n = 44) or placebo (n = 44) groups and both groups followed an LCD for 10 weeks. Pre- and post-intervention comparisons were made regarding the anti-inflammatory markers which included IL-10, TGF-β, VEGF, adiponectin, edema volume, and anthropometric measurements. Also, the same factors were analyzed to find inter-group disparities. RESULTS There were no significant differences among participants in the baseline, except for IL-10 and adiponectin. Post-intervention, no significant differences were observed regarding the anti-inflammatory markers, including IL-10, VEGF, adiponectin, and TGF-β between the groups. After 10 weeks of intervention edema volume significantly decreased in the synbiotic group; additionally, anthropometric measurements (body weight, BMI, body fat percent, and WC) decreased in both groups significantly (P < 0.001 and P < 0.005; respectively). CONCLUSION Synbiotic supplementation coupled with an LCD in a 10-week intervention had beneficial effects on increasing the serum TGF-β, IL-10, and adiponectin levels in women with BCRL. It also reduced arm lymphedema volume. Therefore, synbiotic supplementation can be effective in improving health status in BCRL patients.
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Affiliation(s)
- Ali Saneei Totmaj
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Shahpar Haghighat
- Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Shapour Jaberzadeh
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia
| | - Mehraban Navaei
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Saeideh Vafa
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Janani
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hadi Emamat
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Salehi
- Immunology Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Izad
- Immunology Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Zarrati
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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15
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Hendrickx AA, Damstra RJ, Krijnen WP, van der Schans CP. Improvement of Limb Volumes after Bariatric Surgery in Nine End-Stage Primary, Secondary, and Obesity-Induced Lymphedema Patients: A Multiple Case Report. Lymphat Res Biol 2021; 20:64-70. [PMID: 33780644 DOI: 10.1089/lrb.2020.0055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Lymphedema (LE) is a chronic condition of swelling due to lymphatic impairment and is characterized by edema and fibro-adipose tissue deposition. LE may be caused by an anomalous development of the lymphatic system, known as primary LE, or may develop secondary to traumatic, infectious, or other external events. Knowledge is increasing about the plural and bidirectional relationship between LE and obesity. The rate of obesity is increasing worldwide, and bariatric surgery offers the most effective and durable treatment, as this surgery exhibits positive effects on many obesity-related diseases. We explored whether bariatric surgery could improve leg volumes in morbidly obese LE patients. Patients: Between 2013 and 2019, 829 patients were hospitalized in our Center of Expertise for Lymphovascular Medicine for intensive treatment of their LE. Nine patients with end-stage primary, secondary, or obesity-induced LE underwent a bariatric procedure related to their morbid obesity. Methods and Results: Data concerning age, gender, medical diagnosis, LE stage, type of bariatric treatment, body weight, body mass index (BMI), and limb volumes were retrospectively collected from the patient files. At the individual patient level, body weight, BMI, leg volumes, and their percent reduction between presurgery and postsurgery were calculated. At the group level, paired sample t-tests were conducted to compare the mean body weight, BMI, and volumes of both legs between postsurgery and presurgery. The data demonstrate a significant decrease in body weight, BMI, and leg volumes in morbidly obese end-stage primary, secondary, and obesity-induced LE patients following bariatric surgery. Conclusions: Our multiple case study indicates that bariatric surgery provides a good indication for concomitant treatment of morbid obesity and LE.
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Affiliation(s)
- Ad A Hendrickx
- Center of Expertise for Lymphovascular Medicine, Nij Smellinghe Hospital, Drachten, The Netherlands.,Research Group Healthy Ageing Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.,Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert J Damstra
- Center of Expertise for Lymphovascular Medicine, Nij Smellinghe Hospital, Drachten, The Netherlands
| | - Wim P Krijnen
- Research Group Healthy Ageing Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Cees P van der Schans
- Research Group Healthy Ageing Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.,Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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16
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LeVasseur N, Cheng W, Mazzarello S, Clemons M, Vandermeer L, Jones L, Joy AA, Barbeau P, Wolfe D, Ahmadzai N, Hersi M, Stober C, Shorr R, Hilton J, Hutton B. Optimising weight-loss interventions in cancer patients-A systematic review and network meta-analysis. PLoS One 2021; 16:e0245794. [PMID: 33539414 PMCID: PMC7861370 DOI: 10.1371/journal.pone.0245794] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 01/07/2021] [Indexed: 12/15/2022] Open
Abstract
Background Excess weight has been associated with increased morbidity and a worse prognosis in adult patients with early-stage cancer. The optimal lifestyle interventions to optimize anthropometric measures amongst cancer patients and survivors remain inconsistent. Objective To conduct a systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) comparing the effects of exercise and dietary interventions alone or in combination on anthropometric measures of adult cancer patients and survivors. Methods A systematic search of Medline, Embase and the Cochrane Trials Registry was performed. Outcomes of interest included changes in weight, body mass index (BMI), and waist circumference. Screening and data collection were performed by two reviewers. Bayesian NMAs were performed. Results Overall, 98 RCTs were included; 75 were incorporated in NMAs (n = 12,199). Groups of intervention strategies included: 3 exercise interventions, 8 dietary interventions, 7 combination interventions of diet and exercise and standard care. Median intervention duration was 26 weeks. NMA suggested that diet alone (mean difference [MD] -2.25kg, 95% CrI -3.43 to -0.91kg) and combination strategies (MD -2.52kg, 95% CrI -3.54 to -1.62kg) were associated with more weight loss compared to standard care. All dietary interventions achieved a similar magnitude of weight loss (MD range from -2.03kg to -2.52kg). Both diet alone and combination strategies demonstrated greater BMI reductions versus standard care, and each of diet alone, exercise alone and combination strategies demonstrated greater reductions in waist circumference than standard care. Conclusion Diet and exercise alone or in combination are effective lifestyle interventions to improve anthropometric measures in cancer patients and survivors. All reputable diets appear to be similarly effective to achieve weight loss.
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Affiliation(s)
- Nathalie LeVasseur
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | - Wei Cheng
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sasha Mazzarello
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Mark Clemons
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Lisa Vandermeer
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | - Lee Jones
- Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- Weill Cornell Medical Center, New York, New York, United States of America
| | - Anil Abraham Joy
- Division of Medical Oncology, Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, Canada
| | | | - Dianna Wolfe
- Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Mona Hersi
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Carol Stober
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | | | - John Hilton
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- University of Ottawa School of Epidemiology and Public Health, Ottawa, Canada
- * E-mail:
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17
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Vafa S, Zarrati M, Malakootinejad M, Totmaj AS, Zayeri F, Salehi M, Sanati V, Haghighat S. Calorie restriction and synbiotics effect on quality of life and edema reduction in breast cancer-related lymphedema, a clinical trial. Breast 2020; 54:37-45. [PMID: 32898787 PMCID: PMC7486474 DOI: 10.1016/j.breast.2020.08.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/24/2020] [Accepted: 08/16/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Little evidence exists regarding the clinical value of synbiotics in the management of post-treatment complications of breast cancer especially breast cancer-related lymphedema (BCRL). This study aimed to investigate the effects of synbiotic supplementation along with calorie restriction on quality of life and edema volume in patients with BCRL. METHODS This randomized, placebo-controlled, clinical trial was conducted on 135 overweight and obese women with BCRL aged 18-65 years old. Participants were randomly allocated to receive a calorie-restricted diet plus 109 CFU synbiotic supplement (CRS group; n = 45) or placebo (CRP group; n = 45), daily for 10 weeks. Also, a control group (n = 45) with no intervention was included in the trial. All of the participants received Complete Decongestive Therapy for lymphedema treatment. The quality of life score, edema volume and body mass index (BMI) were measured at baseline and end of the trial. RESULTS A total of 121 subjects completed the trial. CRS group showed a significant decrease in the total quality of life score (P = 0.004), and it's psychosocial (P = 0.022) and functional (P = 0.002) domain scores, as well as edema volume (P = 0.002) and BMI (P < 0.001) in comparison to the control. However, there were no significant differences in changes in trial outcomes between the CRS and CRP groups. CONCLUSION Synbiotic supplementation along with a low-calorie diet was effective in quality of life, edema volume, and BMI improvement; mostly due to low-calorie diet. It seems that adding a dietitian consultation on the lymphedema management strategy may provide a better result in lymphedema control.
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Affiliation(s)
- Saeideh Vafa
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mitra Zarrati
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
| | - Marjan Malakootinejad
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Saneei Totmaj
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Farid Zayeri
- Proteomics Research Center and Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Salehi
- Department of Biostatistics, School of Public Health, Health, Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Sanati
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Shahpar Haghighat
- Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran.
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18
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Baklaci M, Eyigör S, Tanıgör G, Özgür İnbat M, Çalışkan Kabayel S. Assessment of Muscle Strength and Volume Changes in Patients with Breast Cancer-Related Lymphedema. Oncol Res Treat 2020; 43:584-591. [PMID: 32932259 DOI: 10.1159/000509672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/24/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To determine whether complete decongestive therapy (CDT) used in breast cancer-related lymphedema affects muscle strength in the affected arm while assessing the efficacy of the therapy itself. MATERIAL AND METHODS Seventy-four patients with breast cancer-related lymphedema were included in this study. The demographic and clinical history characteristics of the patients were taken. The patients were then evaluated with measurements of extremity volumes and handgrip strengths using a hand dynamometer before and after the CDT. Data were then assessed using relevant statistical methods. RESULTS The mean CDT duration was 17.5 ± 8.93 days for the patients. Therapy resulted in significant improvement in the affected arm (p < 0.01). The difference between the arm with lymphedema and the other side was statistically significant, and this difference remained after the therapy (p < 0.01). The change in handgrip strength in the side with lymphedema was not found to be statistically significant after therapy (p > 0.05). Handgrip strength differences and volume differences before and after the treatment in the affected arm were not correlated (p > 0.05). CONCLUSION Limbs affected with lymphedema were found to be weaker in handgrip strength and this weakness continued throughout the therapy. Strengthening exercises should be considered to be added into the treatment of patients undergoing CDT to gain better functional potential.
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Affiliation(s)
- Musa Baklaci
- Department of Physical Medicine and Rehabilitation, Ege University Medical School, İzmir, Turkey,
| | - Sibel Eyigör
- Department of Physical Medicine and Rehabilitation, Ege University Medical School, İzmir, Turkey
| | - Göksel Tanıgör
- Department of Physical Medicine and Rehabilitation, Ege University Medical School, İzmir, Turkey
| | - Menekşe Özgür İnbat
- Department of Physical Medicine and Rehabilitation, Ege University Medical School, İzmir, Turkey
| | - Sedef Çalışkan Kabayel
- Department of Physical Medicine and Rehabilitation, Ege University Medical School, İzmir, Turkey
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19
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Tsai CL, Chih-Yang Hsu, Chang WW, Yen-Nung Lin. Effects of weight reduction on the breast cancer-related lymphedema: A systematic review and meta-analysis. Breast 2020; 52:116-121. [PMID: 32505860 PMCID: PMC7375642 DOI: 10.1016/j.breast.2020.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/17/2020] [Accepted: 05/24/2020] [Indexed: 11/29/2022] Open
Abstract
Background Obesity has long been considered a risk factor for breast cancer–related lymphedema (BCRL), but the benefits of weight reduction in managing BCRL have not been clearly established. Objective To evaluate the beneficial effects of weight loss interventions (WLIs) on the reduction and prevention of BCRL. Methods We conducted a systematic review and meta-analysis by searching the PubMed, Scopus, and Embase databases from their earliest record to October 1st, 2019. We included randomized and non-randomized controlled trials involving adult patients with a history of breast cancer, that compared WLI groups with no-WLI groups, and provided quantitative measurements of lymphedema. Results Initial literature search yielded 461 nonduplicate records. After exclusion based on title, abstract, and full-text review, four randomized controlled trials involving 460 participants were included for quantitative analysis. Our meta-analysis revealed a significant between-group mean difference (MD) regarding the volume of affected arm (MD = 244.7 mL, 95% confidence interval [CI]: 145.3–344.0) and volume of unaffected arm (MD = 234.5 mL, 95% CI: 146.9–322.1). However, a nonsignificant between-group MD of −0.07% (95% CI: 1.22–1.08) was observed regarding the interlimb volume difference at the end of the WLIs. Conclusions In patients with BCRL, WLIs are associated with decreased volume of the affected and unaffected arms but not with decreased severity of BCRL measured by interlimb difference in arm volume. Weight reduction decreases the volume of both arms in patients with BCRL. Weight reduction does not reduce the severity of BCRL measured objectively. Effects of weight reduction on preventing BCRL are yet unknown.
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Affiliation(s)
- Chi-Lin Tsai
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Chih-Yang Hsu
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Wei-Wen Chang
- Department of General Surgery, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Yen-Nung Lin
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.
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20
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Abstract
Overweight and obesity are known risk factors for the development of lymphoedema, and are also well-recognised factors complicating the management of lymphoedema. However, a degree of uncertainty remains regarding the way in which obesity impacts upon the condition, and there is little detail about the practical application of weight management strategies in the population with lymphoedema. This article provides the background for ongoing research into the association between lymphoedema management and obesity. It is hoped that this research will provide important insights into the long-term management of lymphoedema.
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Affiliation(s)
- Debbie Provan
- Regional Lead for Living With and Beyond Cancer, West of Scotland Cancer Network, Glasgow
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21
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Santa-Maria CA, Coughlin JW, Sharma D, Armanios M, Blackford AL, Schreyer C, Dalcin A, Carpenter A, Jerome GJ, Armstrong DK, Chaudhry M, Cohen GI, Connolly RM, Fetting J, Miller RS, Smith KL, Snyder C, Wolfe A, Wolff AC, Huang CY, Appel LJ, Stearns V. The Effects of a Remote-based Weight Loss Program on Adipocytokines, Metabolic Markers, and Telomere Length in Breast Cancer Survivors: the POWER-Remote Trial. Clin Cancer Res 2020; 26:3024-3034. [PMID: 32071117 DOI: 10.1158/1078-0432.ccr-19-2935] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/29/2019] [Accepted: 02/14/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE We initiated a clinical trial to determine the proportion of breast cancer survivors achieving ≥5% weight loss using a remotely delivered weight loss intervention (POWER-remote) or a self-directed approach, and to determine the effects of the intervention on biomarkers of cancer risk including metabolism, inflammation, and telomere length. EXPERIMENTAL DESIGN Women with stage 0-III breast cancer, who completed local therapy and chemotherapy, with a body mass index ≥25 kg/m2 were randomized to a 12-month intervention (POWER-remote) versus a self-directed approach. The primary objective was to determine the number of women who achieved at least 5% weight loss at 6 months. We assessed baseline and 6-month change in a panel of adipocytokines (adiponectin, leptin, resistin, HGF, NGF, PAI1, TNFα, MCP1, IL1β, IL6, and IL8), metabolic factors (insulin, glucose, lipids, hs-CRP), and telomere length in peripheral blood mononuclear cells. RESULTS From 2013 to 2015, 96 women were enrolled, and 87 were evaluable for the primary analysis; 45 to POWER-remote and 42 to self-directed. At 6 months, 51% of women randomized to POWER-remote lost ≥5% of their baseline body weight, compared with 12% in the self-directed arm [OR, 7.9; 95% confidence interval (CI), 2.6-23.9; P = 0.0003]; proportion were similar at 12 months (51% vs 17%, respectively, P = 0.003). Weight loss correlated with significant decreases in leptin, and favorable modulation of inflammatory cytokines and lipid profiles. There was no significant change in telomere length at 6 months. CONCLUSIONS A remotely delivered weight loss intervention resulted in significant weight loss in breast cancer survivors, and favorable effects on several biomarkers.
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Affiliation(s)
- Cesar A Santa-Maria
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Janelle W Coughlin
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dipali Sharma
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary Armanios
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amanda L Blackford
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Colleen Schreyer
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arlene Dalcin
- The Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ashley Carpenter
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gerald J Jerome
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Kinesiology, Towson University, Towson, Maryland
| | - Deborah K Armstrong
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Gary I Cohen
- Greater Baltimore Medical Center, Baltimore, Maryland
| | - Roisin M Connolly
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John Fetting
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert S Miller
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Karen L Smith
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Claire Snyder
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew Wolfe
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Antonio C Wolff
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chiung-Yu Huang
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lawrence J Appel
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vered Stearns
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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22
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Vafa S, Haghighat S, Janani L, Totmaj AS, Navaei M, Amirinejad A, Emamat H, Salehi Z, Zarrati M. The effects of synbiotic supplementation on serum inflammatory markers and edema volume in breast cancer survivors with lymphedema. EXCLI JOURNAL 2020; 19:1-15. [PMID: 32038113 PMCID: PMC7003637 DOI: 10.17179/excli2019-1876] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/18/2019] [Indexed: 12/17/2022]
Abstract
Breast cancer-related lymphedema (BCRL) is one of the most common complications of breast cancer treatments, which may be exacerbated by obesity. Dysbiosis may negatively impact the management of obesity and lymphedema by increasing inflammation. The objective of this study was to assess the effects of supplementation with synbiotics on inflammatory markers, serum leptin concentration and edema volume in overweight and obese BCRL women following a low-calorie diet (LCD). In a randomized double-blind controlled clinical trial, 88 breast cancer survivors with lymphedema were supplemented once a day for 10 weeks with either a synbiotic or a placebo capsule. Both groups were under a low-calorie diet (LCD). At the end of the study, synbiotic supplementation resulted in a significant reduction in leptin (P=0.003) and TNF-α (P=0.039) between the study groups. Besides, edema volume was significantly reduced within the synbiotic group after the intervention. We did not observe any significant effects of the synbiotic supplementation in hs-CRP, and IL-1β between the study groups (P=0.550, P=0.118 respectively). Conclusively, synbiotic supplementation along with an LCD program in breast cancer survivors with lymphedema had beneficial effects on the concentration of serum inflammatory markers and edema volume.
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Affiliation(s)
- Saeideh Vafa
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Shahpar Haghighat
- Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Leila Janani
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Saneei Totmaj
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mehraban Navaei
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Amirinejad
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hadi Emamat
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Salehi
- Immunology Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Zarrati
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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23
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RACHERIU M, SILIȘTEANU SC, COCA MR. Post-therapeutic lymphedema in breast cancer. BALNEO RESEARCH JOURNAL 2019. [DOI: 10.12680/balneo.2019.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introductions. Lymphedema is an interstitial accumulation of protein-rich lymph fluid, due to the post-therapeutic alteration of lymphatic circulation in the upper limb. The appearance of lymphedema is favoured by a number of risk factors. All of these factors ultimately lead to a process of tissue fibrosis. Materials and methods. This study was carried out in an outpatient regimen, for a period of 12 months, in the kinetotherapy room, using massage elements for lymphatic drainage and kinetotherapy technique. The study group included 15 patients aged 27-65 years.Results and discutions. Patients evaluated the quality of life after surgery based on the physical and mental symptoms, which is why anxiety, pain reduction through massage and kinetotherapy give patients self-confidence as well as confidence in the recovery process. Conclusions. This complex programme that includes lymphatic drainage massage methods and kinetotherapy techniques should be applied individually, progressively, under the control of the kinetotherapist. Key words: lymphedema, kinetotherapy technique, lymphatic drainage massage,
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Affiliation(s)
- Mihaela RACHERIU
- Lucian Blaga University of Sibiu, Faculty of Medicine, Sibiu, Romania 2County Clinical Emergency Hospital, Sibiu, Romania
| | - Sînziana Călina SILIȘTEANU
- Railway Hospital Iasi - Specialty Ambulatory of Suceava - "Stefan cel Mare" University of Suceava FEFS-DSDU
| | - Maria Ramona COCA
- Lucian Blaga University of Sibiu, Faculty of Medicine, Sibiu, Romania 2County Clinical Emergency Hospital, Sibiu, Romania
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24
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Suzuki H, Seki A, Hosaka T, Matsumoto N, Tomita M, Takahashi M, Yamauchi H. Effects of a structured group intervention on obesity among breast cancer survivors. Breast Cancer 2019; 27:236-242. [PMID: 31617073 DOI: 10.1007/s12282-019-01013-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 10/03/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Obesity is associated with an increased risk for developing breast cancer and poor cancer-related outcomes. Endocrine therapy is a key part of treatment for breast cancer, but can result in weight gain. This study examined the efficacy of a structured group intervention during adjuvant endocrine therapy for obese patients with breast cancer. The intervention involved a combination of proper nutrition, exercise, and group coaching. METHODS Participants were patients with breast cancer who were undergoing adjuvant endocrine therapy and exhibited apparent weight gain while undergoing therapy, or had a diagnosis of abnormal lipid metabolism. We conducted a single-arm prospective study with a combined intervention. The intervention comprised 15 min of nutrition education, a 30-min group health coaching program, and three 45-min group aerobic exercise sessions. We evaluated participants' parameters (e.g., body weight, body mass index [BMI], cholesterol, psychological distress) at baseline, and at 1, 3, and 6 months after the intervention. RESULTS At 1 month after the intervention, there were significant reductions in body weight (p < 0.01), BMI (p < 0.01), triglyceride levels (p < 0.05), total cholesterol levels (p < 0.01), psychological distress (p < 0.05), and cancer-related fatigue (p < 0.01). At 3 and 6 months after the intervention, we observed further reductions in body weight, BMI, and triceps skinfold thickness. CONCLUSION Our study showed that a short-term structured intervention helped modify dietary and exercise behaviors and promote health among breast cancer survivors, and resulted in favorable changes in participants' body weight.
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Affiliation(s)
- Hitomi Suzuki
- Department of Breast Surgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.,Department of Surgery, Ichinomiya Nishi Hospital, Aichi, Japan
| | - Akina Seki
- Department of Breast Surgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Takashi Hosaka
- Department of Psycho-Oncology, HOSAKA Psycho-Oncology Clinic, St. Luke's International Hospital, Tokyo, Japan
| | - Noriko Matsumoto
- Department of Nutrition, St. Luke's International Hospital, Tokyo, Japan
| | - Makiko Tomita
- Division of Cancer Survivorship Research, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan.,Research and Development Group, Analysis and Innovation Department, Business Development Division, SMS Co., Ltd., Tokyo, Japan
| | - Miyako Takahashi
- Division of Cancer Survivorship Research, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Hideko Yamauchi
- Department of Breast Surgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
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25
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Ayhan FF, Aykut M, Genç H, Mansız Kaplan B, Soran A. Is Complex Decongestive Physical Therapy Safe for Median Nerve at the Level of Carpal Tunnel in Breast Cancer Related Lymphedema? Lymphat Res Biol 2018; 17:78-86. [PMID: 30358471 DOI: 10.1089/lrb.2018.0011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Multilayer bandaging used in complex decongestive therapy (CDT) may increase tissue pressure resulting in nerve entrapments. The aim of this study was to discover if median nerve damage is a consequence of CDT in patients with breast cancer-related lymphedema (BCRL). METHODS AND RESULTS Eighty-two arms of 41 patients with BCRL were included. Mean age was 56.05 (8.16) years and all stages of lymphedema were equally included. Fifteen sessions of CDT was applied to all patients. The calculated volume of extremities, the quality of life (cancer adaptation of Ferrans-Powell), neuropathic pain (NP; Douleur Neuropathique 4), and disability (quick disabilities of arm, shoulder, and hand [Q-DASH]) tests were recorded before and after therapy. Skin and subcutaneous tissue thicknesses of volar and dorsal sides and median nerve cross-sectional area (CSA) at the level of carpal tunnel were measured using ultrasonography (US), before and after therapy. Carpal tunnel syndrome (CTS; 41.37%) and polyneuropathy (10.34%) were common findings confirmed by electromyography. Neuropathic pain profile was also found in 34.14% of patients. The arm volume of affected side, quality of life, and skin and subcutaneous tissue thicknesses were improved after therapy (p < 0.05). However, median nerve CSA, the NP, and Q-DASH scores were not changed after therapy. CONCLUSIONS Although lymphedema is a painless condition, NP and CTS should not be ignored in patients with BCRL. US is an alternative, precise, and high technological method for evaluating treatment response. CDT is an effective and safe treatment according to volumetric calculations, US measurements of tissue thicknesses, and median nerve size.
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Affiliation(s)
- F Figen Ayhan
- 1 Division of Oncologic Rehabilitation and Lymphedema, Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Health Sciences University, Ankara, Turkey.,2 Department of Physical Therapy and Rehabilitation, High School of Health, Uşak University, Uşak, Turkey
| | - Melek Aykut
- 1 Division of Oncologic Rehabilitation and Lymphedema, Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Hakan Genç
- 1 Division of Oncologic Rehabilitation and Lymphedema, Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Başak Mansız Kaplan
- 1 Division of Oncologic Rehabilitation and Lymphedema, Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Atilla Soran
- 3 Department of Surgery, Magee Women Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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26
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Sierla R, Dylke ES, Kilbreath S. A Systematic Review of the Outcomes Used to Assess Upper Body Lymphedema. Cancer Invest 2018; 36:458-473. [PMID: 30289283 DOI: 10.1080/07357907.2018.1517362] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To ascertain how change in upper body lymphedema is assessed and understand how clinically significant change is determined. METHOD A systematic search of the literature resulted in 55 eligible studies for analysis. RESULTS A range of assessment methods, measurement protocols, and outcomes were used in the literature. Of the 21 studies in which thresholds for change were set a priori, 20 different thresholds were reported. CONCLUSION How data was measured, analysed and reported was inconsistent across studies. Consensus on a core outcome set with standardised assessment protocols and reporting; and investigation into empirically based minimum important differences (MID) is needed.
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Affiliation(s)
- Robyn Sierla
- a Faculty of Health Sciences , University of Sydney , Sydeny , Australia.,b Occupational Therapy Department , Royal Prince Alfred Hospital , Sydney , Australia
| | - Elizabeth Sian Dylke
- c Discipline of Physiotherapy, Faculty of Health Sciences , University of Sydney , Sydney , Australia
| | - Sharon Kilbreath
- d Faculty of Health Sciences , University of Sydney , Sydney , Australia
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27
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Dixon JM, Elder K, McLaughlin S. Evidence-based advice for patients following axillary surgery. BREAST CANCER MANAGEMENT 2018. [DOI: 10.2217/bmt-2018-0018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- J Michael Dixon
- Edinburgh Breast Unit, Western General Hospital, Crewe Road South, Edinburgh, EH2 4XU, UK
| | - Kenneth Elder
- ST6 General Surgery Trainee Edinburgh Breast Unit, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Sarah McLaughlin
- Associate Professor of Surgery Mayo Clinic, 4500 San Pablo Rd Jacksonville, FL 32225, USA
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28
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Yoon JA, Shin YB, Shin MJ, Yun RY, Kim KY, Song YS, Bae Y, Lee S, Jung Y, Lee SH. An Assessment of the Relationship Between Abdominal Obesity and the Severity of Upper Extremity Lymphedema. Lymphat Res Biol 2018; 16:458-463. [PMID: 29870284 DOI: 10.1089/lrb.2017.0068] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Obesity is one of the well-known initiating and aggravating factors of lymphedema. Body mass index (BMI) is typically used to define obesity, but in Asian populations, health risks are elevated at lower BMI levels, and abdominal fat may be a better obesity metric. Thus, we assessed the potential association between abdominal obesity and lymphedema severity in postoperative breast cancer patients. METHODS AND RESULTS Thirty-three women with breast cancer-related lymphedema participated in this study. Arm circumference was measured at four locations per arm to identify the maximal circumference difference (MCD) between the affected and unaffected sides. All patients underwent lymphoscintigraphy, and we calculated the quantitative asymmetry index (QAI) of both arms. A computed tomography was also performed to assess abdominal obesity after lymphedema. Abdominal obesity was classified as a visceral fat cross-sectional area larger than 70 cm2. Fourteen women (42%) were obese (BMI ≥25 kg/m2), and 18 women (54%) had increased abdominal fat. BMI obesity and abdominal obesity were significantly correlated, but five patients were classified with abdominal obesity, despite a BMI below 25 kg/m2. The mean arm circumference difference was 2.8 ± 2.4 cm. Decreased axillary QAI was significantly correlated with obesity, and increased arm edema (MCD ≥2 cm) was significantly correlated with abdominal obesity. CONCLUSION Abdominal obesity was significantly correlated with increased MCD and should be considered along with obesity as an aggravating factor for lymphedema severity.
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Affiliation(s)
- Jin A Yoon
- 1 Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital , Busan, Republic of Korea
| | - Yong Beom Shin
- 1 Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital , Busan, Republic of Korea
| | - Myung Jun Shin
- 1 Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital , Busan, Republic of Korea
| | - Ra Yu Yun
- 1 Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital , Busan, Republic of Korea
| | - Keun Young Kim
- 2 Department of Nuclear Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital , Busan, Republic of Korea
| | - You Sun Song
- 3 Department of Radiology, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital , Busan, Republic of Korea
| | - Youngtae Bae
- 4 Department of Surgery, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital , Busan, Republic of Korea
| | - Seokwon Lee
- 4 Department of Surgery, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital , Busan, Republic of Korea
| | - Younglae Jung
- 4 Department of Surgery, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital , Busan, Republic of Korea
| | - Sang Hyun Lee
- 5 Department of Orthopaedic Surgery, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital , Busan, Republic of Korea
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29
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Tsai RJ, Dennis LK, Lynch CF, Snetselaar LG, Zamba GKD, Scott-Conner C. Lymphedema following breast cancer: The importance of surgical methods and obesity. ACTA ACUST UNITED AC 2018; 3. [PMID: 30555923 DOI: 10.15761/fwh.1000144] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Breast cancer-related arm lymphedema is a serious complication that can adversely affect quality of life. Identifying risk factors that contribute to the development of lymphedema is vital for identifying avenues for prevention. The aim of this study was to examine the association between the development of arm lymphedema and both treatment and personal (e.g., obesity) risk factors. Methods Women diagnosed with breast cancer in Iowa during 2004 and followed through 2010, who met eligibility criteria, were asked to complete a short computer assisted telephone interview about chronic conditions, arm activities, demographics, and lymphedema status. Lymphedema was characterized by a reported physician-diagnosis, a difference between arms in the circumference (> 2cm), or the presence of multiple self-reported arm symptoms (at least two of five major arm symptoms, and at least four total arm symptoms). Relative risks (RR) were estimated using logistic regression. Results Arm lymphedema was identified in 102 of 522 participants (19.5%). Participants treated by both axillary dissection and radiation therapy were more likely to have arm lymphedema than treated by either alone. Women with advanced cancer stage, positive nodes, and larger tumors along with a body mass index > 40 were also more likely to develop lymphedema. Arm activity level was not associated with lymphedema. Conclusions Surgical methods, cancer characteristics and obesity were found to contribute to the development of arm lymphedema. Vigorous arm activity post-surgery was not found to increase the risk of arm lymphedema.
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Affiliation(s)
- Rebecca J Tsai
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Leslie K Dennis
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA.,Division of Epidemiology and Biostatistics, College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Charles F Lynch
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Linda G Snetselaar
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Gideon K D Zamba
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Carol Scott-Conner
- Department of Surgery, College of Medicine, University of Iowa, Iowa City, IA, USA
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Abstract
Complex decongestive therapy is the mainstay of lymphedema (LE) therapy. It consists of two phases: an intensive volume reduction phase, principally involving low-stretch bandages and manual lymph drainage (MLD), followed by compression garment use to maintain the reduction achieved. Adjunctive treatments include the use of a sequential gradient pump, LE-specific exercises, skin and nail care, as well as risk-reduction precautions. Herein the techniques are described and the evidence for their effectiveness is reviewed.
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Affiliation(s)
- Mark V Schaverien
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Julie A Moeller
- Department of Rehabilitation Services, University of Texas MD Anderson Cancer Center, Katy Regional Care Center, Houston, Texas
| | - Sarah D Cleveland
- Department of Rehabilitation Services, University of Texas MD Anderson Cancer Center, Houston, Texas
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Jeffs E, Ream E, Taylor C, Bick D. Clinical effectiveness of decongestive treatments on excess arm volume and patient-centered outcomes in women with early breast cancer-related arm lymphedema: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2018; 16:453-506. [PMID: 29419623 PMCID: PMC5828398 DOI: 10.11124/jbisrir-2016-003185] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To identify the effect of decongestive lymphedema treatment on excess arm volume or patient-centered outcomes in women presenting within either 12 months or a mean nine months of developing arm lymphedema following breast cancer treatment. INTRODUCTION Lymphedema is a common consequence of breast cancer treatment requiring life-long treatment to reduce symptoms and prevent complications. Currently, evidence to inform the optimal decongestive lymphedema treatment package is lacking. INCLUSION CRITERIA The review included studies on women who received lymphedema treatment within either 12 months or a mean of nine months of developing unilateral breast cancer-related arm lymphedema. The intervention was any decongestive lymphedema treatment delivered with the purpose of reducing arm lymphedema, compared to another form of lymphedema treatment (whether self or practitioner-administered), placebo or no treatment. The clinical outcome was excess arm volume; patient-centered outcomes were health-related quality of life, arm heaviness, arm function, patient-perceived benefit and satisfaction with treatment. Experimental study designs were eligible, including randomized and non-randomized controlled trials, quasi-experimental, prospective and retrospective before and after studies were considered. METHODS A three-step search strategy was utilized to find published and unpublished studies. The search identified studies published from the inception of each database to July 6, 2016. Reference lists were scanned to identify further eligible studies. Studies were critically appraised using appropriate standardized critical appraisal instruments from the Joanna Briggs Institute. Details describing each study and treatment results regarding outcomes of interest were extracted from papers included in the review using appropriate standardized data extraction tools from the Joanna Briggs Institute. Due to heterogeneity in included studies, results for similar outcome measures were not pooled in statistical meta-analysis. A narrative and tabular format was used to synthesize results from identified and included studies. RESULTS Seven studies reporting results for outcomes of interest were critically appraised and included in the review: five randomized controlled trials and two descriptive (uncontrolled) studies. Reported outcomes included excess arm volume (five studies), health-related quality of life (three studies), arm heaviness (one study), arm function (two studies) and patient-perceived benefit (two studies). There was some evidence that decongestive treatments were effective for women presenting within either 12 months or a mean of nine months of developing breast cancer-related arm lymphedema, but the wide range of data prevented comparison of treatment findings which limited our ability to answer the review questions. CONCLUSIONS Weak evidence (grade B) for the impact of decongestive lymphedema treatment on women with early lymphedema (i.e. less than 12 months duration of BCRL symptoms) did not allow any conclusions to be drawn about the most effective treatment to be offered when these women first present for treatment. Findings provided no justification to support change to current practice.Future primary research needs to focus on the most effective treatment for women when they first present with lymphedema symptoms, e.g. treatment provided within 12 months of developing symptoms. Studies should be adequately powered and recruit women exclusively with less than 12 months duration of breast cancer-related lymphedema symptoms, provide longer follow-up to monitor treatment effect over time, with comparable treatment protocols, outcome measures and reporting methods.
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Affiliation(s)
- Eunice Jeffs
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, United Kingdom
- The Nottingham Centre for Evidence Based Healthcare: a Joanna Briggs Institute Centre of Excellence
| | - Emma Ream
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Cath Taylor
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, United Kingdom
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Debra Bick
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
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Dönmez AA, Kapucu S. The effectiveness of a clinical and home-based physical activity program and simple lymphatic drainage in the prevention of breast cancer-related lymphedema: A prospective randomized controlled study. Eur J Oncol Nurs 2017; 31:12-21. [DOI: 10.1016/j.ejon.2017.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/21/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
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Winkels RM, Sturgeon KM, Kallan MJ, Dean LT, Zhang Z, Evangelisti M, Brown JC, Sarwer DB, Troxel AB, Denlinger C, Laudermilk M, Fornash A, DeMichele A, Chodosh LA, Schmitz KH. The women in steady exercise research (WISER) survivor trial: The innovative transdisciplinary design of a randomized controlled trial of exercise and weight-loss interventions among breast cancer survivors with lymphedema. Contemp Clin Trials 2017; 61:63-72. [PMID: 28739540 PMCID: PMC5817634 DOI: 10.1016/j.cct.2017.07.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/05/2017] [Accepted: 07/20/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Breast cancer survivors face dual challenges: long term sequelae of treatment, and risk of recurrent disease. Obesity and a sedentary lifestyle complicate both challenges. The WISER Survivor trial assessed the effects of exercise and/or weight-loss on lymphedema, biomarkers of breast cancer recurrence, and quality of life. We report on the innovative transdisciplinary design of this trial and report attrition rates. METHODS This one year trial randomized breast cancer survivors who had a BMI of ≥25kg/m2, were sedentary and had breast-cancer-related-lymphedema to 1) exercise (weight training and aerobic exercise) 2) weight-loss 3) exercise and weight-loss 4) or control group. Innovative aspects included: adaptation of a community-based weight training program to a largely home-based program; use of a commercial meal replacement system as part of the lifestyle modification weight-loss program; inclusion of measures of cost-effectiveness to enable economic evaluations; and alignment with a parallel mouse model for breast cancer recurrence to enable transdisciplinary research. In this model, mice bearing dormant residual tumor cells, which spontaneously relapse, were placed on a high-fat diet. Overweight animals were randomly assigned to exercise, calorie restriction, both, or control group and followed for cancer recurrence. The animal model will guide mechanistic biomarkers to be tested in the human trial. RESULTS & DISCUSSION 351 participants were randomized; 13 experienced breast cancer recurrence during the trial. Of the 338 participants without recurrence, 83% completed the trial. The WISER Survivor trial will show the effects of exercise and weight-loss on lymphedema outcomes, biomarkers of recurrence and quality of life. NCT ClinicalTrials.gov registration #: NCT01515124.
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Affiliation(s)
- Renate M Winkels
- Department of Public Health Sciences, Pennsylvania State University, Hershey, PA, United States
| | - Kathleen M Sturgeon
- Department of Public Health Sciences, Pennsylvania State University, Hershey, PA, United States
| | - Michael J Kallan
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, United States
| | - Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Zi Zhang
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, United States
| | - Margaret Evangelisti
- Center for Human Phenomic Science, University of Pennsylvania, Philadelphia, PA, United States
| | - Justin C Brown
- Division of Population Sciences, Dana Farber Cancer Institute, Boston, MA, United States
| | - David B Sarwer
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, United States
| | - Andrea B Troxel
- Department of Population Health, New York University School of Medicine, New York City, NY, United States
| | - Crystal Denlinger
- Department of Hematology/Oncology, Fox Chase Cancer Centre, Philadelphia, PA, United States
| | | | - Anna Fornash
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, United States
| | - Angela DeMichele
- Division of Hematology/Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Lewis A Chodosh
- Department of Cancer Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Kathryn H Schmitz
- Department of Public Health Sciences, Pennsylvania State University, Hershey, PA, United States.
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Gousopoulos E, Karaman S, Proulx ST, Leu K, Buschle D, Detmar M. High-Fat Diet in the Absence of Obesity Does Not Aggravate Surgically Induced Lymphoedema in Mice. Eur Surg Res 2017; 58:180-192. [PMID: 28301852 DOI: 10.1159/000461579] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/09/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lymphoedema represents the cardinal manifestation of lymphatic dysfunction and is associated with expansion of the adipose tissue in the affected limb. In mice, high-fat diet (HFD)-induced obesity was associated with impaired collecting lymphatic vessel function, and adiposity aggravated surgery-induced lymphoedema in a mouse model. The aim of the current study was to investigate whether adiposity is necessary to impair lymphatic function or whether increased lipid exposure alone might be sufficient in a surgical lymphoedema model. METHODS To investigate the role of increased lipid exposure in lymphoedema development we used a well-established mouse tail lymphoedema model. Female mice were subjected to a short-term (6 weeks) HFD, without development of obesity, before surgical induction of lymphedema. Lymphoedema was followed over a period of 6 weeks measuring oedema, evaluating tissue histology and lymphatic vascular function. RESULTS HFD increased baseline angiogenesis and average lymphatic vessel size in comparison to the chow control group. Upon induction of lymphedema, HFD-treated mice did not exhibit aggravated oedema and no morphological differences were observed in the blood and lymphatic vasculature. Importantly, the levels of fibro-adipose tissue deposition were comparable between the 2 groups and lymphatic vessel function was not impaired as a result of the HFD. Although the net immune cell infiltration was comparable, the HFD group displayed an increased infiltration of macrophages, which exhibited an M2 polarization phenotype. CONCLUSIONS These results indicate that increased adiposity rather than dietary influences determines predisposition to or severity of lymphedema.
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Affiliation(s)
- Epameinondas Gousopoulos
- Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology, ETH Zurich, Zurich, Switzerland
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Chung BY, Oh EH. The Effect of Diet Intervention in Breast Cancer: A Meta-analysis. ASIAN ONCOLOGY NURSING 2017. [DOI: 10.5388/aon.2017.17.1.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Bok Yae Chung
- College of Nursing, Research Institute of Nursing Science, Kyungpook National University, Daegu, Korea
| | - Eun Hee Oh
- Department of Nursing, Kyungpook National University Hospital, Daegu, Korea
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Chlebowski RT, Reeves MM. Weight Loss Randomized Intervention Trials in Female Cancer Survivors. J Clin Oncol 2016; 34:4238-4248. [PMID: 27903147 DOI: 10.1200/jco.2016.69.4026] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose Observational study evidence has associated overweight/obesity with decreased survival in women with breast cancer and with several other cancers. Although full-scale, definitive weight loss adjuvant intervention trials with cancer end points remain to be conducted, a number of randomized controlled trials have evaluated weight loss interventions in survivors of cancer in women. Findings from these trials in breast, endometrial, and ovarian cancer are reviewed. Methods A systematic review of randomized controlled clinical trials evaluating weight loss interventions was updated (for studies published 2013 to 2016), and clinical trials registers were searched for ongoing trials. Results Six new randomized trials in breast cancer survivors and two randomized trials in endometrial cancer survivors were identified. Evidence from these trials and the 10 earlier randomized trials in female cancer survivors provide support for the feasibility of recruiting women closer to the cancer diagnosis and efficacy for achieving weight loss, in particular with telephone-based interventions, and have identified the challenge of achieving significant weight loss in African American cancer survivors and of maintaining weight loss in any cancer survivor group. Seven ongoing randomized trials are evaluating the influence of weight loss interventions on cancer end points (five in breast cancer, one in ovarian cancer, and one in endometrial cancer). Conclusion After a decade of preliminary studies, ongoing randomized, controlled clinical trials will potentially provide definitive assessment of whether weight loss can improve breast cancer clinical outcome. Longer-term interventions (> 2 years' duration) may be needed to optimize weight loss maintenance and any potential benefits on cancer end points.
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Affiliation(s)
- Rowan T Chlebowski
- Rowan T. Chlebowski, Harbor-University of California, Los Angeles Medical Center, Torrance, CA; and Marina M. Reeves, The University of Queensland, Brisbane, Queensland, Australia
| | - Marina M Reeves
- Rowan T. Chlebowski, Harbor-University of California, Los Angeles Medical Center, Torrance, CA; and Marina M. Reeves, The University of Queensland, Brisbane, Queensland, Australia
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Ochoa D, Korourian S, Boneti C, Adkins L, Badgwell B, Klimberg VS. Axillary reverse mapping: five-year experience. Surgery 2014; 156:1261-8. [PMID: 25444319 PMCID: PMC4354953 DOI: 10.1016/j.surg.2014.05.011] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 05/12/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND We hypothesize that mapping the lymphatic drainage of the arm with blue dye (axillary reverse mapping, ARM) during axillary lymphadenectomy decreases the likelihood of disruption of lymphatics and subsequent lymphedema. METHODS This institutional review board-approved study from May 2006 to October 2011 involved 360 patients undergoing SLNB and/or ALND. Technetium sulfur colloid (4 mL) was injected subareolarly and 5 mL of blue dye was injected subcutaneously in the volar surface ipsilateral upper extremity (ARM). Data were collected on variations in lymphatic drainage, successful identification and protection of arm lymphatics, crossover, and occurrence of lymphedema. RESULTS A group of 360 patients underwent SLNB and/or ALND. A total of 348 patients underwent a SLNB. Of those, 237/348(68.1%) had a SLNB only and 111/348(31.9%) went on to an ALND due to a positive axilla. An additional 12/360(3.3%) axilla had ALND due to a clinically positive axilla/preoperative core needle biopsy. In 96%(334/348) of patients with SLNB, breast SLNs were hot but not blue; crossover (SLN hot and blue) was seen in 14/348(4%). Blue lymphatics were identified in 80/237(33.7%) of SLN incisions and in 93/123(75.4%) ALND. Average follow-up was 12 months (range 3 to 48 months) and resulted in a SLNB lymphedema rate of 1.7%(4/237) and ALND of 2.4%(3/123). CONCLUSIONS ARM identified significant lymphatic variations draining the upper extremities and facilitated preservation. Metastases in ARM-identified lymph nodes were acceptably low indicating that ARM is safe. ARM added to present-day ALND and SLNB may be useful to lower lymphedema rates.
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Affiliation(s)
- Daniela Ochoa
- Department of Surgery, University of Arkansas for Medical Sciences and the Winthrop P. Rockefeller Institute, Little Rock, AR
| | - Soheila Korourian
- Department of Pathology, University of Arkansas for Medical Sciences and the Winthrop P. Rockefeller Institute, Little Rock, AR
| | - Cristiano Boneti
- Department of Surgery, University of Arkansas for Medical Sciences and the Winthrop P. Rockefeller Institute, Little Rock, AR
| | - Laura Adkins
- Department of Surgery, University of Arkansas for Medical Sciences and the Winthrop P. Rockefeller Institute, Little Rock, AR
| | - Brian Badgwell
- Department of Surgical Oncology, MD Anderson Cancer Center
| | - V Suzanne Klimberg
- Department of Surgery, University of Arkansas for Medical Sciences and the Winthrop P. Rockefeller Institute, Little Rock, AR; Department of Pathology, University of Arkansas for Medical Sciences and the Winthrop P. Rockefeller Institute, Little Rock, AR.
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Reeves MM, Terranova CO, Eakin EG, Demark-Wahnefried W. Weight loss intervention trials in women with breast cancer: a systematic review. Obes Rev 2014; 15:749-68. [PMID: 24891269 DOI: 10.1111/obr.12190] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 04/15/2014] [Accepted: 04/16/2014] [Indexed: 11/29/2022]
Abstract
Obesity has been associated with poor health outcomes in breast cancer survivors. Thus, weight loss is recommended for overweight and obese survivors. We systematically reviewed studies (published up to July 2013) that evaluated behaviourally based, weight loss interventions in women with breast cancer exclusively. Completed randomized trials, single-arm trials and ongoing trials were reviewed. Within-group and between-group differences for weight loss were extracted, as was data on secondary outcomes, i.e. clinical biomarkers, patient-reported outcomes, adverse events. Ten completed randomized trials, four single-arm trials and five ongoing trials were identified. Statistically significant within-group weight loss was observed over periods of 2 to 18 months in 13 of the 14 trials, with six randomized and two single-arm trials observing mean weight loss ≥5%. Clinical biomarkers, psychosocial and patient-reported outcomes were measured in a small number of studies. No serious adverse events were reported. Only two trials assessed maintenance of intervention effects after the end-of-intervention and none reported on cost-effectiveness. The studies included in this review suggest that weight loss is feasible to achieve and is safe in women following treatment for breast cancer. Future studies should assess (and be powered for) a range of biomarker and patient-reported outcomes, and be designed to inform translation into practice.
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Affiliation(s)
- M M Reeves
- School of Population Health, The University of Queensland, Brisbane, Queensland, Australia
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Lim MC, Lee JS, Joo J, Park K, Yoo HJ, Seo SS, Kang S, Chung SH, Park SY. Development and evaluation of the Korean version of the Gynecologic Cancer Lymphedema Questionnaire in gynecologic cancer survivors. Gynecol Oncol 2014; 133:111-6. [PMID: 24522267 DOI: 10.1016/j.ygyno.2014.01.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 01/15/2014] [Accepted: 01/20/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was two-fold: first, to develop a Korean version of the Gynecologic Cancer Lymphedema Questionnaire (GCLQ-K) and evaluate its reliability and reproducibility and second, to examine the diagnostic efficacy of GCLQ-K in predicting lymphedema in gynecologic cancer survivors. METHODS We designed a case-control study, and the GCLQ-K was completed by 33 gynecologic cancer survivors with lymphedema and 34 gynecologic cancer survivors without lymphedema. A follow-up GCLQ-K was completed 3weeks after the baseline questionnaire. RESULTS The GCLQ-K showed high reliability with a Cronbach's α of 0.83 and high reproducibility with an intraclass correlation of 0.96. Of the 7 symptom clusters, 6 identified patients with lymphedema with statistical significance; identification of lymphedema using the physical functioning and infection-related symptom clusters did not reach significance. The area under the receiver operating characteristic curve (AUC) to distinguish patients with and without lymphedema was 0.868 (95% confidence interval [CI], 0.779-0.956). Following the exclusion of the physical functioning and infection-related symptom clusters, which showed poor prediction value for lymphedema, the AUC of the GCLQ-K total score further improved to 0.922 (95% CI, 0.864-0.981). CONCLUSION The GCLQ-K was successfully developed with minimal modifications to adapt the original GCLQ to the Korean culture and showed high internal consistency and reproducibility. Moreover, gynecologic cancer survivors with and without lymphedema could be satisfactorily distinguished using the GCLQ-K. Thus, GCLQ-K was proven to be a reliable tool, capable of identifying lymphedema in Korean gynecological cancer survivors.
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Affiliation(s)
- Myong Cheol Lim
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea; Gynecologic Cancer Branch, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea.
| | - Jeong Seon Lee
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea
| | - Jungnam Joo
- Biometric Research Branch, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea.
| | - Kibyung Park
- Biometric Research Branch, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea
| | - Heon Jong Yoo
- Department of Obstetrics & Gynecology, Chungnam National University Hospital, 33, Munhwa-ro, Jung-gu, Daejeon 301-721, Republic of Korea
| | - Sang-Soo Seo
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea
| | - Sokbom Kang
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea; Gynecologic Cancer Branch, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea
| | - Seung Hyun Chung
- Rehabilitation Medicine, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea
| | - Sang-Yoon Park
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea; Gynecologic Cancer Branch, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea.
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Playdon M, Thomas G, Sanft T, Harrigan M, Ligibel J, Irwin M. Weight Loss Intervention for Breast Cancer Survivors: A Systematic Review. CURRENT BREAST CANCER REPORTS 2013; 5:222-246. [PMID: 26605003 PMCID: PMC4655116 DOI: 10.1007/s12609-013-0113-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To determine the effectiveness of weight loss intervention for breast cancer survivors. From October 2012 until March 2013, Pubmed was searched for weight loss intervention trials that reported body weight or weight loss as a primary outcome. Fifteen of these studies are included in this review. Of the 15 studies included, 14 resulted in statistically significant weight loss and 10 obtained clinically meaningful weight loss of ≥5 % from baseline. Evidence was provided of the feasibility of using several methods of weight loss intervention (telephone, in person, individual, group). Successful intervention used a comprehensive approach, with dietary, physical activity, and behavior modification components. Weight loss improved cardiovascular risk factors and markers of glucose homeostasis. However, there is insufficient evidence to identify the components of this intervention that led to successful weight loss, or to determine the weight loss necessary to affect biomarkers linked to breast cancer prognosis. The small number of randomized controlled trials shared several limitations, including small study sample sizes and lack of follow-up beyond 6 months. Intervention with longer follow-up revealed weight regain, showing the importance of considering strategies to promote long-term weight maintenance. Weight loss intervention for breast cancer survivors can lead to statistically significant and clinically meaningful weight loss, but the limited number of interventional studies, small sample sizes, and short duration of follow-up in many studies limit our ability to draw conclusions regarding the most efficacious weight-loss intervention after a breast cancer diagnosis. The findings to date are encouraging, but research on the effect of weight loss on breast cancer recurrence and mortality, and on prevention of weight gain for women newly diagnosed with breast cancer, is needed.
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Affiliation(s)
- Mary Playdon
- Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA
| | - Gwendolyn Thomas
- Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA
| | - Tara Sanft
- Yale School of Medicine, New Haven, CT, USA
| | - Maura Harrigan
- Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA
| | | | - Melinda Irwin
- Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA
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Alfano CM, Molfino A, Muscaritoli M. Interventions to promote energy balance and cancer survivorship: priorities for research and care. Cancer 2013; 119 Suppl 11:2143-50. [PMID: 23695926 PMCID: PMC3671486 DOI: 10.1002/cncr.28062] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 11/29/2012] [Accepted: 11/30/2012] [Indexed: 12/13/2022]
Abstract
The growing population of cancer survivors worldwide and the growing epidemics of obesity and physical inactivity have brought increased attention to the role that interventions to promote exercise and a healthy body weight may play in mitigating the chronic and late effects of cancer. In this light, the authors describe the similarities and differences in research and clinical priorities related to energy balance interventions among post-treatment cancer survivors in Europe versus North America. Randomized controlled trials that targeted nutrition, exercise, and weight are reviewed to determine the affect on survivorship outcomes. Interventions focused on improving prognosis or survival are investigated along with the emerging literature on the interventions targeting pathways and mechanisms of prognosis or survival. Current North American and European guidelines for diet, exercise, and weight control among cancer survivors also are investigated along with the implications of the current state of this science for clinical care. Finally, the authors delineate future European and American priorities for research and care involving energy balance among survivors. It is hoped that this dialogue launches an international conversation that will lead to better research and care for all post-treatment cancer survivors.
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Affiliation(s)
- Catherine M Alfano
- Office of Cancer Survivorship, National Cancer Institute/National Institutes of Health, Bethesda, Maryland, USA
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Abstract
Lifestyle factors have been linked to the risk of developing many common malignancies and, increasingly, to prognosis. Observational evidence has shown a relationship between so-called energy balance factors (ie, diet, physical activity, and body weight) and risk of cancer recurrence and mortality in cancers of the breast, prostate, colon and, perhaps, other cancers. Interventional work has shown that individuals who make favorable changes in these lifestyle factors after cancer diagnosis feel better, experience less fatigue, and may possibly even decrease risk of cancer recurrence. Other lifestyle behaviors, such as smoking and alcohol consumption, have also been linked to the development of common cancers and may have important health consequences for cancer survivors. This article reviews the evidence that links lifestyle factors to cancer outcomes, provides clinical recommendations for cancer survivors, and describes future directions for lifestyle research in cancer survivors.
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Chlebowski RT. Clinical Perspective: Influence of Modifiable Lifestyle Factors, Body Weight, Physical Activity, and Alcohol on Breast Cancer Outcome. CURRENT BREAST CANCER REPORTS 2012. [DOI: 10.1007/s12609-012-0084-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hayes SC, Johansson K, Stout NL, Prosnitz R, Armer JM, Gabram S, Schmitz KH. Upper-body morbidity after breast cancer. Cancer 2012; 118:2237-49. [DOI: 10.1002/cncr.27467] [Citation(s) in RCA: 233] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Campbell KL, Van Patten CL, Neil SE, Kirkham AA, Gotay CC, Gelmon KA, McKenzie DC. Feasibility of a lifestyle intervention on body weight and serum biomarkers in breast cancer survivors with overweight and obesity. J Acad Nutr Diet 2012; 112:559-67. [PMID: 22709706 DOI: 10.1016/j.jada.2011.10.022] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 10/26/2011] [Indexed: 12/15/2022]
Abstract
Physical inactivity and being overweight or obese are lifestyle factors that put breast cancer survivors at a higher risk for a cancer recurrence and/or development of other chronic diseases. Despite this, there is limited research that has identified effective lifestyle interventions aimed specifically at weight loss in breast cancer survivors. This pilot study is a single-arm experimental pre-post test design, conducted from November 2009 to July 2010, that tested the efficacy of a 24-week group-based lifestyle intervention modeled on the Diabetes Prevention Program in early stage breast cancer survivors (N=14). The intervention included 16 diet sessions led by a registered dietitian and 150 min/wk of moderate-to-vigorous exercise. Study outcome measures were completed at baseline, 24, and 36 weeks (nonintervention follow-up). The primary outcome was change in body weight, and secondary outcomes were change in body composition, aerobic fitness, dietary intake, and blood biomarkers. Overall, participants were postmenopausal women aged 54.6±8.3 years with obesity (body mass index 30.1±3.6), and had completed adjuvant cancer treatment 2 years prior. Results showed an average weight loss of 3.8±5.0 kg and a decrease in body mass index, percent body fat, and waist and hip circumferences at 24 weeks and an additional mean weight loss of 0.8±1.2 kg at 36 weeks. In exploratory analysis, participants who lost >7% body weight were older and attended a greater percentage of diet and supervised exercise sessions. There were no significant changes in any of the blood biomarkers at 24 and 36 weeks; however, the results provide a measure of expected effect size for future research studies. This pilot study demonstrated the efficacy of a lifestyle intervention based on the Diabetes Prevention Program in early stage breast cancer survivors and represents an innovative clinical intervention for dietetics practitioners to address the unmet need for programs.
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Affiliation(s)
- Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, 2177Wesbrook Mall, Vancouver, BC, Canada.
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Oremus M, Dayes I, Walker K, Raina P. Systematic review: conservative treatments for secondary lymphedema. BMC Cancer 2012; 12:6. [PMID: 22216837 PMCID: PMC3320521 DOI: 10.1186/1471-2407-12-6] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 01/04/2012] [Indexed: 11/20/2022] Open
Abstract
Background Several conservative (i.e., nonpharmacologic, nonsurgical) treatments exist for secondary lymphedema. The optimal treatment is unknown. We examined the effectiveness of conservative treatments for secondary lymphedema, as well as harms related to these treatments. Methods We searched MEDLINE®, EMBASE®, Cochrane Central Register of Controlled Trials®, AMED, and CINAHL from 1990 to January 19, 2010. We obtained English- and non-English-language randomized controlled trials or observational studies (with comparison groups) that reported primary effectiveness data on conservative treatments for secondary lymphedema. For English-language studies, we extracted data in tabular form and summarized the tables descriptively. For non-English-language studies, we summarized the results descriptively and discussed similarities with the English-language studies. Results Thirty-six English-language and eight non-English-language studies were included in the review. Most of these studies involved upper-limb lymphedema secondary to breast cancer. Despite lymphedema's chronicity, lengths of follow-up in most studies were under 6 months. Many trial reports contained inadequate descriptions of randomization, blinding, and methods to assess harms. Most observational studies did not control for confounding. Many studies showed that active treatments reduced the size of lymphatic limbs, although extensive between-study heterogeneity in areas such as treatment comparisons and protocols, and outcome measures, prevented us from assessing whether any one treatment was superior. This heterogeneity also precluded us from statistically pooling results. Harms were rare (< 1% incidence) and mostly minor (e.g., headache, arm pain). Conclusions The literature contains no evidence to suggest the most effective treatment for secondary lymphedema. Harms are few and unlikely to cause major clinical problems.
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Affiliation(s)
- Mark Oremus
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Leal NFBDS, Dias LAR, Carrara HHA, Ferreira CHJ. Linfedema pós-câncer de mama: comparação de duas técnicas fisioterapêuticas - estudo piloto. FISIOTERAPIA EM MOVIMENTO 2011. [DOI: 10.1590/s0103-51502011000400008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUÇÃO: O câncer de mama apresenta relevantes efeitos físicos e psicológicos. Entre as formas de tratamento, as cirurgias conservadoras, muitas vezes com esvaziamento linfático axilar e seguidas por radioterapia, têm papel preponderante. Uma importante complicação pós-tratamento é o surgimento do linfedema no membro superior homolateral. A principal terapêutica para o linfedema é a fisioterapia complexa descongestiva. A estimulação elétrica vem sendo utilizada na prática clínica para a redução do edema, sendo, por isso, uma nova alternativa para o tratamento do linfedema a ser pesquisada. OBJETIVO: Realizar um estudo piloto para comparar os efeitos da fisioterapia complexa descongestiva com um protocolo que inclui estimulação elétrica, exercícios terapêuticos e uso da braçadeira elástica na redução do linfedema secundário com o esvaziamento linfático axilar. MATERIAIS E MÉTODOS: Doze voluntárias foram divididas aleatoriamente em dois grupos e submetidas a diferentes protocolos terapêuticos (FCD e EAV). A redução do linfedema foi avaliada por meio da perimetria e da volumetria de ambos os membros superiores. As intervenções foram realizadas duas vezes por semana por um período de sete semanas. RESULTADOS: Não se observou diferença na redução do linfedema entre os protocolos utilizados. CONCLUSÃO: Com uma amostra pequena de pacientes, não se observaram diferenças entre as técnicas na redução do linfedema quando aplicadas na fase de manutenção. Fatores como tempo de instalação do linfedema, grau de esvaziamento axilar, radicalidade da cirurgia e aplicação de radioterapia na região afetada contribuem para o estágio do linfedema e sucesso de seu tratamento.
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Lymphedema: a therapeutic approach in the treatment and rehabilitation of cancer patients. Am J Phys Med Rehabil 2011; 90:S69-75. [PMID: 21765266 DOI: 10.1097/phm.0b013e31820be160] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Lymphedema therapy has gone by many names in the recent past, being referred to as complex decongestive therapy, complex physical therapy, or decongestive lymphatic therapy, among others. There are two phases of lymphedema treatment: the acute "intensive" phase and the maintenance phase. In the acute phase of treatment, the individual is typically wrapped with medical short-stretch compression bandages; receives a therapeutic exercise routine, skin care, and education; and undergoes manual lymphatic drainage by a specially trained physical therapist or healthcare professional. In the maintenance phase, the goals are for the individual to be able to wear a well-fitted appropriate gradient pressure garment during the day and compression bandaging (or a device that serves as an alternative to bandaging) at night, to maintain good skin care, to continue with therapeutic exercise, and to self-perform manual lymphatic drainage (or use a mechanical device that can perform manual lymphatic drainage) for the area of the body with impaired lymphatics. The effectiveness of the various components in each phase, as well as the motivation and compliance of the patient, differs. Further randomized trials are required to determine which component or combination of components in complex decongestive therapy works most effectively. It is recommended for patients not only to maintain physical activity for its many health benefits but also to facilitate muscle pumping to move lymphatic fluid throughout the body. Knowledge of some of the pathophysiologic mechanisms involved in the development of lymphedema is increasing, and it is possible that current modes of treatment of lymphedema will be augmented by molecular therapies in the future.
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