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Redondo-Sáenz D, Solano-López AL, Vílchez-Barboza V. Body image, illness uncertainty and symptom clusters in surgically treated breast cancer survivors: An exploratory factor analysis and correlational study. Eur J Oncol Nurs 2024; 72:102662. [PMID: 39053380 DOI: 10.1016/j.ejon.2024.102662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 06/19/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE To determine the relationship among body image, illness uncertainty, and symptom clusters in surgically treated breast cancer survivors. METHODS A correlational, descriptive study was conducted in a convenience sample of 60 women surgically treated breast cancer survivors recruited in a private hospital and a survivor center. A questionnaire of sociodemographic characteristics, MUIS-C Scale, and QLQ-C30 and Module BR-23 were used. Variable characteristics and associations were analyzed with descriptive statistics and Pearson correlation coefficient, and exploratory factor analysis using unweighted least squares and Promax rotation was used for symptom clustering. RESULTS A three-factor structure was found: an anxiety symptom cluster, a breast symptom cluster, and an arm symptoms, depression, and fatigue symptom cluster, explaining 46,47% of the variance. Significant correlations were found among body image and illness uncertainty (r = -0,390, p < 0,01), body image and the anxiety symptom cluster (r = 0,613, p < 0,01), illness uncertainty and the anxiety symptom cluster (r = -0,421, p < 0,01), the breast symptom cluster (r = -0,425, p < 0,01), and the arm symptoms - depression - fatigue symptom cluster (r = -0,443, p < 0,01). CONCLUSION The relationships among all variables were statistically significant. Nurses providing care to BC survivors need to address the multidimensionality of the symptom experience and its correlates to better assist their patients. Further research is needed to elucidate the biopsychosocial underpinnings of those relationships.
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Affiliation(s)
- Diego Redondo-Sáenz
- School of Nursing, University of Costa Rica, Costa Rica; School of Medicine, University of Costa Rica, Costa Rica.
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Du X, Huang X, Feng X, Shui Y, Zhang A, Li J, Qiu C, Wang G. The effects of the-optimal-lymph-flow health IT system application on treatment-related high risk lymphedema in breast cancer patients: a randomized controlled trial. Breast Cancer Res Treat 2024:10.1007/s10549-024-07468-7. [PMID: 39177930 DOI: 10.1007/s10549-024-07468-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 08/13/2024] [Indexed: 08/24/2024]
Abstract
PURPOSE To evaluate the application effects of The-Optimal-Lymph-Flow IT System in Chinese patients at high risk of developing breast cancer-related lymphedema. METHODS A total of 104 breast cancer patients were randomly assigned to either the control group or the intervention group. The intervention group was provided with the The-Optimal-Lymph-Flow program, while the control group received the usual care. Trial outcomes including symptom experience, quality of life, and limb volume were evaluated at baseline, and at end of the 1- and 3-month trials. RESULTS After controlling for covariates, the incidence of eight symptoms was significantly higher in the control group than in the intervention group. There were significant differences in the changes in the severity of symptoms and arm volume between the two groups from baseline to 3 months after the intervention. CONCLUSIONS The application of TOLF in patients at high risk of developing lymphedema following breast cancer treatment significantly improved the lymphedema-related symptoms experienced in the early stage after surgery. Trial registration ChiCTR1800016713.
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Affiliation(s)
- Xinwen Du
- Department of Hematology, Department of Operating Room, Department of Neurosurgery, Cancer Center, Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Xuan Huang
- Department of Hematology, Department of Operating Room, Department of Neurosurgery, Cancer Center, Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Xianqiong Feng
- Department of Hematology, Department of Operating Room, Department of Neurosurgery, Cancer Center, Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu, 610041, China.
| | - Yuping Shui
- Department of Hematology, Department of Operating Room, Department of Neurosurgery, Cancer Center, Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Aihua Zhang
- Department of Hematology, Department of Operating Room, Department of Neurosurgery, Cancer Center, Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Jialing Li
- Department of Hematology, Department of Operating Room, Department of Neurosurgery, Cancer Center, Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Chujin Qiu
- Department of Hematology, Department of Operating Room, Department of Neurosurgery, Cancer Center, Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Guan Wang
- Department of Hematology, Department of Operating Room, Department of Neurosurgery, Cancer Center, Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu, 610041, China
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Huang J, Li J, Li Y, Huang L, Li B, Huang F, Lv C, Fang F. Bibliometric analysis of breast cancer-related lymphedema research trends over the last 2 decades. Front Oncol 2024; 14:1360899. [PMID: 38444687 PMCID: PMC10912165 DOI: 10.3389/fonc.2024.1360899] [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: 12/24/2023] [Accepted: 02/05/2024] [Indexed: 03/07/2024] Open
Abstract
Objective As breast cancer cases rise globally, post-mastectomy lymphedema garners increasing scholarly attention. This study aims to conduct a comprehensive bibliometric analysis of Breast Cancer-Related Lymphedema (BCRL) research from 2003 to 2022, identifying trends and providing global research insights for future studies. Method The literature for this analysis was extracted from the Web of Science (WoS) Core Collection, encompassing 1199 publications, including 702 articles and 101 reviews, totaling 803. Using advanced bibliometric tools such as VOSviewer and CiteSpace, quantitative and visual analyses were performed to map collaboration networks, research clusters, and emerging trends. The search strategy included specific terms related to lymphedema, breast cancer, and BCRL, ensuring a comprehensive representation of the research landscape. Results The bibliometric analysis revealed a steady increase in BCRL publications over the studied period, reaching a peak in 2018. The United States emerged as the leading contributor to BCRL literature, with China also demonstrating a significant presence. Collaboration networks were visualized, showcasing the interconnectedness of institutions and researchers globally. Key research hotspots identified include preventive strategies, complex decongestive therapy, and reconstructive interventions. Conclusion In conclusion, this pioneering bibliometric analysis provides a comprehensive overview of BCRL research trends and collaborations globally. The findings contribute valuable insights into the evolution of the field, highlighting areas of focus and emerging research themes. This study serves as a foundational resource for researchers, clinicians, and policymakers, fostering evidence-based practices and interventions for BCRL in the future.
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Affiliation(s)
- Jinghui Huang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, China
| | - Jiamin Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, China
| | - Ying Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, China
| | - Lele Huang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Bai Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, China
| | - Feng Huang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, China
| | - Can Lv
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, China
| | - Fanfu Fang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, China
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Rockson SG, Skoracki R. Effectiveness of a Nonpneumatic Active Compression Device in Older Adults with Breast Cancer-Related Lymphedema: A Subanalysis of a Randomized Crossover Trial. Lymphat Res Biol 2023; 21:581-584. [PMID: 37729078 PMCID: PMC10753982 DOI: 10.1089/lrb.2022.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
Background: A recently completed clinical trial compared a novel nonpneumatic compression device (NPCD) with a traditional advanced pneumatic compression device (APCD) for the treatment of breast cancer-related lymphedema (BCRL); the study revealed that the NPCD produced superior clinical and quality-of-life (QOL) outcomes. In this subanalysis, we sought to examine these results within the subset of trial subjects aged ≥65 years. Methods: A randomized crossover head-to-head trial was conducted to compare the NPCD with a commercially available APCD. Patients were randomly assigned to one or the other device for 28 days of use, followed by a 4-week washout period before a comparable 28-day utilization of the alternate device. Limb edema, adherence to daily device use, and QOL measures were collected at day 0 and 28 of each period. Results: A total of 14 subjects were aged ≥65. During NPCD use, subjects experienced a mean decrease in limb edema of 100.3% (p = 0.0082) as well as improvements in mean overall and subscale scores of the Lymphedema Quality of Life Questionnaire (LYMQOL). By comparison, during APCD use limb edema decreased by a mean of 2.9% (p = 0.8899) with no significant changes in any LYMQOL scores. Mean adherence was significantly higher during NPCD use (96.6%) than during APCD use (58.3%, p < 0.0001). Conclusions: The novel NPCD produced superior clinical and QOL outcomes in older subjects with BCRL. ClinicalTrials.gov ID: NCT04908254.
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Affiliation(s)
- Stanley G. Rockson
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Roman Skoracki
- Department of Plastic Surgery, The Ohio State University Medical Center, Columbus, Ohio, USA
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Ji H, Hu C, Yang X, Liu Y, Ji G, Ge S, Wang X, Wang M. Lymph node metastasis in cancer progression: molecular mechanisms, clinical significance and therapeutic interventions. Signal Transduct Target Ther 2023; 8:367. [PMID: 37752146 PMCID: PMC10522642 DOI: 10.1038/s41392-023-01576-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 07/04/2023] [Accepted: 07/26/2023] [Indexed: 09/28/2023] Open
Abstract
Lymph nodes (LNs) are important hubs for metastatic cell arrest and growth, immune modulation, and secondary dissemination to distant sites through a series of mechanisms, and it has been proved that lymph node metastasis (LNM) is an essential prognostic indicator in many different types of cancer. Therefore, it is important for oncologists to understand the mechanisms of tumor cells to metastasize to LNs, as well as how LNM affects the prognosis and therapy of patients with cancer in order to provide patients with accurate disease assessment and effective treatment strategies. In recent years, with the updates in both basic and clinical studies on LNM and the application of advanced medical technologies, much progress has been made in the understanding of the mechanisms of LNM and the strategies for diagnosis and treatment of LNM. In this review, current knowledge of the anatomical and physiological characteristics of LNs, as well as the molecular mechanisms of LNM, are described. The clinical significance of LNM in different anatomical sites is summarized, including the roles of LNM playing in staging, prognostic prediction, and treatment selection for patients with various types of cancers. And the novel exploration and academic disputes of strategies for recognition, diagnosis, and therapeutic interventions of metastatic LNs are also discussed.
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Affiliation(s)
- Haoran Ji
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Chuang Hu
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Xuhui Yang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yuanhao Liu
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Guangyu Ji
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Shengfang Ge
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xiansong Wang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Mingsong Wang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
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Skjødt Rafn B, Jensen S, Bjerre ED, Wittenkamp MC, Benjaminsen K, Christensen LP, Flyger H, Christiansen P, Johansen C. Prospective surveillance for breast cancer-related lymphedema (PROTECT). Acta Oncol 2023; 62:808-813. [PMID: 37042161 DOI: 10.1080/0284186x.2023.2197125] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/26/2023] [Indexed: 04/13/2023]
Affiliation(s)
- Bolette Skjødt Rafn
- Danish Cancer Society National Cancer Survivorship and Late Effects Research Center (CASTLE), Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Sandra Jensen
- Danish Cancer Society National Cancer Survivorship and Late Effects Research Center (CASTLE), Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Merete Celano Wittenkamp
- Department of Physiotherapy and Occupational Therapy, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | | | - Louise Pia Christensen
- Department of Occupational and Physical Therapy, Zealand University Hospital, Roskilde, Denmark
| | - Henrik Flyger
- Department of Breast Surgery, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Peer Christiansen
- Danish Breast Cancer Group Center and Clinic for Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Christoffer Johansen
- Danish Cancer Society National Cancer Survivorship and Late Effects Research Center (CASTLE), Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Le NK, Liu L, Jesus Cruz R, Parikh J, Rotatori RM, Wainwright DJ, Weinstein B, Tavares T, Panetta NJ. Efficacy of Immediate Lymphatic Reconstruction in Prevention of Breast Cancer-Related Lymphedema. Ann Plast Surg 2023; 90:S363-S365. [PMID: 36913564 DOI: 10.1097/sap.0000000000003457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
INTRODUCTION Breast cancer-related lymphedema (BCRL) is a chronic condition that can negatively affect the quality of life of breast cancer survivors. Immediate lymphatic reconstruction (ILR) at the time of axillary lymph node dissection is emerging as a technique for the prevention of BCRL. This study compared the incidence of BRCL in patients who received ILR and those who were not amenable to ILR. METHODS Patients were identified through a prospectively maintained database between 2016 and 2021. Some patients were deemed nonamenable to ILR due to a lack of visualized lymphatics or anatomic variability (eg, spatial relationships or size discrepancies). Descriptive statistics, independent t test, and Pearson χ 2 test were used. Multivariable logistic regression models were created to assess the association between lymphedema and ILR. A loose age-matched subsample was created for subanalysis. RESULTS Two hundred eighty-one patients were included in this study (252 patients who underwent ILR and 29 patients who did not). The patients had a mean age of 53 ± 12 years and body mass index of 28.6 ± 6.8 kg/m 2 . The incidence of developing lymphedema in patients with ILR was 4.8% compared with 24.1% in patients who underwent attempted ILR without lymphatic reconstruction ( P = 0.001). Patients who did not undergo ILR had significantly higher odds of developing lymphedema compared with those who had ILR (odds ratio, 10.7 [3.2-36.3], P < 0.001; matched OR, 14.2 [2.6-77.9], P < 0.001). CONCLUSIONS Our study showed that ILR was associated with lower rates of BCRL. Further studies are needed to determine which factors place patients at highest risk of developing BCRL.
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Affiliation(s)
- Nicole K Le
- From the Department of Plastic Surgery, Morsani College of Medicine, University of South Florida
| | - Langfeier Liu
- From the Department of Plastic Surgery, Morsani College of Medicine, University of South Florida
| | - Rachel Jesus Cruz
- From the Department of Plastic Surgery, Morsani College of Medicine, University of South Florida
| | - Jeegan Parikh
- College of Public Health, University of South Florida
| | - Robert M Rotatori
- From the Department of Plastic Surgery, Morsani College of Medicine, University of South Florida
| | - D'Arcy J Wainwright
- From the Department of Plastic Surgery, Morsani College of Medicine, University of South Florida
| | - Brielle Weinstein
- From the Department of Plastic Surgery, Morsani College of Medicine, University of South Florida
| | - Tina Tavares
- Department of Women's Oncology, Breast Program, Moffitt Cancer Center, Tampa, FL
| | - Nicholas J Panetta
- From the Department of Plastic Surgery, Morsani College of Medicine, University of South Florida
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Gandhi A, Xu T, DeSnyder SM, Smith GL, Lin R, Barcenas CH, Stauder MC, Hoffman KE, Strom EA, Ferguson S, Smith BD, Woodward WA, Perkins GH, Mitchell MP, Garner D, Goodman CR, Aldrich M, Travis M, Lilly S, Bedrosian I, Shaitelman SF. Prospective, early longitudinal assessment of lymphedema-related quality of life among patients with locally advanced breast cancer: The foundation for building a patient-centered screening program. Breast 2023; 68:205-215. [PMID: 36863241 PMCID: PMC9996356 DOI: 10.1016/j.breast.2023.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/08/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND We examined how breast cancer-related lymphedema (BCRL) affects health-related quality of life (HRQOL), productivity, and compliance with therapeutic interventions to guide structuring BCRL screening programs. METHODS We prospectively followed consecutive breast cancer patients who underwent axillary lymph node dissection (ALND) with arm volume screening and measures assessing patient-reported health-related quality of life (HRQOL) and perceptions of BCRL care. Comparisons by BCRL status were made with Mann-Whitney U, Chi-square, Fisher's exact, or t tests. Trends over time from ALND were assessed with linear mixed-effects models. RESULTS With a median follow-up of 8 months in 247 patients, 46% self-reported ever having BCRL, a proportion that increased over time. About 73% reported fear of BCRL, which was stable over time. Further in time from ALND, patients were more likely to report that BCRL screening reduced fear. Patient-reported BCRL was associated with higher soft tissue sensation intensity, biobehavioral, and resource concerns, absenteeism, and work/activity impairment. Objectively measured BCRL had fewer associations with outcomes. Most patients reported performing prevention exercises, but compliance decreased over time; patient-reported BCRL was not associated with exercise frequency. Fear of BCRL was positively associated with performing prevention exercises and using compressive garments. CONCLUSIONS Both incidence and fear of BCRL were high after ALND for breast cancer. Fear was associated with improved therapeutic compliance, but compliance decreased over time. Patient-reported BCRL was more strongly associated with worse HRQOL and productivity than was objective BCRL. Screening programs must support patients' psychological needs and aim to sustain long-term compliance with recommended interventions.
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Affiliation(s)
- Anusha Gandhi
- Baylor College of Medicine, USA; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Tianlin Xu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, USA
| | - Sarah M DeSnyder
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Grace L Smith
- Department of GI Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Ruitao Lin
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, USA
| | - Carlos H Barcenas
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Michael C Stauder
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Karen E Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Eric A Strom
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Susan Ferguson
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Benjamin D Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Wendy A Woodward
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - George H Perkins
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Melissa P Mitchell
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Desmond Garner
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Chelain R Goodman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Melissa Aldrich
- Center for Molecular Imaging, UT Health Science Center at Houston, USA
| | - Marigold Travis
- Department of Rehabilitative Therapy, The University of Texas MD Anderson Cancer Center, USA
| | - Susan Lilly
- Department of Rehabilitative Therapy, The University of Texas MD Anderson Cancer Center, USA
| | - Isabelle Bedrosian
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, USA
| | - Simona F Shaitelman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA.
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Guliyeva G, Huayllani MT, Boczar D, Avila FR, Lu X, Forte AJ. Age as a risk factor for breast cancer-related lymphedema: a systematic review. J Cancer Surviv 2023; 17:246-253. [PMID: 33486706 DOI: 10.1007/s11764-021-00994-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/15/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Breast cancer-related lymphedema (BCRL) has been widely reported in the medical literature. Various patient characteristics, including age, have been investigated as possible risk factors for this disease entity, but the existence and direction of the cause-and-effect relationship are still unclear. In this review, we aimed to evaluate the effect of age on development of BRCL. METHODS PubMed, Scopus, and Ovid MEDLINE were searched for relevant articles, which were found to be published between 1974 and 2020. RESULTS Twenty-six studies involving 19,396 patients were selected. The average age of patients was 54.9. 26 studies were included in the final analysis, and 13 articles reported no association between age and BCRL development. CONCLUSIONS Though studies presented different findings, the majority did not identify age as a risk factor for development of lymphedema. However, the level of evidence of individual studies was low. In this article, we call attention to the need for uniform design of lymphedema studies and diagnosis. IMPLICATIONS FOR CANCER SURVIVORS All patients should be informed and screened regularly for lymphedema during and after the treatment independent of their age.
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Affiliation(s)
- Gunel Guliyeva
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Maria T Huayllani
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Daniel Boczar
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Francisco R Avila
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Xiaona Lu
- Section of Plastic Surgery, Yale University, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Antonio Jorge Forte
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
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Vang AR, Shaitelman SF, Rasmussen JC, Chan W, Sevick-Muraca EM, Aldrich MB. Plasma Cytokines/Chemokines as Predictive Biomarkers for Lymphedema in Breast Cancer Patients. Cancers (Basel) 2023; 15:676. [PMID: 36765631 PMCID: PMC9913278 DOI: 10.3390/cancers15030676] [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: 12/21/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 01/25/2023] Open
Abstract
Breast cancer-related lymphedema (BCRL) occurs in ~ 40% of patients after axillary lymph node dissection (ALND), radiation therapy (RT), or chemotherapy. First-line palliative treatment utilizes compression garments and specialized massage. Reparative microsurgeries have emerged as a second-line treatment, yet both compression and surgical therapy are most effective at early stages of LE development. Identifying patients at the highest risk for BCRL would allow earlier, more effective treatment. Perometric arm volume measurements, near-infrared fluorescent lymphatic imaging (NIRF-LI) data, and blood were collected between 2016 and 2021 for 40 study subjects undergoing treatment for breast cancer. Plasma samples were evaluated using MILLIPLEX human cytokine/chemokine panels at pre-ALND and at 12 months post-RT. A Mann-Whitney t-test showed that G-CSF, GM-CSF, IFN-2α, IL-10, IL-12p40, IL-15, IL-17A, IL-1β, IL-2, IL-3, IL-6, and MIP-1β were significantly higher at pre-ALND in those presenting with BCRL at 12 months post-RT. MIP-1β and IL-6 were significantly higher at pre-ALND in those who developed dermal backflow, but no BCRL, at 12 months post-RT. Plasma IL-15, IL-3, and MIP-1β were elevated at 12 months after RT in those with clinical BCRL. These findings establish BCRL as a perpetual inflammatory disorder, and suggest the use of plasma cytokine/chemokine levels to predict those at highest risk.
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Affiliation(s)
- Anna R. Vang
- UT Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, Houston, TX 77030, USA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA
| | | | - John C. Rasmussen
- UT Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, Houston, TX 77030, USA
| | - Wenyaw Chan
- UT Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, Houston, TX 77030, USA
| | - Eva M. Sevick-Muraca
- UT Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, Houston, TX 77030, USA
| | - Melissa B. Aldrich
- UT Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, Houston, TX 77030, USA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA
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Rockson SG, Whitworth PW, Cooper A, Kania S, Karnofel H, Nguyen M, Shadduck K, Gingerich P, Armer J. Safety and effectiveness of a novel nonpneumatic active compression device for treating breast cancer-related lymphedema: A multicenter randomized, crossover trial (NILE). J Vasc Surg Venous Lymphat Disord 2022; 10:1359-1366.e1. [PMID: 35952956 DOI: 10.1016/j.jvsv.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/06/2022] [Accepted: 06/15/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Advanced pneumatic compression devices (APCDs) have been shown to be an effective intervention for lymphedema when used as part of a self-care maintenance treatment regimen. However, adherence to self-care has been poor, and APCDs require patients to be immobile during treatment. We evaluated the safety and efficacy of a novel nonpneumatic compression device (NPCD) for treating lymphedema vs an APCD. METHODS A randomized, crossover head-to-head investigation was performed at five U.S. sites in 2021. The patients had been randomized to either the NPCD or a commercially available APCD. The patients used the randomly assigned initial device for 28 days with a 4-week washout period before a comparable 28-day use of the second device. RESULTS Data from 50 adult women with unilateral breast cancer-related lymphedema were analyzed. Compared with the APCD, the NPCD was associated with a greater mean reduction in the limb edema volume (64.6% vs 27.7%; P < .001), significantly greater mean improvements in quality of life scores, greater adherence (95.6% vs 49.8%; P < .001), and greater satisfaction with the device (90% vs 14%; P < .001). The patients indicated that use of the NPCD facilitated exercise and was convenient for travel. No adverse events were reported. CONCLUSIONS The results have shown that the novel NPCD is an effective maintenance treatment for reducing the limb volume in patients with breast cancer-related lymphedema. The NPCD device was more effective than an APCD and resulted in greater adherence to self-care interventions and greater patient satisfaction.
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Affiliation(s)
- Stanley G Rockson
- Falk Cardiovascular Research Center, Stanford University, Stanford, CA.
| | | | | | - Sarah Kania
- Good Samaritan Hospital, Mission Oaks Campus, Los Gatos, CA
| | | | | | | | | | - Jane Armer
- Ellis Fischel Cancer Center, University of Missouri, Columbia, MO
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12
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Wei X, Lu Q, Shen A, Fu X, Zhang L, Wang Y, Wang Y. Development and psychometric evaluation of a lymphoedema self-management behaviour questionnaire for breast cancer patients. Eur J Cancer Care (Engl) 2022; 31:e13743. [PMID: 36259244 DOI: 10.1111/ecc.13743] [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: 02/27/2022] [Revised: 09/24/2022] [Accepted: 09/27/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The study was aimed to develop and evaluate a lymphoedema self-management behaviour questionnaire (LSMBQ) for breast cancer patients. METHODS The initial version of the behaviour questionnaire was developed based on the framework of self-management and the evidence summary of lymphoedema self-management. Two rounds of expert consultation were conducted to validate the questionnaire's content validity. A cross-sectional survey was then conducted in breast wards of two hospitals in China to evaluate the reliability and validity of this scale. Exploratory structural equation model was used to test the construct validity. T-test was used to analyse the known group validity. Structural equation model was applied to verify the relationship between self-efficacy, social support, and lymphoedema self-management behaviour to test the convergent validity. Also, the internal consistency reliability and test-retest reliability were evaluated. RESULTS The questionnaire's content validity was satisfactory. There were 22 items included in the LSMBQ for validation and 260 completed the survey. A six-factor structure with good construct validity was identified. The result of t-test verified that patients who knew the risk of lymphoedema and those who received lymphoedema health education had higher scores of lymphoedema self-management behaviours (P < 0.05), indicating that the questionnaire has good known group validity. The fitting results of the structural equation model indicated that the 22-item questionnaire had good convergent validity. Cronbach's alpha coefficients and test-retest reliability for the total questionnaire were 0.910 and 0.875, respectively. CONCLUSIONS The 22-item LSMBQ appears to have adequate reliability and validity to assess the lymphoedema self-management behaviours for breast cancer patients.
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Affiliation(s)
- Xiaoxia Wei
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Qian Lu
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Aomei Shen
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Xin Fu
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Lichuan Zhang
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Yujie Wang
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Yingxin Wang
- Division of General Surgery, Peking University First Hospital, Beijing, China
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13
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Yaghoobi Notash A, Yaghoobi Notash A, Omidi Z, Haghighat S. Prediction of lymphedema occurrence in patients with breast cancer using the optimized combination of ensemble learning algorithm and feature selection. BMC Med Inform Decis Mak 2022; 22:195. [PMID: 35879760 PMCID: PMC9310496 DOI: 10.1186/s12911-022-01937-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer-related lymphedema is one of the most important complications that adversely affect patients' quality of life. Lymphedema can be managed if its risk factors are known and can be modified. This study aimed to select an appropriate model to predict the risk of lymphedema and determine the factors affecting lymphedema. METHOD This study was conducted on data of 970 breast cancer patients with lymphedema referred to a lymphedema clinic. This study was designed in two phases: developing an appropriate model to predict the risk of lymphedema and identifying the risk factors. The first phase included data preprocessing, optimizing feature selection for each base learner by the Genetic algorithm, optimizing the combined ensemble learning method, and estimating fitness function for evaluating an appropriate model. In the second phase, the influential variables were assessed and introduced based on the average number of variables in the output of the proposed algorithm. RESULT Once the sensitivity and accuracy of the algorithms were evaluated and compared, the Support Vector Machine algorithm showed the highest sensitivity and was found to be the superior model for predicting lymphedema. Meanwhile, the combined method had an accuracy coefficient of 91%. The extracted significant features in the proposed model were the number of lymph nodes to the number of removed lymph nodes ratio (68%), feeling of heaviness (67%), limited range of motion in the affected limb (65%), the number of the removed lymph nodes ( 64%), receiving radiotherapy (63%), misalignment of the dominant and the involved limb (62%), presence of fibrotic tissue (62%), type of surgery (62%), tingling sensation (62%), the number of the involved lymph nodes (61%), body mass index (61%), the number of chemotherapy sessions (60%), age (58%), limb injury (53%), chemotherapy regimen (53%), and occupation (50%). CONCLUSION Applying a combination of ensemble learning approach with the selected classification algorithms, feature selection, and optimization by Genetic algorithm, Lymphedema can be predicted with appropriate accuracy. Developing applications by effective variables to determine the risk of lymphedema can help lymphedema clinics choose the proper preventive and therapeutic method.
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Affiliation(s)
- Anaram Yaghoobi Notash
- The Computer Engineering Department, Rasht Branch, Islamic Azad University, Rasht, Iran
- Shariati Hospital, Tehran University of Medical Science (TUMS), Tehran, Iran
| | | | - Zahra Omidi
- Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Shahpar Haghighat
- Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran.
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14
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Huang Z, Wu S. Acceptance of disability, coping style, perceived social support and quality of life among patients with chronic lymphedema: a cross-sectional study. Support Care Cancer 2022; 30:4099-4108. [PMID: 35072790 DOI: 10.1007/s00520-022-06855-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/19/2022] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To examine acceptance of disability, coping style, perceived social support, and quality of life and to explore the relationships between acceptance of disability, coping style, perceived social support, and quality of life among Chinese patients with chronic lymphedema. METHODS Chronic lymphedema patients were recruited from five tertiary hospitals between May and July 2020 in China. Recruited patients were assessed for quality of life (QOL), acceptance of disability (AOD), coping styles, perceived social support (PSS), and sociodemographic and disease-related factors. Multivariate linear regression models were conducted to examine the multivariate effect of AOD, coping style, PSS, and sociodemographic and disease-related factors on QOL. RESULTS A total of 163 chronic lymphedema patients were recruited. The mean score of QOL was 2.23 (SD = 0.68). AOD, number of symptoms, acceptance-resignation, avoidance, degree of pain, PSS, and educational level were found to be significant predictors of QOL. CONCLUSION Chinese patients with chronic lymphedema had moderate levels of QOL. The QOL and specific domains of patients were affected by different factors. Special attention and targeted interventions should be given to improve patients' QOL.
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Affiliation(s)
- Zehao Huang
- The Nethersol School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Horse Material Water, Shatin, New Territories, Hong Kong, Hong Kong SAR, China. .,School of Nursing, Sun Yat-Sen University, Guangzhou, China.
| | - Siyu Wu
- Foshan Hospital of Traditional Chinese Medicine, Foshan, China
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15
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Fu MR, McTernan ML, Qiu JM, Miaskowski C, Conley YP, Ko E, Axelrod D, Guth A, Somers TJ, Wood LJ, Wang Y. Co-occurring Fatigue and Lymphatic Pain Incrementally Aggravate Their Negative Effects on Activities of Daily Living, Emotional Distress, and Overall Health of Breast Cancer Patients. Integr Cancer Ther 2022; 21:15347354221089605. [PMID: 35446180 PMCID: PMC9047803 DOI: 10.1177/15347354221089605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/16/2022] [Accepted: 03/08/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Fatigue and lymphatic pain are the most common and debilitating long-term adverse effects of breast cancer treatment. Fatigue and pain independently have negative effects on quality of life, physical functions, and cancer recurrence-free survival. The interactions between fatigue and pain may aggravate their negative effects. OBJECTIVES Examine the effects of co-occurring fatigue and lymphatic pain on activities of daily living (ADLs), emotional distress, and overall health of breast cancer patients. METHODS A cross-sectional and observational design was used to enroll 354 breast cancer patients. Valid and reliable instruments were used to assess fatigue, lymphatic pain, ADLs, emotional distress, and overall health. Descriptive statistics and multivariable regression models were used for data analysis. RESULTS After controlling for demographic and clinical factors, patients with co-occurring fatigue and lymphatic pain had higher odds of having impaired ADLs (OR = 24.43, CI = [5.44-109.67], P < .001) and emotional distress (OR = 26.52, CI = [9.64-72.90], P < .001) compared to patients with only fatigue and only lymphatic pain. Patients with co-occurring fatigue and lymphatic pain had 179% increase in impaired ADL scores (B = 8.06, CI = [5.54-10.59]) and 211% increase in emotional distress scores (B = 9.17, CI = [5.52-12.83]) compared to those without co-occurring fatigue and lymphatic pain. Patients with co-occurring fatigue and lymphatic pain had a 34% decrease (B = -26.29, CI = [-31.90 to -20.69]) and patients with only fatigue had a 33% decrease in overall health scores (B = -25.74, 95% CI = [-34.14 to -17.33]), indicating poor overall health. CONCLUSIONS Fatigue and lymphatic pain affected 66.4% of breast cancer patients. Findings from this study suggest that co-occurring fatigue and lymphatic pain have negative effects on breast cancer patients' ADLs, emotional distress, and overall health. The synergistic interactions between fatigue and lymphatic pain incrementally aggravated their negative effects on ADLs and emotional distress. Findings of the study highlight the need to evaluate the underlying mechanisms for co-occurring fatigue and lymphatic pain and develop interventions that target both fatigue and lymphatic pain to improve breast cancer patients' the quality of life.
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Affiliation(s)
| | | | | | | | | | - Eunjung Ko
- The Ohio State University, Columbus,
OH, USA
| | | | - Amber Guth
- New York University School of Medicine,
New York, NY, USA
| | | | | | - Yao Wang
- New York University Tandon School of
Engineering, Brooklyn, NY, USA
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16
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Deutscher D, Hayes D, Cook KF, Werneke MW, Tucker CA, Mioduski JE, Levenhagen K, Tidhar D, Pfarr M, Kallen MA. Upper Quadrant Edema Patient-Reported Outcome Measure Is Reliable, Valid, and Efficient for Patients With Lymphatic and Venous Disorders. Phys Ther 2021; 101:pzab219. [PMID: 34636891 DOI: 10.1093/ptj/pzab219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 06/02/2021] [Accepted: 08/01/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The main aims of this study were to (1) create a patient-reported outcome measure (PROM) item bank for measuring the impact of upper quadrant edema (UQE) on physical function by calibrating responses to newly developed items; and (2) assess reliability, validity, and administration efficiency of scores based on computerized adaptive test (CAT) and 10-item short-form (SF) administration modes. METHODS This was a retrospective study including data from patients treated in outpatient rehabilitation clinics for UQE that responded to all 27 candidate items at intake. Item response theory model assumptions of unidimensionality, local item independence, item fit, and presence of differential item functioning were evaluated. UQE-CAT- and UQE-SF-generated scores were assessed for reliability, validity, and administration efficiency. RESULTS The total cohort included 3486 patients (mean [SD] age = 61 [13] years; range = 14-89 years). After removing 2 items, a 25-item solution was supported for its unidimensionality and fit to the item response theory model with reliability estimates of more than 0.93 for scores based on both CAT and SF administration modes. No items demonstrated differential item functioning. Scores discriminated among multiple patient groups in clinically logical ways and were moderately responsive to change with negligible floor and acceptable ceiling effects. CAT scores were generated using an average of 5.6 items (median = 5). CONCLUSION Scores on the UQE PROM were reliable, valid, and efficient for assessing perceived physical function of patients with upper quadrant edema; thus, the measure is suitable for research and routine clinical administration. IMPACT The newly developed UQE PROM is reliable and valid and offers efficient administration modes for assessing perceived physical function of patients with UQE caused by lymphatic and venous disorders, both for research and routine clinical care in busy outpatient rehabilitation settings. As an item response theory-based measure, the UQE PROM allows administration of condition-specific functional questions with low response burden for patients. This study supports a transition to PROMs that are based on modern measurement approaches to achieve high accuracy and efficiency.
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Affiliation(s)
- Daniel Deutscher
- Net Health Systems, Inc, Pittsburgh, Pennsylvania, USA
- Maccabitech Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Deanna Hayes
- Net Health Systems, Inc, Pittsburgh, Pennsylvania, USA
| | | | | | - Carole A Tucker
- Department of Health and Rehabilitation Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
| | | | - Kim Levenhagen
- Program in Physical Therapy, Saint Louis University, Saint Louis, Missouri, USA
| | - Dorit Tidhar
- Physical Therapy Department, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Megan Pfarr
- HSHS Wisconsin & Prevea Health, Green Bay, Wisconsin, USA
| | - Michael A Kallen
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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17
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Wang Y, Ge Y, Xing W, Liu J, Wu J, Lin H, Lu Y. The effectiveness and safety of low-level laser therapy on breast cancer-related lymphedema: An overview and update of systematic reviews. Lasers Med Sci 2021; 37:1389-1413. [PMID: 34779937 PMCID: PMC8971164 DOI: 10.1007/s10103-021-03446-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/15/2021] [Indexed: 12/24/2022]
Abstract
The objective of our overview of systematic reviews was to critically analyze the evidence from existing systematic reviews investigating the effectiveness and safety of low-level laser therapy (LLLT) in patients with breast cancer–related lymphedema (BCRL). In addition, an updated and comprehensive systematic review was conducted, which aimed to provide updated evidence about this topic. PubMed, EMBASE, and Cochrane Library databases were systematically searched for systematic reviews and randomized controlled trials (RCTs) investigating the effectiveness and safety of LLLT in patients with BCRL. The methodological quality for each of included systematic reviews or RCTs was assessed using the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2) tool or Cochrane risk of bias tool, respectively. The updated systematic review separately compared the effectiveness of LLLT to each of active or negative interventions. Data were pooled with random-effects models for each outcome per comparison. The evidence quality of outcomes was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) or GRADE-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) for quantitative studies and qualitative studies, respectively. Seven systematic reviews and ten RCTs met the eligibility criteria. Conflicting results regarding the effectiveness of LLLT were presented by the overview of systematic reviews. The AMSTAR 2 showed that the methodological quality of included systematic reviews was low or critically low quality due to one or more critical weaknesses. The GRADE and GRADE-CERQual showed that the evidence quality was low to very low for most outcomes. The updated systematic review showed that LLLT may offer additional benefits as compared to compression therapies (pneumatic compression or compression bandage), placebo laser, or no treatment for patients with BCRL. However, when compared to other types of active interventions, LLLT did not improve outcomes significantly. None of the treatment-related adverse event was reported. Many trials had a high or unclear risk of bias for two or more items, and our updated systematic review showed low quality of evidence per outcome using GRADE approach. Due to insufficient data and poor quality of evidence, there is uncertain to reach these conclusions that LLLT is superior to another active or negative intervention and is safe. More RCTs of high methodological quality, with large sample sizes and long-term follow-up, are needed to inform clinical guidelines and routine practice.
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Affiliation(s)
- Yuping Wang
- Department of Rehabilitation, The First Hospital of Lanzhou University, No. 1 Donggang West Road, Chengguan District, Lanzhou, 730000, People's Republic of China
| | - Yonggui Ge
- Department of Rehabilitation, The First Hospital of Lanzhou University, No. 1 Donggang West Road, Chengguan District, Lanzhou, 730000, People's Republic of China
| | - Wenting Xing
- Department of Rehabilitation, The First Hospital of Lanzhou University, No. 1 Donggang West Road, Chengguan District, Lanzhou, 730000, People's Republic of China
| | - Junping Liu
- Department of Rehabilitation, The First Hospital of Lanzhou University, No. 1 Donggang West Road, Chengguan District, Lanzhou, 730000, People's Republic of China
| | - Jiqi Wu
- Department of Rehabilitation, The First Hospital of Lanzhou University, No. 1 Donggang West Road, Chengguan District, Lanzhou, 730000, People's Republic of China
| | - Haijuan Lin
- Department of Rehabilitation, The First Hospital of Lanzhou University, No. 1 Donggang West Road, Chengguan District, Lanzhou, 730000, People's Republic of China
| | - Yaqin Lu
- Department of Rehabilitation, The First Hospital of Lanzhou University, No. 1 Donggang West Road, Chengguan District, Lanzhou, 730000, People's Republic of China.
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18
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Anbari AB, Wanchai A, Armer JM. Breast cancer-related lymphedema and quality of life: A qualitative analysis over years of survivorship. Chronic Illn 2021; 17:257-268. [PMID: 31483692 DOI: 10.1177/1742395319872796] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The study purpose was to examine perspectives of women with newly diagnosed breast cancer-related lymphedema (BCRL) regarding their quality of life over seven years. METHOD Data were collected over seven years using the Lymphedema and Breast Cancer Questionnaire (LBCQ). Participants with BCRL answered open-ended questions corresponding to changes in mood and lifestyle from post-op through annual interviews and surveys. Self-reported data from 97 participants with BCRL were analyzed using in vivo coding and template-style content analysis to elicit the impact of BCRL on quality of life domains. RESULTS Data saturation was achieved as participants neared 30 to 36 months post- breast cancer diagnosis. Three major themes were identified related to BCRL's impact on: physical function; daily living and social function; and psychological function. DISCUSSION Findings suggest that BCRL impacts quality of life not only soon after diagnosis, but also throughout survivorship years. Healthcare providers should develop programs to enhance quality of life for survivors with BCRL.
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Affiliation(s)
- Allison B Anbari
- Sinclair School of Nursing University of Missouri, Columbia, MO, USA
| | - Ausanee Wanchai
- Boromarajonani College of Nursing, Buddhachinaraj, Phitsanulok, Thailand
| | - Jane M Armer
- Sinclair School of Nursing University of Missouri, Columbia, MO, USA
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19
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Rockson SG, Karaca-Mandic P, Skoracki R, Hock K, Nguyen M, Shadduck K, Gingerich P, Campione E, Leifer A, Armer J. Clinical Evaluation of a Novel Wearable Compression Technology in the Treatment of Lymphedema, an Open-Label Controlled Study. Lymphat Res Biol 2021; 20:125-132. [PMID: 34227842 PMCID: PMC9081034 DOI: 10.1089/lrb.2020.0126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
A diagnosis of lymphedema comes with a lifetime requirement for careful self-care and treatment to control skin deterioration and the consequences of excessive fluid and protein buildup leading to abnormal limb volume and an increased risk of infection. The burden of care and psychosocial aspects of physical disfiguration and loss of function are associated with compromised quality of life (QoL). The current standard therapeutic intervention is complex decongestive therapy with manual lymph drainage and frequent wearing of compression garments. With insurance limitations on therapy visits and the time and travel required, additional home treatment options are needed. Pneumatic compression pumps that mimic the manual massage pressure and pattern are sometimes prescribed, but these are bulky, difficult to apply, and require immobility during treatment. An open-label pilot study in 40 subjects was performed to evaluate the QoL and limb volume maintenance efficacy of a novel wearable compression system (Dayspring™) that is low profile, easy to use, and allows for mobility during treatment. After 28 days of use, subjects had a statistically significant 18% (p < 0.001) improvement in overall QoL as measured by the Lymphedema Quality-of-Life Questionnaire compared with baseline. Individual QoL domains, and limb volume improved with therapy. Adherence was 98% over the course of the study. Results of the clinical evaluation suggest the Dayspring wearable compression device is safe and effective and improves QoL and limb volume. The novel, low-profile device is easy to use and allows for mobility during treatment, addressing a potential barrier to adherence with pneumatic compression devices.
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Affiliation(s)
- Stanley G Rockson
- Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - Pinar Karaca-Mandic
- Carlson School of Management, University of Minnesota, Minneapolis, Minnesota, USA
| | - Roman Skoracki
- James Cancer Treatment and Research Center, Ohio State University, Columbus, Ohio, USA
| | - Karen Hock
- James Cancer Treatment and Research Center, Ohio State University, Columbus, Ohio, USA
| | | | | | | | - Elizabeth Campione
- Department of Physical Therapy, Midwestern University, Downers Grove, Illinois, USA
| | | | - Jane Armer
- Ellis Fischel Cancer Center, University of Missouri, Columbia, Missouri, USA
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20
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The effects of complex decongestive therapy on kinesthetic sense of hands, upper extremity function, and quality of life in patients with breast cancer-related lymphedema. Turk J Phys Med Rehabil 2021; 67:211-217. [PMID: 34396072 PMCID: PMC8343150 DOI: 10.5606/tftrd.2021.5191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 03/13/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to investigate the effect of complex decongestive therapy (CDT) on the kinesthetic sense of hands, upper extremity function, and the quality of life in patients with breast cancer-related lymphedema (BCRL). Patients and methods Between August 2018 and August 2019, total of 50 women with BCRL (mean age: 56.5±9.6 years; range, 36 to 71 years) were included in the study. Kinesthetic sense of the hand, upper extremity function (Disabilities of the Arm, Shoulder and Hand [DASH]), quality of life (European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire [EORTC QLQ-C30]), and arm volume of all patients were evaluated before and after the treatment. All patients received CDT for 20 sessions for 1 h over a total of four weeks. Results A statistically significant decrease in the volume of the involved extremity was observed after the treatment (p<0.001). There was a significant decrease in the symptom score (p<0.001) and a significant improvement in the general health status and functional scales of the EORTC QLQ-C30 (p<0.001 and p=0.012, respectively). The DASH scores and visual and kinesthetic sense scores of the patients significantly improved after the treatment (p=0.016, p=0.008, and p<0.001, respectively). Conclusion Our study results show that BCRL is a serious complication which may lead to impairment in the kinesthetic sense of hand and upper extremity function with the increased arm volume. The CDT is an effective and safe method not only to achieve significant volume reduction in the extremities, but also to achieve favorable results in managing these problems.
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21
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Buki LP, Rivera-Ramos ZA, Kanagui-Muñoz M, Heppner PP, Ojeda L, Lehardy EN, Weiterschan KA. "I never heard anything about it": Knowledge and psychosocial needs of Latina breast cancer survivors with lymphedema. ACTA ACUST UNITED AC 2021; 17:17455065211002488. [PMID: 33764235 PMCID: PMC8010798 DOI: 10.1177/17455065211002488] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective: Breast cancer is the most commonly diagnosed form of cancer and the leading cause of cancer-related death among Latina women in the United States. One aspect of recovery that has been underrepresented in the English-language literature is the recovery of Latina women who have developed lymphedema, a debilitating condition characterized by persistent swelling of the arm, hand, chest, and/or breast. To fill this research gap, a study was conducted to examine the lived experiences of Latina women with breast cancer-related lymphedema. Methods: Given the limited scholarship on this topic, qualitative methods were used to obtain a foundational and nuanced understanding of Latina women’s experiences. Semi-structured interviews were conducted with a sample of 10 Latina survivors with breast cancer-related lymphedema. Data were analyzed through thematic analysis and constant comparison methodology. Results: The data analysis yielded three major themes: knowledge of lymphedema, impact of lymphedema diagnosis, and coping with lymphedema. Participants had limited knowledge of lymphedema and its risk factors upon diagnosis, in addition to barriers accessing quality care. They also noted psychological distress related to a significant financial burden as well as social anxiety related to interacting with others while wearing compression gloves or sleeves. A major coping strategy was receiving social support from friends, family, peers in structured support groups, and spiritual/religious groups or practices. Conclusions: Our findings bring to light contextual factors that may place Latina breast cancer survivors at increased risk for lymphedema and for experiencing a high burden managing their condition. Recommendations are provided for primary, secondary, and tertiary prevention.
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Affiliation(s)
- Lydia P Buki
- Department of Educational and Psychological Studies, University of Miami, Coral Gables, FL, USA.,University of Illinois, Champaign, IL, USA
| | - Zully A Rivera-Ramos
- Department of Educational Psychology, University of Illinois, Champaign, IL, USA.,Counseling & Wellness Center, University of Florida, Gainesville, FL, USA
| | - Marlen Kanagui-Muñoz
- Department of Educational, School & Counseling Psychology, University of Missouri, Columbia, MO, USA.,Department of Psychiatry, Kaiser Permanente Medical Center, Richmond, CA, USA
| | - Puncky P Heppner
- Department of Educational, School & Counseling Psychology, University of Missouri, Columbia, MO, USA
| | - Lizette Ojeda
- Department of Educational, School & Counseling Psychology, University of Missouri, Columbia, MO, USA.,Department of Education and Human Development, Texas A&M University, College Station, TX, USA
| | - Emaan N Lehardy
- Department of Educational and Psychological Studies, University of Miami, Coral Gables, FL, USA.,Department of Behavioral Health, University of Nebraska Medicine, Omaha, NE, USA
| | - Kari A Weiterschan
- Department of Educational and Psychological Studies, University of Miami, Coral Gables, FL, USA.,Rush University Medical Center, Chicago, IL, USA
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22
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Zhang L, Zhang H, Zhong Q, Luo Q, Gong N, Zhang Y, Qin H, Zhang H. Predictors of Quality of Life in Patients with Breast Cancer-Related Lymphedema: Effect of Age, Lymphedema Severity, and Anxiety. Lymphat Res Biol 2021; 19:573-579. [PMID: 33555980 DOI: 10.1089/lrb.2020.0073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Patients with breast cancer-related lymphedema (BCRL) have lower quality of life (QOL). However, some important predictors, such as the effect of age, lymphedema severity, depression, and anxiety, have not yet been discovered. The overall objective of this study is to explore the QOL predictors associated with BCRL in China. Methods and Results: A cross-sectional design was conducted. Data were collected before treatment, including sociodemographic characteristics (height, heaviness, age, education level, work status, marital status, and economic status), clinical characteristics (surgical method, clinical cancer stage, lymphedema severity, and lymphedema duration), the hospital anxiety (HA) and depression scale, and the functional assessment of cancer therapy-breast quality of life instrument. Univariate analysis or bivariate correlation was first made to explore the correlation of QOL with sociodemographic/clinical characteristics, anxiety, and depression. The multiple linear regression model was used to identify the independent QOL predictors. Seventy-one patients with BCRL were recruited. Age, education level, work status, family income, lymphedema duration, lymphedema severity, and HA and hospital depression scale scores are significantly correlated with QOL (p < 0.05). Age, lymphedema severity, and HA accounted for 85.9% in QOL (F = 62.76, p < 0.001). Conclusions: Age, lymphedema, and anxiety are the most important QOL predictors. Therefore, it is very important to establish a BCRL prevention system and pay attention to psychological distress in the patients with BCRL.
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Affiliation(s)
- Lijuan Zhang
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Breast Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Huizhen Zhang
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Breast Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Qiaoling Zhong
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Breast Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Qinghua Luo
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Breast Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Ni Gong
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Yiheng Zhang
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Huiying Qin
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Nursing, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Huiting Zhang
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Breast Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, China
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23
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Eaton LH, Narkthong N, Hulett JM. Psychosocial Issues Associated with Breast Cancer-Related Lymphedema: a Literature Review. CURRENT BREAST CANCER REPORTS 2020; 12:216-224. [PMID: 32864036 PMCID: PMC7445072 DOI: 10.1007/s12609-020-00376-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Breast cancer-related lymphedema (BCRL) is a chronic disease affecting breast cancer survivors. The purpose of this article is to update the scientific literature regarding psychosocial issues associated with BCRL. RECENT FINDINGS Reports describe economic burdens, social support, sexuality, BCRL patient-education needs, and interventions to reduce BCRL symptoms and improve QOL among women with breast cancer. The psychosocial impact of BCRL may differ between younger and older women which has implications for age-related interventions to reduce the adverse psychosocial experiences of women with BCRL. We did not locate studies reporting the psychosocial impact of BCRL on male breast cancer survivors. SUMMARY More psychosocial-based interventions are needed that target the concerns of those with BCRL, including age-related needs, sexual concerns, body image, and social support. Future research is indicated to study the psychosocial impact of BCRL among men. Researchers may consider how pandemic-driven health care policies affect the psychosocial needs of those with BCRL.
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Affiliation(s)
- L. H. Eaton
- School of Nursing & Health Studies, University of Washington Bothell, Box 358531, Bothell, WA 98011 USA
| | - N. Narkthong
- Sinclair School of Nursing, University of Missouri, 115 Business Loop 70W, Mizzou North, Room 408C, Columbia, MO 65211-6000 USA
| | - J. M. Hulett
- Sinclair School of Nursing, University of Missouri, 115 Business Loop 70W, Mizzou North, Room 408C, Columbia, MO 65211-6000 USA
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24
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Wolfs J, Beugels J, Kimman M, Piatkowski de Grzymala AA, Heuts E, Keuter X, Tielemans H, Ulrich D, van der Hulst R, Qiu SS. Improving the quality of life of patients with breast cancer-related lymphoedema by lymphaticovenous anastomosis (LVA): study protocol of a multicentre randomised controlled trial. BMJ Open 2020; 10:e035337. [PMID: 31948992 PMCID: PMC7045191 DOI: 10.1136/bmjopen-2019-035337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Early breast cancer detection and advancements in treatment options have resulted in an increase of breast cancer survivors. An increasing number of women are living with the long-term effects of breast cancer treatment, making the quality of survivorship an increasingly important goal. Breast cancer-related lymphoedema (BCRL) is one of the most underestimated complications of breast cancer treatment with a reported incidence of 20%. A microsurgical technique called lymphaticovenous anastomosis (LVA) might be a promising treatment modality for patients with BCRL. The main objective is to assess whether LVA is more effective than the current standard therapy (conservative treatment) in terms of improvement in quality of life and weather it is cost-effective. METHODS AND ANALYSIS A multicentre, randomised controlled trial, carried out in two academic and two community hospitals in the Netherlands. The study population includes 120 women over the age of 18 who have undergone treatment for breast cancer including axillary treatment (sentinel lymph node biopsy or axillary lymph node dissection) and/or axillary radiotherapy, presenting with an early stage lymphoedema of the arm, viable lymphatic vessels and received at least 3 months conservative treatment. Sixty participants will undergo the LVA operation and the other sixty will continue their regular conservative treatment, both with a follow-up of 24 months. The primary outcome is the health-related quality of life. Secondary outcomes are societal costs, quality adjusted life years, cost-effectiveness ratio, discontinuation rate of conservative treatment and excess limb volume. ETHICS AND DISSEMINATION The study was approved by the Ethics Committee of Maastricht University Medical Center (METC) on 19 December 2018 (NL67059.068.18). The results of this study will be disseminated in presentations at academic conferences, publications in peer-reviewed journals and other news media. TRIAL REGISTRATION NUMBER NCT02790021; Pre-results.
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Affiliation(s)
- Joost Wolfs
- Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Jop Beugels
- Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Merel Kimman
- Clinical Epidemiology and Medical Technology Assessment, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | | | - Esther Heuts
- Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Xavier Keuter
- Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Hanneke Tielemans
- Plastic, Reconstructive & Hand Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Dietmar Ulrich
- Plastic, Reconstructive & Hand Surgery, Radboudumc, Nijmegen, The Netherlands
| | - R van der Hulst
- Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Shan Shan Qiu
- Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
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25
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Matoso LBBMDM, Boing L, Korpalski T, Dias M, Moratelli J, Fausto DY, Guimarães ACDA. Relationship of fatigue with depressive symptoms and level of physical activity in women with breast cancer diagnosis. REVISTA BRASILEIRA DE CINEANTROPOMETRIA E DESEMPENHO HUMANO 2020. [DOI: 10.1590/1980-0037.2020v22e59189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Breast cancer is the most frequent in women, resulting in fatigue and depressive symptoms as consequence of treatment, but physical activity can help in this process. The aim of this study was to investigate the relationship between fatigue, depressive symptoms and practice of physical activity of women with breast cancer during treatment or after cancer treatment. This is a cross-sectional study with 179 women (56.89 ± 9.4 years) from the Oncology Research Center - CEPON, using questionnaire on general and clinical information, fatigue (Piper Fatigue Scale) depressive symptoms (Beck Depression Inventory) and physical activity (IPAQ - short version). Women with moderate to severe fatigue underwent physiotherapy (p = 0.001) and women with no fatigue had minimum depressive symptoms (p ?0.001). Level of physical activity was not associated with fatigue, with most women being insufficiently active and women with mild fatigue had longer walking time than those without fatigue (p = 0.049). Women with depressive symptoms were almost three times more likely of having mild to severe fatigue and those who underwent physiotherapy were twice as likely of having mild to severe fatigue. Women with fatigue had greater presence of depressive symptoms. Professionals working in the field of oncology should recommend the practice of physical activity in order to minimize the side effects of treatment and observe depressive symptoms and fatigue in these women.
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26
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Acebedo JC, Haas BK, Hermanns M. Breast Cancer-Related Lymphedema in Hispanic Women: A Phenomenological Study. J Transcult Nurs 2019; 32:41-49. [PMID: 31791189 DOI: 10.1177/1043659619891236] [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] [Indexed: 12/28/2022] Open
Abstract
Introduction: Breast cancer-related lymphedema (BCRL), a long-term side effect of treatment, can occur at any point in time. With the extensive physical and psychological effects of BCRL, few studies have focused on the lived experience. The purpose of this study was to examine the lived experience of Hispanic women dealing with BCRL, particularly women of Mexican descent or origin. Method: Using interpretive phenomenology, 13 Hispanic women with BCRL, 42 to 80 years, were individually interviewed. Data analysis was conducted using interpretive reading of field notes, journal entries, and transcribed interviews. Results: Three central themes emerged from the findings, "sense of loss," "resignation to the new self," and "not knowing." Further subthemes highlight the physical, psychological, and spiritual aspects of living with BCRL. Discussion: Cultural awareness of the impact BCRL has on activities of daily living of Hispanic women should be part of a holistic plan of nursing care when caring for this population.
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27
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Kojima M, Yamauchi C, Oyamada S, Hojo T, Iwase S, Naito A, Yamano K, Takahashi S, Ochiai A. Assessment of Upper Limb Physiological Features in Patients with Lymphedema After Breast Surgery Using Multiple Instruments. Lymphat Res Biol 2019; 18:239-246. [PMID: 31657652 DOI: 10.1089/lrb.2019.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background: Objective assessment of upper limb physiological features may allow for early detection and proper intervention for lymphedema after breast surgery. However, the development of diagnostic instruments and standard measurement procedures are required. Methods and Results: Four instruments (Venustron, Softmeasure, Myoton Pro, and iBDent), tape measurement, and water volumetry were investigated in this study. Inter-limb differences in physiological data were obtained from 40 patients with lymphedema after breast surgery and 38 control subjects. Four instruments and tape measurements were performed at four points. Inter-limb differences between patients with lymphedema and control subjects were determined. All measurements took <20 minutes with minimal pain reported. Inter-limb differences in water volumetry and tape measurements, especially when measured at 5 cm distal to the cubital fossa, were increased in International Society of Lymphology (ISL) stage II cases. All four instruments showed high reproducibility in standard silicon sample measurement. On the other hand, data from human samples were varied, and the utility for assessment of lymphedema was not determined. Conclusion: Water volumetry and tape measurement at 5 cm distal to the cubital fossa were useful to assess lymphedema in ISL stage II cases. Four instruments used in this study were feasible in clinical practice. In addition, inconsistent data from human tissue were not due to sensor limitations, rather, acquisition of accurate data from human tissue seemed to be difficult due to anatomical factors. In addition to high-quality sensor, development of system that produce accurate and reproducible results from human tissue is required.
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Affiliation(s)
- Motohiro Kojima
- Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Chiba, Japan
| | - Chisako Yamauchi
- Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Chiba, Japan.,Department of Breast Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Shunsuke Oyamada
- NPO Japanese Organization for Research and Treatment of Cancer, Tokyo, Japan
| | - Takashi Hojo
- Department of Breast Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Satoru Iwase
- Department of Palliative Medicine, Saitama Medical University, Saitama, Japan
| | | | | | - Shinichiro Takahashi
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Atsushi Ochiai
- Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Chiba, Japan
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28
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Denlinger CS, Sanft T, Baker KS, Broderick G, Demark-Wahnefried W, Friedman DL, Goldman M, Hudson M, Khakpour N, King A, Koura D, Lally RM, Langbaum TS, McDonough AL, Melisko M, Montoya JG, Mooney K, Moslehi JJ, O'Connor T, Overholser L, Paskett ED, Peppercorn J, Pirl W, Rodriguez MA, Ruddy KJ, Silverman P, Smith S, Syrjala KL, Tevaarwerk A, Urba SG, Wakabayashi MT, Zee P, McMillian NR, Freedman-Cass DA. Survivorship, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019; 16:1216-1247. [PMID: 30323092 DOI: 10.6004/jnccn.2018.0078] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for common physical and psychosocial consequences of cancer and cancer treatment to help healthcare professionals who work with survivors of adult-onset cancer in the posttreatment period. This portion of the guidelines describes recommendations regarding the management of anthracycline-induced cardiotoxicity and lymphedema. In addition, recommendations regarding immunizations and the prevention of infections in cancer survivors are included.
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29
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Ridner SH, Dietrich MS, Davis AJ, Sinclair V. A Randomized Clinical Trial Comparing the Impact of a Web-Based Multimedia Intervention Versus an Educational Pamphlet on Patient Outcomes in Breast Cancer Survivors with Chronic Secondary Lymphedema. J Womens Health (Larchmt) 2019; 29:734-744. [PMID: 31314661 DOI: 10.1089/jwh.2019.7676] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: The purpose of this study was to evaluate the effects of a Web-based Multimedia Intervention (WBMI) for breast cancer-related lymphedema (BCRL) patients on symptom burden, function, psychological well-being, costs, and arm volume. Methods: Women with BCRL were randomized to intervention (n = 80) or control (n = 80) groups. The WBMI offered 12 modules, each of which took about 30 minutes to complete. The Pamphlet took about 2 hours to read. Data on symptom burden, psychological well-being, function, and costs were collected preintervention; and 1, 3, 6, and 12 months postintervention. A subgroup of 45 regional patients had arm extracellular fluid measured by bioimpedance at baseline and at 3, 6, and 12 months postintervention. Intervention perceived value was also captured. Results: A statistically significant difference (p = 0.011) was observed for rates of intervention completion, WBMI (58%), and Pamphlet (77%). With the exception of the number of biobehavioral symptoms (mood), no statistically significant differences between groups in symptom reduction were apparent between baseline and 1 or 12 months (effect sizes = 0.05-0.28, p > 0.05) based on the Lymphedema Symptom Intensity and Distress Scale-Arm (LSIDS-A). No statistically significant differences between the groups were observed for changes in other variables. The WBMI was perceived as providing better self-care information than the Pamphlet (p = 0.001). Conclusions: WBMI participants experienced improved biobehavioral symptoms and higher perceived quality of information. The lack of significant differences on other variables may be due to the high percentage of participants who did not complete the WBMI.
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Affiliation(s)
- Sheila H Ridner
- Center for Research Development and Scholarship, School of Nursing, Vanderbilt University, Nashville, Tennessee
| | - Mary S Dietrich
- Center for Research Development and Scholarship, School of Nursing, Vanderbilt University, Nashville, Tennessee.,Department of Biostatistics, School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Amanda J Davis
- Center for Research Development and Scholarship, School of Nursing, Vanderbilt University, Nashville, Tennessee
| | - Vaughn Sinclair
- Center for Research Development and Scholarship, School of Nursing, Vanderbilt University, Nashville, Tennessee
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30
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Introduction of the Lymphedema Action Plan (LeAP): Clinical Advancement in Proactive Lymphedema Care. REHABILITATION ONCOLOGY 2019. [DOI: 10.1097/01.reo.0000000000000145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Boing L, Pereira GS, Araújo CDCRD, Sperandio FF, Loch MDSG, Bergmann A, Borgatto AF, Guimarães ACDA. Factors associated with depression symptoms in women after breast cancer. Rev Saude Publica 2019; 53:30. [PMID: 30942272 PMCID: PMC6474749 DOI: 10.11606/s1518-8787.2019053000786] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/05/2018] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE: To analyze the factors associated with the presence of depression symptoms in women after breast cancer. METHODS: Cross-sectional study with 181 women with breast cancer, aged 57.0 years (SD = 9.5), who were undergoing treatment or after treatment in the Oncology Research Center in Florianópolis, state of Santa Catarina, Brazil. The questionnaire comprised items addressing general and health information, economic level, anthropometric measures, depression symptoms (Beck Depression Inventory), self-esteem (Rosenberg Self-Esteem Scale), and body image (Body Image After Breast Cancer Questionnaire). Descriptive and inferential statistical analysis were performed by chi-square and Fisher's exact tests to verify association, Mann-Whitney U test to compare the groups and Poisson regression to identify the prevalence ratio of the factors associated with presence of depression symptoms (p < 0.05). RESULTS: We found an association between the presence of depression symptoms and the group of younger women (aged 40–60 years), those who had another disease besides cancer, those who had mastectomy surgery, those who suffered from lymphedema, and those who presented low–medium self-esteem. Less educated women presented more depressive symptoms, as did women with worse body image on the subscales of limitations, transparency, and arm concerns. CONCLUSIONS: Age, educational attainment, diagnosis of other diseases, type of surgery, lymphedema, self-esteem, and body image were factors associated with the presence of depression symptoms in Brazilian women after breast cancer. Health professionals should be aware of these relationships and try to detect depression symptoms earlier and improve the care they provide to these women.
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Affiliation(s)
- Leonessa Boing
- Universidade do Estado de Santa Catarina. Programa de Pós-Graduação em Ciências do Movimento Humano. Florianópolis, SC, Brasil
| | - Gustavo Soares Pereira
- Universidade do Estado de Santa Catarina. Programa de Pós-Graduação em Ciências do Movimento Humano. Florianópolis, SC, Brasil
| | - Camila da Cruz Ramos de Araújo
- Universidade do Estado de Santa Catarina. Departamento de Educação Física. Área de Ciências do Movimento Humano. Florianópolis, SC, Brasil
| | - Fabiana Flores Sperandio
- Universidade do Estado de Santa Catarina. Departamento de Fisioterapia. Florianópolis, SC, Brasil
| | | | - Anke Bergmann
- Instituto Nacional do Câncer. Rio de Janeiro, RJ, Brasil
| | - Adriano Ferreti Borgatto
- Universidade Federal de Santa Catarina. Departamento de Informática e Estatística. Florianópolis, SC, Brasil
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32
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Findings of lymphoscintigraphy and the severity of lymphedema according to the extent of axillary lymph node dissection. Asian J Surg 2019; 43:95-101. [PMID: 30857863 DOI: 10.1016/j.asjsur.2019.02.003] [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: 10/09/2018] [Revised: 01/25/2019] [Accepted: 02/14/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Lymphedema of the upper extremity is a common disease in breast cancer patients following breast cancer operation accompanied by lymphadenectomy. However, clinically, there is a discrepancy between the extent of axillary lymph node dissection (ALND) and the severity of lymphedema. Therefore, we investigated the relationship between the severity of lymphedema following breast cancer operation, including ALND, and axillary lymph node findings on lymphoscintigraphy. METHODS Eighty-two patients with lymphedema following breast cancer operation with ALND (82 women; mean age 55.57 ± 9.39, range 36-65) were retrospectively recruited. Lymphoscintigraphy was conducted after an average of 5.44 ± 2.01 months following operation. Percentage differences in the circumference of the upper extremities between affected and unaffected sides were used as a severity index. RESULTS Percentage differences in the circumference of the upper extremities in a positive and negative group in lymphoscintigraphy were 3.42 ± 2.47% and 12.87 ± 10.23% in the mid-arm respectively (p < 0.05), and 3.36 ± 3.80% and 12.83 ± 10.00% in the mid-forearm respectively (p < 0.05). However, the extent of lymph node dissection and the difference in the circumference of mid-arm and mid-forearm volume did not have a statistically significant relationship. CONCLUSION Lymph node activity in the proximal upper extremity is not related to the extent of ALND. The existence of a bypass connection and remainder function of a lymph node is crucial for the severity of lymphedema.
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33
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Wanchai A, Armer JM. Effects of weight-lifting or resistance exercise on breast cancer-related lymphedema: A systematic review. Int J Nurs Sci 2019; 6:92-98. [PMID: 31406873 PMCID: PMC6608669 DOI: 10.1016/j.ijnss.2018.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 12/16/2022] Open
Abstract
The purpose of this systematic review was to identify the effects of weight-lifting or resistance exercise on breast cancer-related lymphedema. Published articles written in English were retrieved from electronic databases, including ScienceDirect, PubMed, Scopus, and CINAHL databases. Hand-searches for unpublished papers were also completed. Content analysis was used to examine articles that met the inclusion criteria. Among 525 searched papers, 15 papers met the inclusion criteria: 13 trials evaluated weight-lifting or resistance exercise alone and two trials evaluated weight-lifting or resistance exercise plus aerobic exercise. The results of the review showed that no arm volume change was observed for either exercise modality. In addition, six included studies showed that weight-lifting or resistance exercise did not cause lymphedema or adverse events in patients at risk of breast cancer-related lymphedema. For patients with breast cancer-related lymphedema, six studies reported that change of swelling outcome measures were not significantly different between the weight-lifting or resistance exercise group and the control group. However, three included studies reported that volume of arm was significantly more reduced in the weight-lifting or resistance exercise group than those in the control group. The findings suggest that supervised resistance exercise may be safe, feasible, and beneficial in patients with breast cancer-related lymphedema or at risk for breast cancer-related lymphedema. However, the limitation of small sample size implies that further research is needed to confirm these findings.
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Affiliation(s)
- Ausanee Wanchai
- Deputy Director for Academic Services and Research, Boromarajonani College of Nursing Buddhachinaraj, Muang, Phitsanulok, Thailand
| | - Jane M. Armer
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
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34
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Carter S, Neuman H, Mamounas EP, Bedrosian I, Moulder S, Montero AJ, Jagsi R. Debating the Optimal Approach to Nodal Management After Pathologic Complete Response to Neoadjuvant Chemotherapy in Patients With Breast Cancer. Am Soc Clin Oncol Educ Book 2019; 39:42-48. [PMID: 31099648 DOI: 10.1200/edbk_237701] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Greater use of neoadjuvant chemotherapy in patients with breast cancer has led surgeons and radiation oncologists to have frequent encounters with women with upfront node-positive disease and a clinical complete response. These cases raise many important questions about what the optimal locoregional management should be to minimize recurrence risk while minimizing treatment-related toxicities. A particular point of debate is whether all patients who are known to have had node-positive disease before neoadjuvant chemotherapy should receive complete axillary lymph node dissection (ALND) if they have had a complete clinical and radiologic response. In this article, we present arguments and evidence in favor of and against axillary dissection after a complete response to neoadjuvant chemotherapy, followed by a brief data-driven review of implications for adjuvant radiotherapy in this context. We conclude that as trials continue to gather more evidence to guide decisions in the future, we must encourage patients to enroll in clinical trials when eligible, and otherwise support them to make decisions that are informed and congruent with their personal values in areas where there is clinical equipoise.
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Affiliation(s)
- Stacey Carter
- 1 Department of Surgical Oncology, Baylor College of Medicine, Lester and Sue Smith Breast Center, Dan L. Duncan Comprehensive Cancer Center, Houston, TX
| | - Heather Neuman
- 2 Department of Surgery, Division of Surgical Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Isabelle Bedrosian
- 4 Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stacy Moulder
- 5 Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alberto J Montero
- 6 Department of Medicine, School of Medicine, Case Comprehensive Cancer Center, Cleveland, OH
| | - Reshma Jagsi
- 7 Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI
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35
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Tackling the diversity of breast cancer related lymphedema: Perspectives on diagnosis, risk assessment, and clinical management. Breast 2018; 44:15-23. [PMID: 30580170 DOI: 10.1016/j.breast.2018.12.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/06/2018] [Accepted: 12/17/2018] [Indexed: 01/20/2023] Open
Abstract
Breast cancer related lymphedema (BCRL) develops as a consequence of surgical treatment and/or radiation therapy in a significant number of breast cancer patients. The etiology of this condition is multifactorial and has not yet been completely elucidated. Risk factors include high body mass index, radical surgical procedures (i.e. mastectomy and axillary lymph node dissection), number of lymph nodes removed and number of metastatic lymph nodes, as well as nodal radiation, and chemotherapy. However, these predisposing factors explain only partially the BCRL occurrence, suggesting the possible involvement of individual determinants. Despite the implementation of conservative approaches, BCRL still remains in a proportion of cases an incurable and progressive condition with major physical and psychological implications. To date, diagnostic methods and staging systems lack uniformity, leading to a possible underestimation of the real incidence of this condition, decreasing early detection and thus the possibility of an effective treatment. Several preventive and therapeutic options are available, both conservative and surgical, but are not included in a standardized intervention protocol, tailored on patient's specific characteristics. In this review, we provide a comprehensive overview of the current state-of-knowledge of BCRL management, novel advantages in the assessment of pre-operative evaluation and risk prediction and discuss strengths and weaknesses of diagnostic and treatment strategies currently accessible in clinical practice.
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Johnson AR, Singhal D. Immediate lymphatic reconstruction. J Surg Oncol 2018; 118:750-757. [DOI: 10.1002/jso.25177] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 06/28/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Anna Rose Johnson
- Division of Plastic and Reconstructive SurgeryBeth Israel Deaconess Medical Center, Harvard Medical SchoolBoston Massachusetts
| | - Dhruv Singhal
- Division of Plastic and Reconstructive SurgeryBeth Israel Deaconess Medical Center, Harvard Medical SchoolBoston Massachusetts
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Moffatt CJ, Aubeeluck A, Franks PJ, Doherty DC, Mortimer P, Quere I. Psychological Factors in Chronic Edema: A Case-Control Study. Lymphat Res Biol 2018; 15:252-261. [PMID: 28937923 DOI: 10.1089/lrb.2017.0022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To examine psychological health and perceived social support in patients with chronic edema (CE). METHODS AND RESULTS A random sample of 107 patients with CE was group matched for age and gender with 102 community controls. The cases had swelling of the arm (38%) and leg (61%) and midline swelling (14%). Cases were more likely to be single or divorced/separated (p = 0.041) and have reduced mobility (p < 0.001). They had significantly poorer overall health related quality of life (HRQoL), in particular physical functioning (p = 0.003); role physical (p < 0.001); general health (p = 0.026); vitality (p = 0.015); social function (p = 0.007); and role emotional (p = 0.041). EQ5-D health index scores were significantly reduced in cases by 13 points (p = <0.001, 95% confidence interval 5.8, 21.6). Cases had similar sized social networks to the control group (5.8 vs. 6.6 p = 0.49), but had lower total perceived social support scores (67.8 vs. 76.1 p = 0.018). CE patients used significantly fewer coping strategies (COPE scale) than controls with regard to the following: active coping (p = 0.024); planning (p < 0.001); and use of instrumental support (p = 0.006). Significantly higher levels of coping were used in restraint (p = 0.031), positive reinterpretation and growth (p < 0.001); acceptance (<0.001); denial (p < 0.001); mental disengagement (p < 0.001); behavioral disengagement (<0.001); substance abuse (p = 0.010); and humor (p < 0.001). CONCLUSIONS Patients with CE have poorer health and greater impact on many aspects of HRQoL. Perceived social support is reduced. Deficits in social function combined with perceived reduction in support, and reduced mental health and emotional scores indicate the risk of psychological issues. Systems of care should offer an environment to address these issues.
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Affiliation(s)
- Christine J Moffatt
- 1 Division of Nursing, School of Health Sciences, Royal Derby Hospital, The University of Nottingham , Derby, United Kingdom
| | - Aimee Aubeeluck
- 1 Division of Nursing, School of Health Sciences, Royal Derby Hospital, The University of Nottingham , Derby, United Kingdom
| | - Peter J Franks
- 2 Centre for Research and Implementation of Clinical Practice , London, United Kingdom .,3 Division of Nursing and Healthcare, Faculty of Medicine, University of Glasgow , Glasgow, United Kingdom
| | - Debra C Doherty
- 2 Centre for Research and Implementation of Clinical Practice , London, United Kingdom
| | - Peter Mortimer
- 4 St. George's University of London , London, United Kingdom
| | - Isabelle Quere
- 5 Medecine Vasculaire, EA2992, Universite Montpellier I , CHU Saint Eloi, Montpellier, France
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Haghighat S, Montazeri A, Zayeri F, Ebrahimi M, Weiss J. Psychometric evaluation of the Persian version of the Lymphedema Life Impact Scale (LLIS, version 1) in breast cancer patients. Health Qual Life Outcomes 2018; 16:132. [PMID: 29954381 PMCID: PMC6025716 DOI: 10.1186/s12955-018-0958-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 06/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Despite the high prevalence of lymphedema in Iranian breast cancer patients, there is no valid instrument for measuring quality of life in this population. The aim of this study was to assess reliability and validity of the Persian version of Lymphedema Life Impact Scale (LLIS) in breast cancer patients. Methods Forward-backward procedure was applied to translate The LLIS from English into Persian. The LLIS is an 18-item measure of physical, psychosocial, and functional impairments caused by lymphedema. Experts and patients assessed content and face validity, respectively. Discriminant validity was evaluated by comparing breast cancer patients with and without lymphedema. Convergent validity was assessed by comparing LLIS score with SF-36 (functional component) and the EORTC-QLQ-C30 (functional component). The construct validity also was evaluated using confirmatory and exploratory factor analyses. Internal consistency was evaluated by Cronbach’s alpha coefficient. Stability was assessed by test-retest analysis over a one-week interval in 13 patients. Results In all 446 breast cancer patients were entered into the study. The content and face validity of Persian version of LLIS were acceptable and minor corrections were applied in final version. The questionnaire differentiated well in patients’ with and without lymphedema and not lending support to its discriminant validity. Confirmatory factor analysis showed a good fit for the data. Cronbach’s alpha coefficient in physical, psychosocial and functional subscales were 0.873, 0.854 and 0.884 respectively. Intra-class correlation coefficient of total score of the LLIS was 0.96. Conclusions The findings of this study suggest a first indication that reliability and validity of the Persian version of LLIS in patients with breast cancer induced lymphedema was good. Application of this instrument for identifying problems of patients with upper extremity lymphedema may be helpful in designing interventions to improve quality of life.
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Affiliation(s)
- Shahpar Haghighat
- Quality of Life Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran.
| | - Ali Montazeri
- Health Metrics Research Center, Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Farid Zayeri
- Proteomics Research Center and Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mandana Ebrahimi
- Quality of Life Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Jan Weiss
- Lymphedema Clinic, Cox Health Outpatient Rehabilitation, Springfield, Missouri, USA
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The Influence of Adverse Effects on Quality of Life of Survivors of Gynecologic Cancer. Int J Gynecol Cancer 2017; 27:2014-2019. [DOI: 10.1097/igc.0000000000001125] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveThe objective of this observational study was to investigate correlations between adverse effects (lower-extremity lymphedema [LEL], dysuria, and severe gastrointestinal symptoms) and quality of life (QOL) (physical well-being [PWB], social well-being, emotional well-being [EWB], and functional well-being) before treatment, at least 6 weeks after treatment (posttreatment1), and 3 or 6 months after treatment (posttreatment2) of patients with gynecologic cancer (GC).MethodsFrom August 2012 to October 2016, questionnaire responses and clinical data of 75 patients with GC were collected and assessed by treatment received. The χ2 test was used to determine the significance of correlations.ResultsParticipants with LEL had significantly poorer QOL than did those without it in the domains of PWB at posttreatment1 (P = 0.026) and EWB at posttreatment2 (P = 0.020). Moreover, patients with 2 adverse effects (LEL plus dysuria or severe gastrointestinal symptoms) had significantly poorer QOL than did those with no or single adverse effect in the domains of PWB at posttreatment1 and posttreatment2 (posttreatment1: P = 0.049, P = 0.001; posttreatment2: P = 0.002, P = 0.028) and poorer QOL compared with those with no adverse effect in the domain of EWB at posttreatment1 (P = 0.017).ConclusionsPoorer QOL in emotional and physical domains is associated with adverse effects of treatment in patients with GC. It is important to consider the effects of radical therapy not only on survival but also on the QOL of survivors.
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Chronic Effects of Resistance Training in Breast Cancer Survivors. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8367803. [PMID: 28835898 PMCID: PMC5557266 DOI: 10.1155/2017/8367803] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/15/2017] [Accepted: 06/28/2017] [Indexed: 01/05/2023]
Abstract
Objective. To analyse effects of resistance training (RT) in breast cancer survivors (BCS) and how protocols and acute variables were manipulated. Methods. Search was made at PubMed, Science Direct, and LILACS. All articles published between 2000 and 2016 were considered. Studies that met the following criteria were included: written in English, Spanish, or Portuguese; BCS who have undergone surgery, chemotherapy, and/or radiotherapy; additional RT only; analysis of muscle performance, body mass composition (BMC), psychosocial parameters, or blood biomarkers. Results. Ten studies were included. PEDro score ranged from 5 to 9. Rest interval and cadence were not reported. Two studies reported continuous training supervision. All reported improvements in muscle strength, most with low or moderate effect size (ES), but studies performed with high loads presented large ES. Five described no increased risk or exacerbation of lymphedema. Most studies that analysed BMC showed no relevant changes. Conclusions. RT has been shown to be safe for BCS, with no increased risk of lymphedema. The findings indicated that RT is efficient in increasing muscle strength; however, only one study observed significant changes in BMC. An exercise program should therefore consider the manipulation of acute and chronic variables of RT to obtain optimal results.
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Syrowatka A, Motulsky A, Kurteva S, Hanley JA, Dixon WG, Meguerditchian AN, Tamblyn R. Predictors of distress in female breast cancer survivors: a systematic review. Breast Cancer Res Treat 2017; 165:229-245. [PMID: 28553684 PMCID: PMC5543195 DOI: 10.1007/s10549-017-4290-9] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 05/10/2017] [Indexed: 12/12/2022]
Abstract
Purpose Unmanaged distress has been shown to adversely affect survival and quality of life in breast cancer survivors. Fortunately, distress can be managed and even prevented with appropriate evidence-based interventions. Therefore, the objective of this systematic review was to synthesize the published literature around predictors of distress in female breast cancer survivors to help guide targeted intervention to prevent distress. Methods Relevant studies were located by searching MEDLINE, Embase, PsycINFO, and CINAHL databases. Significance and directionality of associations for commonly assessed candidate predictors (n ≥ 5) and predictors shown to be significant (p ≤ 0.05) by at least two studies were summarized descriptively. Predictors were evaluated based on the proportion of studies that showed a significant and positive association with the presence of distress. Results Forty-two studies met the target criteria and were included in the review. Breast cancer and treatment-related predictors were more advanced cancer at diagnosis, treatment with chemotherapy, longer primary treatment duration, more recent transition into survivorship, and breast cancer recurrence. Manageable treatment-related symptoms associated with distress included menopausal/vasomotor symptoms, pain, fatigue, and sleep disturbance. Sociodemographic characteristics that increased the risk of distress were younger age, non-Caucasian ethnicity, being unmarried, and lower socioeconomic status. Comorbidities, history of mental health problems, and perceived functioning limitations were also associated. Modifiable predictors of distress were lower physical activity, lower social support, and cigarette smoking. Conclusions This review established a set of evidence-based predictors that can be used to help identify women at higher risk of experiencing distress following completion of primary breast cancer treatment. Electronic supplementary material The online version of this article (doi:10.1007/s10549-017-4290-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ania Syrowatka
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada. .,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
| | - Aude Motulsky
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Siyana Kurteva
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - James A Hanley
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Mathematics and Statistics, McGill University, Montreal, QC, Canada
| | - William G Dixon
- Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK.,Health eResearch Centre, Farr Institute, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - Ari N Meguerditchian
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada.,Department of Surgery, McGill University Health Centre, Montreal, QC, Canada.,Department of Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Robyn Tamblyn
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada
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Herberger K, Blome C, Heyer K, Ellis F, Münter KC, Augustin M. Quality of life in patients with primary and secondary lymphedema in the community. Wound Repair Regen 2017; 25:466-473. [PMID: 28370792 DOI: 10.1111/wrr.12529] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 01/31/2017] [Indexed: 10/19/2022]
Abstract
Lymphedema is a complex and burdensome medical problem and requires continuous specific therapy. The aim of this cross-sectional study of community lymphedema care in the metropolitan area of Hamburg, Germany, was to evaluate health-related quality of life (QoL) in lymphedema patients. Generic as well as disease-specific health-related QoL was assessed using EQ-5D and FLQA-LK, respectively. Pain was assessed using a visual analogue scale (VAS). About 301 patients (median age of 60.5 years, 90.8% female) with lymphedema of any origin were included. About 66.4% had lymphedema, 24.1% combined lipolymphedema, and 9.5% lipoedema. Mean disease-specific QoL (FLQA-LK) was 2.4 (range 0 = no to 4 = maximum burden). The highest impairment values were observed in subscales for physical complaints, everyday life, and emotional well-being. Mean EQ-5D VAS was 70.4, mean EQ-5D score 63.3. Lymphedema was associated with major impairments in QoL, which differed for subgroups of pain, clinical severity, and comorbidity. Pain as a common problem for lymphedema patients seemed to be underestimated and undertreated. Early diagnosis and structured treatment strategies are urgently needed.
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Affiliation(s)
- Katharina Herberger
- CVderm - German Center for Health Services Research in Dermatology, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Blome
- CVderm - German Center for Health Services Research in Dermatology, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kristina Heyer
- CVderm - German Center for Health Services Research in Dermatology, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franziska Ellis
- CVderm - German Center for Health Services Research in Dermatology, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Matthias Augustin
- CVderm - German Center for Health Services Research in Dermatology, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Hoffner M, Bagheri S, Hansson E, Manjer J, Troëng T, Brorson H. SF-36 Shows Increased Quality of Life Following Complete Reduction of Postmastectomy Lymphedema with Liposuction. Lymphat Res Biol 2017; 15:87-98. [PMID: 28135120 PMCID: PMC5369397 DOI: 10.1089/lrb.2016.0035] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: Arm lymphedema after breast cancer surgery affects women both from physical and psychological points of view. Lymphedema leads to adipose tissue deposition. Liposuction and controlled compression therapy (CCT) reduces the lymphedema completely. Methods and Results: Sixty female patients with arm lymphedema were followed for a 1-year period after surgery. The 36-item short-form health survey (SF-36) was used to assess health-related quality of life (HRQoL). Patients completed the SF-36 questionnaire before liposuction, and after 1, 3, 6, and 12 months. Preoperative excess arm volume was 1365 ± 73 mL. Complete reduction was achieved after 3 months and was sustained during follow-up. The adipose tissue volume removed at surgery was 1373 ± 56 mL. One month after liposuction, better scores were found in mental health. After 3 months, an increase in physical functioning, bodily pain, and vitality was detected. After 1 year, an increase was also seen for social functioning. The physical component score was higher at 3 months and thereafter, while the mental component score was improved at 3 and 12 months. Compared with SF-36 norm data for the Swedish population, only physical functioning showed lower values than the norm at baseline. After liposuction, general health, bodily pain, vitality, mental health, and social functioning showed higher values at various time points. Conclusions: Liposuction of arm lymphedema in combination with CCT improves patients HRQoL as measured with SF-36. The treatment seems to target and improve both the physical and mental health domains.
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Affiliation(s)
- Mattias Hoffner
- 1 Department of Clinical Sciences in Malmö, Lund University , Malmö, Sweden .,2 Department of Surgery, Blekinge Hospital , Karlskrona, Sweden
| | - Shirin Bagheri
- 3 Department of Rheumatology, Cedars-Sinai, Los Angeles, California
| | - Emma Hansson
- 1 Department of Clinical Sciences in Malmö, Lund University , Malmö, Sweden .,4 Department of Plastic and Reconstructive Surgery, Skåne University Hospital , Malmö, Sweden
| | - Jonas Manjer
- 1 Department of Clinical Sciences in Malmö, Lund University , Malmö, Sweden .,4 Department of Plastic and Reconstructive Surgery, Skåne University Hospital , Malmö, Sweden
| | - Thomas Troëng
- 2 Department of Surgery, Blekinge Hospital , Karlskrona, Sweden .,5 Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University , Uppsala, Sweden
| | - Håkan Brorson
- 1 Department of Clinical Sciences in Malmö, Lund University , Malmö, Sweden .,4 Department of Plastic and Reconstructive Surgery, Skåne University Hospital , Malmö, Sweden
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Bowenwork for symptom management of women breast cancer survivors with lymphedema: A pilot study. Complement Ther Clin Pract 2016; 25:142-149. [DOI: 10.1016/j.ctcp.2016.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 08/23/2016] [Accepted: 09/15/2016] [Indexed: 11/22/2022]
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Chang HY, Jotwani AC, Lai YH, Jensen MP, Syrjala KL, Fann JR, Gralow J. Hot flashes in breast cancer survivors: Frequency, severity and impact. Breast 2016; 27:116-21. [PMID: 27065357 DOI: 10.1016/j.breast.2016.02.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 01/06/2016] [Accepted: 02/27/2016] [Indexed: 12/22/2022] Open
Abstract
PURPOSES To (1) determine the frequency and severity of hot flashes, (2) examine the associations between hot flash frequency and severity and quality of life, and (3) identify the predictors of hot flash activity in breast cancer survivors. METHODS The study used a cross-sectional design and mailed survey of 253 breast cancer survivors recruited from a cancer wellness clinic. Participants provided information regarding cancer history, hot flashes, pain intensity, sleep problems, physical functioning, and psychological functioning. RESULTS About half of the survivors reported at least one hot flash in the past 24 h (45%) or past week (52%). The average frequency of hot flashes was 1.9 in the past 24 h and 1.8 in the past week. Hot flash severity was usually mild or asymptomatic. However, participants with hot flashes reported significantly more sleep problems and higher pain severity than those reporting no hot flashes. Moreover, the severity of hot flashes was associated with more sleep problems, higher pain severity, and more psychological dysfunction. History of hormonal suppression therapy and younger age predicted hot flash activity in the study sample. CONCLUSIONS In breast cancer survivors, hot flashes are common and are associated with unpleasant symptoms and poor quality of life. Research is needed to determine if treatments that reduce the frequency and severity of hot flashes in breast cancer survivors also result in improvements in symptoms such as sleep problems, pain, and psychological dysfunction.
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Affiliation(s)
- Hao-Yuan Chang
- School of Nursing, College of Medicine, National Taiwan University, No. 1, Jen-Ai Rd., Sec. 1, Taipei, 10051, Taiwan; Department of Nursing, National Taiwan University Hospital, No. 7, Zhong-Shan S. Rd., Taipei, 10002, Taiwan
| | - Aparna C Jotwani
- Rice University, 6100 Main St, MS-760, Houston, TX 77005-1827, United States
| | - Yeur-Hur Lai
- School of Nursing, College of Medicine, National Taiwan University, No. 1, Jen-Ai Rd., Sec. 1, Taipei, 10051, Taiwan; Department of Nursing, National Taiwan University Hospital, No. 7, Zhong-Shan S. Rd., Taipei, 10002, Taiwan
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Box 356490, 325 Ninth Avenue, Seattle, WA, 98104, United States.
| | - Karen L Syrjala
- Biobehavioral Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D5-220, Seattle, WA, 98109, United States; Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195, United States
| | - Jesse R Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195, United States
| | - Julie Gralow
- Division of Medical Oncology, University of Washington School of Medicine, 825 Eastlake Ave E., Seattle, WA, 98109-1023, United States; Breast Medical Oncology, Seattle Cancer Care Alliance, 825 Eastlake Ave East, G3-630, Seattle, WA, 98109, United States
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Ostby PL, Armer JM. Complexities of Adherence and Post-Cancer Lymphedema Management. J Pers Med 2015; 5:370-88. [PMID: 26580657 PMCID: PMC4695861 DOI: 10.3390/jpm5040370] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/29/2015] [Accepted: 11/09/2015] [Indexed: 11/19/2022] Open
Abstract
Breast cancer survivors are at increased risk for breast cancer-related lymphedema (BCRL), a chronic, debilitating, condition that is progressive and requires lifelong self-management. Up to 40% of 3 million breast cancer survivors in the US will develop BCRL, which has no cure, is irreversible, and requires self-management with regimens that may include multiple components. The complexities of treatment can negatively affect adherence to BCRL self-management which is critical to preventing progressive swelling and infection. The aim of this review of contemporary literature published from 2005-2015 is to examine the complexities of BCRL self-management, to identify adherence-focused studies relevant to BCRL, and to summarize barriers to self-management of BCRL. Six electronic indices were searched from which 120 articles were retrieved; 17 were BCRL-focused; and eight met inclusion criteria. Seventeen of 120 articles identified barriers to self-management of BCRL such as complexities of treatment regimens, symptom burden, balance of time for treatment and life demands, and lack of education and support; however, only eight studies included outcome measures of adherence to BCRL treatment regimens with a subsequent improvement in reduced limb volumes and/or perceptions of self-efficacy and self-regulation. A major limitation is the few number of rigorously developed outcome measures of BCRL adherence. In addition, randomized studies are needed with larger sample sizes to establish adequate levels of evidence for establishing best practice standards for improving adherence to BCRL self-management treatment regimens.
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Affiliation(s)
- Pamela L Ostby
- Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, USA.
- Lymphedema Research Laboratory, Sinclair School of Nursing, University of Missouri, DC 116.05, Suite 408, Mizzou North Campus, Columbia, MO 65211, USA.
| | - Jane M Armer
- Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, USA.
- Lymphedema Research Laboratory, Sinclair School of Nursing, University of Missouri, DC 116.05, Suite 408, Mizzou North Campus, Columbia, MO 65211, USA.
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Kim SI, Lim MC, Lee JS, Lee Y, Park K, Joo J, Seo SS, Kang S, Chung SH, Park SY. Impact of lower limb lymphedema on quality of life in gynecologic cancer survivors after pelvic lymph node dissection. Eur J Obstet Gynecol Reprod Biol 2015; 192:31-6. [DOI: 10.1016/j.ejogrb.2015.06.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 05/22/2015] [Accepted: 06/12/2015] [Indexed: 11/30/2022]
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Harder H, Langridge C, Solis-Trapala I, Zammit C, Grant M, Rees D, Burkinshaw L, Jenkins V. Post-operative exercises after breast cancer surgery: Results of a RCT evaluating standard care versus standard care plus additional yoga exercise. Eur J Integr Med 2015. [DOI: 10.1016/j.eujim.2015.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Analysis of factors related to arm weakness in patients with breast cancer-related lymphedema. Support Care Cancer 2015; 23:2297-304. [DOI: 10.1007/s00520-014-2584-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
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