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Hemati M, Rivaz M, Khademian Z. Lymphedema self-management mobile application with nurse support for post breast cancer surgery survivors: description of the design process and prototype evaluation. BMC Cancer 2024; 24:973. [PMID: 39118042 PMCID: PMC11308577 DOI: 10.1186/s12885-024-12744-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Self-management is the key to control breast cancer related lymphedema (BCRL). This study aimed to develop a mobile application with nurse support for lymphedema self-management and evaluate its usability from the patients' points of view. METHODS This applied developmental study was conducted on 87 women in a lymphedema clinic, Shiraz, Iran, May-November 2023. The study included three phases: development, distribution of the application and usability evaluation. In the development phase, the researchers developed application using the Java programming language. In distribution phase, the application was installed on the participants' phones. For usability evaluation, 87 patients completed the user satisfaction questionnaire after three months access to the application. Data was analyzed using descriptive and analytical statistics using SPSS software 22. P-value less than 0.05 was considered significant. RESULTS We designed a self-management application specific to BCRL that included ten unique modules mainly related to patient education, interaction with peers and nurse, self-management support, and settings. The application mean usability score was 7.72 ± 1.08. The usability dimensions of "screen" (8.06 ± 1.02) and "terminology and systems information" (7.29 ± 1.62) received the highest and lowest mean scores, respectively. CONCLUSION The application has new features to meet more patients' needs compared to what other existing lymphedema self-management applications already have addressed. The findings showed that the participants rated the application usability at the "good" level that is similar to some previous studies. Considering the unique nature of the application and its favorable usability, we recommend its use for BCRL self-management.
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Affiliation(s)
- Mehrvash Hemati
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mozhgan Rivaz
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Khademian
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
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Kandasoglu H, Unsal Delialioglu S. Adherence to complete decongestive therapy in patients with postmastectomy lymphedema and related factors. Turk J Phys Med Rehabil 2024; 70:204-211. [PMID: 38948639 PMCID: PMC11209341 DOI: 10.5606/tftrd.2024.12178] [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: 01/23/2023] [Accepted: 09/25/2023] [Indexed: 07/02/2024] Open
Abstract
Objectives The study aimed to determine the rates of adherence to phase 2 components of complex decongestive therapy (CDT) and related factors among patients with postmastectomy lymphedema. Patients and methods This cross-sectional study included 90 female patients (mean age: 54.4±8.0 years; range, 24 to 65 years) with unilateral postmastectomy lymphedema who completed chemotherapy or radiotherapy and had previously undergone CDT phase 1 at our clinic or elsewhere between May 2018 and May 2019. Patients were included in the study at their usual visit to the lymphedema polyclinic. After physical examination, study questionnaires that involved patients' demographic and clinic data and Lymphedema Quality of Life scores were recorded. Patients who applied CDT phase 2 methods four days a week or more frequently were considered adherent, while those who applied these methods less frequently or who never applied these methods were considered nonadherent. The body mass index (BMI) scores were classified based on the criteria of the World Health Organization. Results Lymphedema stages of the patients were Stage I in 33.3% (n=30), Stage II in 60% (n=54), and Stage III in 6.7% (n=6). The rates of adherence were 74.4% (n=67) for skin care, 46.6% (n=42) for compression garment use, 42.2% (n=38) for self-massage, 42.2% (n=38) for exercise, and 18.8% (n=17) for multilayer bandaging. The rate of adherence to the multilayer bandaging method was found to be significantly higher in the obese group (BMI >30) than in the other BMI groups. Conclusion Patient adherence to CDT phase 2 was not sufficient except for the skin care component. There was a significant relationship between BMI and adherence to multilayer bandaging.
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Affiliation(s)
- Habibe Kandasoglu
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Türkiye
| | - Sibel Unsal Delialioglu
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Ankara City Hospital, Physical Therapy and Rehabilitation Hospital, Ankara, Türkiye
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Fu X, Shen A, Zhang L, Wang Y, Lu Q. Development and psychometric testing of the lymphedema self-management support scale for breast cancer survivors. Asia Pac J Oncol Nurs 2024; 11:100494. [PMID: 38808012 PMCID: PMC11130995 DOI: 10.1016/j.apjon.2024.100494] [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: 03/05/2024] [Accepted: 04/18/2024] [Indexed: 05/30/2024] Open
Abstract
Objective Effective self-management support should be tailored to the individual. To provide personalized and targeted self-management support, a rigorous assessment tool is needed to screen the actual degree of lymphedema self-management support received by breast cancer survivors. This study aims to develop and psychometrically test the Lymphedema Self-Management Support Scale for Breast Cancer Survivors (LSMS-BCs). Methods This study involves two phases: scale development and psychometric testing. In the scale development phase, preliminary items and domains were identified through a qualitative meta-synthesis, a quantitative systematic review, and reference to previous similar scales. Expert consultation and pilot study were conducted to refine the scale and evaluate the content validity. The psychometric characteristics were tested with 447 participants using item analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), reliability assessments, as well as measurement invariance. Results A preliminary 21-item scale with four domains, basic management support, management support for limb volume reduction, role management support, and emotional management support, was constructed in the scale development phase and well supported by EFA and CFA. The scale-level content validity index was 0.983. Cronbach's α coefficient for overall scale and subscales ranged from 0.732 to 0.949. McDonald's ω ranged from 0.848 to 0.955. Excellent known-groups validity, concurrent validity, predictive validity, and measurement invariance were demonstrated. Conclusions The LSMS-BCs is psychometrically valid and reliable. It can serve as a valuable tool for assessing and understanding the lymphedema self-management support received by breast cancer survivors.
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Affiliation(s)
- Xin Fu
- School of Nursing, Peking University, Beijing, China
- Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Peking University, Beijing, China
| | - Aomei Shen
- School of Nursing, Peking University, Beijing, China
- Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Peking University, Beijing, China
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Lichuan Zhang
- School of Nursing, Peking University, Beijing, China
- Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Peking University, Beijing, China
| | - Yujie Wang
- Department of Nursing, Henan Provincial People's Hospital, Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou, Henan, China
| | - Qian Lu
- School of Nursing, Peking University, Beijing, China
- Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Peking University, Beijing, China
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4
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Brown JA, Olshan AF, Bae-Jump VL, Ogunleye AA, Smith S, Black-Grant S, Nichols HB. Lymphedema self-assessment among endometrial cancer survivors. Cancer Causes Control 2024; 35:771-785. [PMID: 38175324 PMCID: PMC11045305 DOI: 10.1007/s10552-023-01838-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Lower extremity lymphedema (LEL), which causes ankle, leg, and feet swelling, poses a significant challenge for endometrial cancer survivors, impacting physical functioning and psychological well-being. Inconsistent LEL diagnostic methods result in wide-ranging LEL incidence estimates. METHODS We calculated the cumulative incidence of LEL based on survivor-reported Gynecologic Cancer Lymphedema Questionnaire (GCLQ) responses in addition to survivor- and nurse-reported leg circumference measurements among a pilot sample of 50 endometrial cancer survivors (27 White, 23 Black) enrolled in the ongoing population-based Carolina Endometrial Cancer Study. RESULTS Self-leg circumference measurements were perceived to be difficult and were completed by only 17 survivors. Diagnostic accuracy testing measures (sensitivity, specificity, positive and negative predictive value) compared the standard nurse-measured ≥ 10% difference in leg circumference measurements to GCLQ responses. At a mean of ~11 months post-diagnosis, 54% of survivors met established criteria for LEL based on ≥ 4 GCLQ cutpoint while 24% had LEL based on nurse-measurement. Percent agreement, sensitivity, and specificity approximated 60% at a threshold of ≥ 5 GCLQ symptoms. However, Cohen's kappa, a measure of reliability that corrects for agreement by chance, was highest at ≥ 4 GCLQ symptoms (κ = 0.27). CONCLUSION Our findings emphasize the need for high quality measurements of LEL that are feasible for epidemiologic study designs among endometrial cancer survivors. Future studies should use patient-reported survey measures to assess lymphedema burden and quality of life outcomes among endometrial cancer survivors.
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Affiliation(s)
- Jordyn A Brown
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2104F McGavran-Greenberg Hall, CB #7435, 135 Dauer Drive, Chapel Hill, NC, 27599-7435, USA
| | - Andrew F Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2104F McGavran-Greenberg Hall, CB #7435, 135 Dauer Drive, Chapel Hill, NC, 27599-7435, USA
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Victoria L Bae-Jump
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adeyemi A Ogunleye
- Division of Plastic Surgery and Reconstructive Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shawn Smith
- Endometrial Cancer Action Network for African Americans, Seattle, WA, USA
| | | | - Hazel B Nichols
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2104F McGavran-Greenberg Hall, CB #7435, 135 Dauer Drive, Chapel Hill, NC, 27599-7435, USA.
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
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Barnhart H, Maldonado T, Rockson SG. Various Therapies for Lymphedema and Chronic Venous Insufficiency, Including a Multimodal At-Home Nonpneumatic Compression Treatment. Adv Skin Wound Care 2024; 37:212-215. [PMID: 38353650 DOI: 10.1097/asw.0000000000000091] [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: 03/21/2024]
Abstract
ABSTRACT Lymphedema and chronic venous insufficiency (CVI) affect millions of people and require lifelong management. Many compression options exist for the long-term management of these conditions; however, limitations in patient mobility and adherence are common. Current options for care often present challenges with adherence because they are time-intensive and cumbersome. Innovation is needed to improve compression options for patients with chronic edematous conditions, particularly because lymphedema and CVI benefit from combination interventions. In this narrative review, the authors focus on long-term management strategies for lymphedema and CVI and highlight a nonpneumatic compression device designed for ease of use in the management of lymphedema and CVI. Using a nonpneumatic compression device that combines multiple treatment modalities demonstrates improved efficacy, quality of life, and patient adherence.
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Affiliation(s)
- Heather Barnhart
- Heather Barnhart, PhD, is Professor, Department of Physical Therapy, Nova Southeastern University, Ft Lauderdale, Florida. Thomas Maldonado, MD, is Professor, Department of Surgery, New York University Langone Health, New York and Chief Medical Officer, Koya Medical. Stanley G. Rockson, MD, is Professor, Cardiovascular Medicine, Stanford University, Stanford, California and Head of Koya Medical Advisory Board
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Wang Q, Du N. Relationship between kinesiophobia and quality of life among patients with breast cancer-related lymphedema: Chain-mediating effect of self-care and functional exercise compliance. Asia Pac J Oncol Nurs 2024; 11:100346. [PMID: 38179136 PMCID: PMC10764254 DOI: 10.1016/j.apjon.2023.100346] [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: 09/01/2023] [Accepted: 11/16/2023] [Indexed: 01/06/2024] Open
Abstract
Objective Breast cancer-related lymphedema (BCRL) significantly impacts the quality of life (QoL) of breast cancer survivors following treatment. This study explores the association between kinesiophobia (fear of pain caused by movement) and QoL in postsurgical BCRL survivors and examines whether self-care and compliance with functional exercise act as mediators between these variables. Methods This cross-sectional study surveyed 274 BCRL patients at three tertiary hospitals in Shenyang City, China, from May 2020 to October 2022. The participants completed self-reported questionnaires on self-care, functional exercise compliance, kinesiophobia, and QoL. Medication analysis was conducted using the PROCESS macro (Model 6). Results Kinesiophobia was found to have negative association with self-care (P < 0.001), functional exercise compliance (P < 0.001), and QoL (P < 0.001). Kinesiophobia indirectly affected QoL through three mediating pathways: self-care (effect = -0.132), functional exercise compliance (effect = -0.390), and a combination of self-care and functional exercise compliance (effect = -0.220), collectively accounting for 7.9%, 23.3%, and 13.1% of the total effect, respectively. Conclusions This study highlights the substantial chain-mediating role of self-care and functional exercise compliance in the relationship between kinesiophobia and QoL. It provides valuable evidence supporting the protective effects of self-care and functional exercise compliance in mitigating kinesiophobia and enhancing the QoL of BCRL survivors.
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Affiliation(s)
- Qi Wang
- Department of Obstetrics and Gynaecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Na Du
- Department of Obstetrics and Gynaecology, Shengjing Hospital of China Medical University, Shenyang, China
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Sun Y, Fu MR, Jiang Y, Little AS. Initiating and Maintaining Complete Decongestive Therapy Self-Management of Lymphedema Among Breast Cancer Survivors: Descriptive Qualitative Study. Integr Cancer Ther 2024; 23:15347354241226625. [PMID: 38281117 PMCID: PMC10823848 DOI: 10.1177/15347354241226625] [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: 01/07/2022] [Revised: 12/08/2023] [Accepted: 01/02/2024] [Indexed: 01/29/2024] Open
Abstract
PURPOSE This study aimed to identify determinants that promote the initiation and maintenance of complete decongestive therapy (CDT) as well as effective strategies for mitigating barriers to self-management of lymphedema among breast cancer survivors. METHODS A descriptive and qualitative design was used. In-depth interviews were conducted with 13 breast cancer survivors who were managing breast cancer-related lymphedema. Interviews were transcribed verbatim. An iterative descriptive data analysis method was employed to examine the data, compare codes, challenge interpretations, and inductively identify themes. RESULTS A realization that lymphedema requires daily self-management was the primary determinant leading breast cancer survivors to initiate CDT self-management. The determinants for maintaining daily CDT self-management included the perceived effectiveness of CDT, being willing to assume accountability, and perceived efficacy to undertake CDT. Developing strategies to integrate CDT regimens into daily life is key to maintaining CDT self-management of lymphedema. Three core concepts mediate initiation and maintenance of CDT self-management: understanding lymphedema as a chronic condition that can be managed with CDT self-management, being worried about lymphedema exacerbation, and having support from patient peers and family. CONCLUSIONS Interventions should be tailored to promote the initiation and maintenance of CDT self-management. While clinicians provided knowledge-based and clinical skills-based information, patient peers provided daily life examples, and real-life implementation strategies for CDT self-management. Ongoing patient-provider and patient-peer communication functioned as effective support for maintaining CDT self-management. Reliable and realistic methods of symptom self-assessment are important for maintaining CDT at home.
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Affiliation(s)
| | | | - Yun Jiang
- University of Michigan, Ann Arbor, MI, USA
| | - Amy S. Little
- University of Iowa Hospital and Clinics, Iowa City, IA, USA
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Maingi S, O'Malley EM. Impact of text reminders on pneumatic compression device (PCD) compliance in patients with breast cancer-related lymphedema. Support Care Cancer 2023; 32:33. [PMID: 38102530 PMCID: PMC10724087 DOI: 10.1007/s00520-023-08246-9] [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: 08/21/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE Do cell phone text reminders impact the rate of compliance with pneumatic compression device (PCD) therapy among women with breast cancer-related lymphedema (BCRL)? METHODS A prospective, randomized, 2-group feasibility study conducted at 2 centers. Participants were adult females (≥18 years old) with unilateral BCRL who had the capability of receiving reminder text messages. All participants underwent PCD therapy. Participants were randomized 1:1 to control (no text messages) or test group (received text message reminders if the PCD had not been used for 2 consecutive days). The rate of compliance between treatment groups was the main outcome measure. Secondary outcome measures were changes in arm girth, quality of life (QOL), and symptom severity. RESULTS Twenty-nine participants were enrolled and randomized, 25 were available for follow-up at 60 days (14 test, 11 control). Overall, 52.2% (12/23) of all participants were completely compliant, an additional 43.5% (10/23) were partially compliant, and 1 patient (4.3%) was noncompliant. The test and control groups did not differ in device compliance. In the pooled population, weight, BMI, and arm girth were improved. Overall disease-specific QOL and symptom severity were improved. Regression analysis showed benefits were greater among participants with higher rates of compliance. CONCLUSIONS Automated text reminders did not improve compliance in patients with BCRL as compliance rates were already high in this patient population. Improvements in weight, BMI, arm girth, disease-specific quality of life, and symptom severity measures were observed regardless of the treatment assignment. Full compliance resulted in greater functional and QOL benefits. TRIAL REGISTRATION The study was registered at www. CLINICALTRIALS gov (NCT04432727) on June 16, 2020.
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Affiliation(s)
- Shail Maingi
- St Peter's Health Partners, Albany, NY, 12208, USA.
- Dana-Farber Cancer Institute, 101 Columbian St., South Weymouth, MA, 02190, USA.
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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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Shen A, Wu P, Qiang W, Zhu F, Zhang Z, Wang Y, Lu Q. Breast cancer survivors' experiences of barriers and facilitators to lymphedema self-management behaviors: a theory-based qualitative study. J Cancer Surviv 2023:10.1007/s11764-023-01497-9. [PMID: 37971555 DOI: 10.1007/s11764-023-01497-9] [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: 06/29/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Lifelong self-management plays a critical role in the prevention and management of lymphedema among breast cancer survivors. However, adherence to lymphedema self-management behaviors has remained suboptimal. Hence, we adopted a theory-informed method to elucidate the facilitators and barriers of lymphedema self-management for breast cancer survivors. METHODS In-depth semi-structured interviews were conducted between August and October 2022 in the lymphedema nursing clinic of a tertiary cancer hospital. The maximum variation sampling technique was used to ensure a diverse sample. The ITHBC (Integrated Theory of Health Behavior Change) framework was used to inform the interview outline and data analysis. Interview transcripts were coded line-by-line and mapped to domains in accordance with the ITHBC, using both deductive and inductive content analysis. RESULTS A total of 16 participants were interviewed (aged 35 to 67). Twenty-three themes (12 facilitators and 11 barriers) were mapped onto the three domains (knowledge and belief, social facilitation, and self-regulation skill and ability) of ITHBC as facilitators and barriers to lymphedema self-management. Three additional themes including limited treatment resources for lymphedema, inconvenience of lymphedema management, boredom and tedium of lymphedema self-management were categorized under the domain of other barriers. CONCLUSIONS Incorporating these findings into the ITHBC framework allows for a more systematic selection of theory-based strategies that may improve the design of effective lymphedema self-management interventions for breast cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Elucidating impact factors, especially facilitators and barriers, for lymphedema self-management adherence is essential for developing effective intervention programs to enhance breast cancer survivors' lymphedema self-management behaviors.
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Affiliation(s)
- Aomei Shen
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, Huanhuxi Road, Hexi District, Tianjin, China
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, China
| | - Peipei Wu
- Lymphedema Clinic, Tianjin Medical University Cancer Institute & Hospital, Huanhuxi Road, Hexi District, Tianjin, China
| | - Wanmin Qiang
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, Huanhuxi Road, Hexi District, Tianjin, China
| | - Fei Zhu
- School of Nursing, Hebei University, No. 342 Yuhua East Road, Lianchi District, Baoding, China
| | - Zijuan Zhang
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, China
| | - Ying Wang
- Department of Breast Cancer, Tianjin Medical University Cancer Institute & Hospital, Huanhuxi Road, Hexi District, Tianjin, China
| | - Qian Lu
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, China.
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Karaca-Mandic P, Solid CA, Armer JM, Skoracki R, Campione E, Rockson SG. Lymphedema self-care: economic cost savings and opportunities to improve adherence. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:47. [PMID: 37516870 PMCID: PMC10386258 DOI: 10.1186/s12962-023-00455-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/20/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Breast cancer-related lymphedema (BCRL) imposes a significant economic burden on patients, providers, and society. There is no curative therapy for BCRL, but management through self-care can reduce symptoms and lower the risk of adverse events. MAIN BODY The economic burden of BCRL stems from related adverse events, reductions in productivity and employment, and the burden placed on non-medical caregivers. Self-care regimens often include manual lymphatic drainage, compression garments, and meticulous skin care, and may incorporate pneumatic compression devices. These regimens can be effective in managing BCRL, but patients cite inconvenience and interference with daily activities as potential barriers to self-care adherence. As a result, adherence is generally poor and often worsens with time. Because self-care is on-going, poor adherence reduces the effectiveness of regimens and leads to costly treatment of BCRL complications. CONCLUSION Novel self-care solutions that are more convenient and that interfere less with daily activities could increase self-care adherence and ultimately reduce complication-related costs of BCRL.
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Affiliation(s)
- Pinar Karaca-Mandic
- Carlson School of Management, University of Minnesota, Carlson School of Management, 321 19th Avenue South, Minneapolis, MN, 55455, USA.
| | | | - Jane M Armer
- University of Missouri Sinclair School of Nursing, Columbia, MO, USA
| | - Roman Skoracki
- James Cancer Treatment and Research Center, Ohio State University, Columbus, OH, USA
| | | | - Stanley G Rockson
- Stanford Center for Lymphatic and Venous Disorders, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Deveci Z, Karayurt Ö, Bilik O, Eyigör S. Development of the Breast Cancer Related Lymphedema Self-Care Scale. Clin Nurs Res 2023; 32:221-232. [PMID: 32757769 DOI: 10.1177/1054773820947980] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The purpose of study was to develop the Breast Cancer Related Lymphedema Self-Care Scale to evaluate the self-care practices of women with breast cancer-related lymphedema (BRCL); and to examine the psycholinguistic and psychometric characteristics of this scale. The item pool of the scale was created based on the literature in this descriptive study. Content validity, explanatory and confirmatory factor analyses used in evaluation of the validity; and item analyzes, the Cronbach's Alpha and Split Half analyzes were made for reliability in the study. The content validity index was found to be above 0.80. In the Explanatory Factor Analysis, a four-factor structure was obtained. In Confirmatory Factor Analysis, fit indices were found to be acceptable. Cronbach's Alpha coefficients of the sub-dimensions of the scale varied between 0.62 and 0.86. It was determined the Breast Cancer Related Lymphedema Self-Care Scale was a valid and reliable scale for women with BRCL.
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Affiliation(s)
- Zeynep Deveci
- PhD Student at Dokuz Eylul University, Institute of Health Sciences, Izmir, and Research Assistant at Pamukkale University, Faculty of Health Science, Nursing Department, Denizli, Turkey
| | - Özgül Karayurt
- Izmir University of Economics, Faculty of Health Science, Department of Nursing, Izmir, Turkey
| | - Ozlem Bilik
- Dokuz Eylul University, Nursing Faculty, Surgical Nursing Department, Izmir, Turkey
| | - Sibel Eyigör
- Ege University Faculty of Medicine, Department of Physical Therapy and Rehabilitation, Izmir, Turkey
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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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14
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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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15
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Clinical Characteristics and Implications of Indocyanine Green Lymphography-Identified Contralateral Inguinal Pathway of Lower-Limb Lymphedema. REHABILITATION ONCOLOGY 2022. [DOI: 10.1097/01.reo.0000000000000322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Devitt M, Ramanan D, Armitstead J, Zhu X, Mackie H. Usability evaluation of a novel compact pneumatic compression device for the treatment of lymphoedema: Pilot study. Phlebology 2022; 37:564-571. [PMID: 35503339 PMCID: PMC9446425 DOI: 10.1177/02683555221096298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective To perform a preliminary usability evaluation of a novel, compact pneumatic
compression device in patients with lymphoedema. Methods This open-label, single-arm trial had two phases: the first focused on the
fitting of the pneumatic compression device (Aria FreeTM, Aria
Health, San Diego CA, USA) and the second focused on evaluating the comfort
of the entire system during a 45-min usage period. Both phases were
conducted in a monitored clinical environment. Patients aged ≥18 years with
a diagnosis of lower limb lymphoedema who had used a pneumatic compression
device for ≥3 months were eligible. Patients rated subjective fit, comfort
and usability on an 11-point Likert scale (where higher scores indicate
better fit/comfort/usability). The truncated cone method was used to infer
limb volume before and after therapy in phase 2. Results Twenty-four patients were screened, and 15 were enrolled (80% female; mean
age 62 years); all completed both study phases. Patients rated the garment
as easy to set up and fit (median score 6.5), and all reported that the
therapy was comfortable (median score 10; p < 0.001 vs.
reference score of 6). There was a 1.85% reduction in limb volume after
device use for 45 min (p = 0.018 vs. before therapy). No
safety issues were identified. Conclusions The new pneumatic compression device fitted well, was easy to use and reduced
leg oedema.
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Affiliation(s)
| | | | | | - Xueling Zhu
- ResMed Science Center, Sydney, NSW, Australia
| | - Helen Mackie
- ALERT Macquarie University, Sydney, NSW, Australia
- Mt Wilga Private Hospital, Hornsby, NSW, Australia
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17
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Lee S, Lee DG, Kim KT. Temporal Changes in Subcutaneous Fibrosis in Patients with Lower Extremity Lymphedema Following Surgery for Gynecologic Cancer: A Computed Tomography-Based Quantitative Analysis. Diagnostics (Basel) 2022; 12:diagnostics12081949. [PMID: 36010297 PMCID: PMC9406798 DOI: 10.3390/diagnostics12081949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/11/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
Lymphedema causes inflammation, which provokes fibrosis within the epifascial tissue. Temporal change in fibrosis according to severity of the lymphedema has not been widely investigated. We aimed to study the quantitative changes in epifascial fibrosis during lymphedema treatment using computed tomography (CT). Forty-five patients (mean age: 57.75 ± 11.12 years) who developed lymphedema following gynecologic surgery were included in this retrospective study. Two weeks of complete decongestive therapy and continued self-bandaging or compression garments were prescribed under regular follow-up monitoring. Lower-extremity epifascial fibrosis was quantitatively analyzed on the initial and follow-up CT scans. Circumference, skin fibrosis, subcutaneous tissue, and fibrosis ratio were calculated in the axial scan. Based on the change in lymphedema severity, we divided subjects into ‘improved’ and ‘aggravated’ groups. The affected lower extremities showed higher circumference, more skin fibrosis and subcutaneous tissue, and higher fibrosis ratio than the unaffected sides on initial CT scan. At follow-up, compared to the aggravated group, the improved group showed significant decreases in fibrosis of skin and subcutaneous tissue and fibrosis ratio. Subcutaneous fibrosis was reversible with volume resolution of lymphedema. Therapeutic approaches should be established on the basis of the reversible nature of fibrotic changes in patients with lower extremity lymphedema.
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Affiliation(s)
- Soyoung Lee
- Department of Rehabilitation Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Korea
| | - Dong Gyu Lee
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu 42415, Korea
| | - Kyoung Tae Kim
- Department of Rehabilitation Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Korea
- Correspondence: ; Tel.: +82-53-258-7692
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18
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Fu X, Lu Q, Pang D, Shen A, Shih YA, Wei X. Experiences of breast cancer survivors with lymphedema self-management: a systematic review of qualitative studies. J Cancer Surviv 2022; 17:619-633. [PMID: 35773611 DOI: 10.1007/s11764-022-01225-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/13/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE This study systematically identified, evaluated, and synthesized qualitative literature on the experiences of breast cancer survivors with lymphedema self-management. METHODS This systematic review followed the Joanna Briggs Institute meta-aggregation approach and was guided by the ENTREQ, graded according to the ConQual approach, and evaluated using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). Qualitative studies related to the experiences in lymphedema self-management among breast cancer survivors conducted until March 9, 2022, were searched. The selected studies were reviewed independently, and the data were synthesized collaboratively into core themes. RESULTS A total of 24 studies were included, and 85 findings resulted in three synthesis findings: (a) breast cancer survivors face challenges in lymphedema self-management, (b) breast cancer survivors are entangled in rebuilding a new balance between different roles, and (c) breast cancer survivors seek internal and external resources to regulate negative emotions. CONCLUSIONS Lymphedema self-management is a lifetime commitment and a challenge for breast cancer survivors, who find it difficult to adhere to self-management and cope with their problems. They require timely and continuous effective self-management education, and instrumental and emotional support from others, particularly healthcare providers and family members. IMPLICATIONS FOR CANCER SURVIVORS Timely self-management education and access to lymphedema treatment and related resources are important for survivors to prevent and manage lymphedema. Breast cancer survivors should develop coping skills, and family members should participate in survivors' lymphedema self-management.
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Affiliation(s)
- Xin Fu
- Peking University School of Nursing, Beijing, China
| | - Qian Lu
- Peking University School of Nursing, Beijing, China.
| | - Dong Pang
- Peking University School of Nursing, Beijing, China
| | - Aomei Shen
- Peking University School of Nursing, Beijing, China
| | - Yi-An Shih
- Peking University School of Nursing, Beijing, China
| | - Xiaoxia Wei
- Peking University School of Nursing, Beijing, China
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19
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Cansız G, Arıkan Dönmez A, Kapucu S, Borman P. The effect of a self-management lymphedema education program on lymphedema, lymphedema-related symptoms, patient compliance, daily living activities and patient activation in patients with breast cancer-related lymphedema: A quasi-experimental study. Eur J Oncol Nurs 2021; 56:102081. [PMID: 34875398 DOI: 10.1016/j.ejon.2021.102081] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE This study was undertaken to determine the effects of self-management lymphedema education program (SMLEP) on lymphedema, lymphedema-related symptoms, patient compliance, activities of daily living (ADL) and patient activation in patients with breast cancer-related lymphedema (BCRL). METHODS A quasi-experimental design without a control group was used to conduct this study in a lymphedema center of a university hospital in Ankara. A total of 44 patients with BCRL participated in the study. Patients (n = 44) received a SMLEP in the form of face-to-face sessions and information booklet at the beginning of the study. Patients were evaluated for upper extremity (UE) volume, and they were followed for 12 months. UE volume, symptom severity, physical function, patient compliance, ADL and patient activity level were measured at the beginning and end of the study. RESULTS A significant reduction was found in the UE volume (P = 0.000; ES = -0.79) and swelling and numbness symptom scores (P = 0.016; ES = - 0.26; P = 0.002; ES = -0.45, respectively). In addition, a significant increase was found in patient compliance (P = 0.001; ES = -0.29), ADL (P = 0.018; ES = -0.16) and patient activity level (P = 0.000; ES = -0.39) compared to those at the baseline. CONCLUSION The present study results showed that SMLEP reduced UE volume and lymphedema-related symptoms. In addition, results demonstrated its effectiveness on patient compliance and activity level, and independent performance of ADL. The results suggest that SMLEP is an effective approach in long-term lymphedema self-management.
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Affiliation(s)
- Gizem Cansız
- Hacettepe University Adult Hospital, Department of Thorax, Cardiovascular Surgery Intensive Care Unit, Ankara, Turkey
| | | | | | - Pınar Borman
- University of Health Sciences, Ankara City Hospital, Rehabilitation Hospital, Ankara, Turkey
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20
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McNeely ML, Dolgoy ND, Rafn BS, Ghosh S, Ospina PA, Al Onazi MM, Radke L, Shular M, Kuusk U, Webster M, Campbell KL, Mackey JR. Nighttime compression supports improved self-management of breast cancer-related lymphedema: A multicenter randomized controlled trial. Cancer 2021; 128:587-596. [PMID: 34614195 DOI: 10.1002/cncr.33943] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/11/2021] [Accepted: 06/28/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lymphedema is a prevalent long-term effect of breast cancer treatment associated with reduced quality of life. This study examined the efficacy of nighttime compression as a self-management strategy for women with chronic breast cancer-related lymphedema. METHODS Th authors conducted a parallel 3-arm, multicenter, randomized trial. Women were recruited from 3 centers in Canada and randomized to group 1 (daytime compression garment alone [standard care]), group 2 (daytime compression garment plus nighttime compression bandaging), or group 3 (daytime compression garment plus the use of a nighttime compression system garment). The primary outcome was the change in excess arm volume from the baseline to 12 weeks. Participants from all groups used a nighttime compression system garment from weeks 13 to 24. RESULTS One hundred twenty women were enrolled, 118 completed the randomized trial, and 114 completed the 24-week follow-up. The rates of adherence to nighttime compression were 95% ± 15% and 96% ± 11% in the compression bandaging and nighttime compression system groups, respectively. After the intervention, the addition of nighttime compression was found to be superior to standard care for both absolute milliliter reductions (P = .006) and percentage reductions (P = .002) in excess arm lymphedema volume. Significant within-group changes were seen for quality of life across all groups; however, no between-group differences were found (P > .05). CONCLUSIONS The trial demonstrated a significant improvement in arm lymphedema volume from the addition of nighttime compression whether through the application of compression bandaging or through the use of a nighttime compression system garment. LAY SUMMARY Lymphedema is swelling that occurs in the arm on the side of the surgery for breast cancer. Lymphedema occurs in approximately 21% of women. Lymphedema tends to worsen over time and can result in recurrent infections in the arm, functional impairment, and pain. Currently, treatment consists of intensive treatments to reduce the swelling followed by regular use of a compression sleeve during the day. This study examined and found a benefit from the addition of nighttime compression (whether through self-applied compression bandaging or through the use of a nighttime compression system garment) to the use of a daytime compression sleeve.
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Affiliation(s)
- Margaret L McNeely
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada.,Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - Naomi D Dolgoy
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Bolette Skjodt Rafn
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sunita Ghosh
- Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - Paula A Ospina
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Mona M Al Onazi
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Lori Radke
- Tom Baker Cancer Centre, Alberta Health Service, Calgary, Alberta, Canada
| | - Mara Shular
- Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - Urve Kuusk
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marc Webster
- Tom Baker Cancer Centre, Alberta Health Service, Calgary, Alberta, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - John R Mackey
- Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
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21
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Rangon FB, da Silva J, Dibai-Filho AV, Guirro RRDJ, Guirro ECDO. Effects of Complex Physical Therapy and Multimodal Approaches on Lymphedema Secondary to Breast Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil 2021; 103:353-363. [PMID: 34407446 DOI: 10.1016/j.apmr.2021.06.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/26/2021] [Accepted: 06/07/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE What are the immediate, short-term, and long-term effects of complex physical therapy and multimodal approaches on lymphedema secondary to breast cancer? DATA SOURCES Four electronic databases (MEDLINE, Embase, Cochrane Library, Physiotherapy Evidence Database) were searched from inception up to August 2020. STUDY SELECTION Randomized controlled trials comparing complex physical therapy and multimodal approaches to the conservative treatment of lymphedema secondary to breast cancer. DATA EXTRACTION Two independent researchers performed data extraction and assessed the risk of bias, respectively, using the predefined form and Cochrane Collaboration of Risk of Bias. The determination of evidence quality was carried out using the Grading of Recommendations Assessment, Development, and Evaluation tools. DATA SYNTHESIS Fourteen studies were identified for the systematic review and 11 studies for the meta-analysis with standardized mean difference (SMD), 95% CI, and random-effect model. The common outcomes involved total volume, pain, and physical function of the upper limb. Complex physical therapy has shown a favorable tendency to control outcomes in the short- and long-term. The meta-analysis indicated a small effect for volume reduction (SMD, -0.18; 95% confidence interval [CI], -0.35 to 0.00) and a moderate effect for short-term pain reduction (SMD, -0.61; 95% CI, -1.19 to -0.02). CONCLUSIONS High-quality evidence suggests a more significant effect of complex physical therapy on multimodal approaches to the control of the upper limb total volume, substantiating the absence of changes in the current clinical practice in the management of lymphedema secondary to breast cancer. Future research should aim to identify concrete effect of therapeutic modalities in the immediate-, short-, and long-term.
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Affiliation(s)
- Flávia Belavenuto Rangon
- Postgraduate Program in Rehabilitation and Functional Performance, Department of Health Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirao Preto, São Paulo.
| | - Jéssica da Silva
- Postgraduate Program in Rehabilitation and Functional Performance, Department of Health Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirao Preto, São Paulo
| | - Almir Vieira Dibai-Filho
- Postgraduate Program in Physical Education, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | - Rinaldo Roberto de Jesus Guirro
- Postgraduate Program in Rehabilitation and Functional Performance, Department of Health Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirao Preto, São Paulo
| | - Elaine Caldeira de Oliveira Guirro
- Postgraduate Program in Rehabilitation and Functional Performance, Department of Health Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirao Preto, São Paulo
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Breast cancer-related lymphedema patient and healthcare professional experiences in lymphedema self-management: a qualitative study. Support Care Cancer 2021; 29:8027-8044. [PMID: 34226959 DOI: 10.1007/s00520-021-06390-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Breast cancer-related lymphedema (BCRL) self-management plays an important role in the lymphedema therapy. However, clinical knowledge of BCRL self-management remains minimal. This study aims to explore the experience surrounding lymphedema self-management from the perspectives of BCRL patients and healthcare professionals. METHODS Semi-structured interviews were implemented with BCRL patients and healthcare professionals. Audio-recordings of interviews were transcribed verbatim and thematic analysis was undertaken to analyze the interview data. RESULTS Thirteen BCRL patients (aged 34-65 years) and nine healthcare professionals (2 physicians, 4 nurses, and 3 lymphedema therapists) were interviewed. Five themes emerged from interviews with participants: knowledge-attitude-practice surrounding lymphedema self-management, emotional reactions towards lymphedema self-management, factors influencing lymphedema self-management, support needs for lymphedema self-management, healthcare professional support of BCRL self-management. CONCLUSIONS This study showed knowledge-attitude-practice, feelings, influencing factors, roles, dilemmas, and support needs regarding BCRL self-management. Greater effort is required for healthcare professionals to strengthen the lymphedema self-management. Providing more educational program and holistic support, and strengthening the facilitators and controlling the barriers might benefit promoting lymphedema self-management. Likewise, healthcare professionals need adequate training to be able to meet patients' self-management support needs.
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23
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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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24
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Bucci LK, Brunelle CL, Bernstein MC, Shui AM, Gillespie TC, Roberts SA, Naoum GE, Taghian AG. Subclinical Lymphedema After Treatment for Breast Cancer: Risk of Progression and Considerations for Early Intervention. Ann Surg Oncol 2021; 28:8624-8633. [PMID: 34117574 DOI: 10.1245/s10434-021-10173-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/29/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Breast cancer-related lymphedema (BCRL) is a devastating complication of breast cancer (BC) treatment. The authors hypothesized that identifying subclinical lymphedema (SCL) presents an opportunity to prevent BCRL development. They aimed to assess rates of SCL progression (relative volume change [RVC], 5-10%) to BCRL (RVC, ≥10%) in women undergoing axillary surgery for BC via axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB). METHODS Patients treated for BC were prospectively screened at preoperative baseline and throughout the follow-up period using the perometer. The cohort was stratified according to nodal surgery (ALND or SLNB) to analyze rates of progression to BCRL. RESULTS The study cohort included 1790 patients. Of the 1359 patients who underwent SLNB, 331 (24.4%) experienced SCL, with 38 (11.5%) of these patients progressing to BCRL. Of the 431 patients who underwent ALND, 171 (39.7%) experienced SCL, with 67 (39.2%) of these patients progressing to BCRL. Relative to the patients without SCL, those more likely to experience BCRL were the ALND patients with early SCL (< 3 months postoperatively; hazard ratio [HR], 2.60; 95% confidence interval [CI], 1.58-4.27; p = 0.0002) or late SCL (≥3 months postoperatively; HR, 3.14; 95% CI, 1.95-5.05; p < 0.0001) and the SLNB patients with early SCL (HR, 6.75; 95% CI, 3.8-11.98; p < 0.0001 or late SCL (HR, 3.02; 95% CI, 1.65-5.50; p = 0.0003). CONCLUSION The study suggests that patients with SCL after axillary nodal surgery for BC are more likely to progress to BCRL than those who do not experience SCL. This presents a tremendous opportunity for early intervention to prevent BCRL and improve the quality of life for women treated for BC.
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Affiliation(s)
- Loryn K Bucci
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cheryl L Brunelle
- Department of Physical and Occupational Therapy, Massachusetts General Hospital, Boston, MA, USA
| | - Madison C Bernstein
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Amy M Shui
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Tessa C Gillespie
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sacha A Roberts
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - George E Naoum
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alphonse G Taghian
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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The efficacy of different bandaging methods in patients with breast cancer-related lymphedema: A prospective, randomized study. Turk J Phys Med Rehabil 2021; 67:155-166. [PMID: 34396066 PMCID: PMC8343160 DOI: 10.5606/tftrd.2021.6287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/17/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives
The aim of this study was to evaluate the comparative efficacy of 3MTM CobanTM 2 layer system and conventional multi-layer short-stretch bandaging in terms of volume reduction, ultrasonographic measurements, functional status, and quality of life (QoL) in the treatment of patients with breast cancer-related lymphedema (BCRL).
Patients and methods
This prospective, single-blind, randomized study included a total of 60 BCRL patients (60 females; mean age 54.9±9.6 years; range, 30 to 73 years). The patients were randomly allocated to Group 1 (n=30) and Group 2 (n=30). Both groups received complex decongestive therapy (CDT) including skin care, lymphedema exercises, and manual lymphatic drainage (MLD) combined with traditional multi-layer short-stretch bandaging five times per week for three weeks in Group 1 and with 3MTM CobanTM 2 layer system bandaging two times per week for three weeks in Group 2. Differences in volumes, excess volumes, ultrasonographic measurements, QoL, and functional assessment scores were evaluated at baseline, after three weeks of intensive treatment period, and at two months of follow-up. Functional status was evaluated by the Quick Disability of Arm Shoulder and Hand Questionnaire (Q-DASH), while the QoL was assessed using the Turkish version of Lymphedema Quality of Life Questionnaire-Arm (LYMQOL-Arm). The duration and easiness of applying bandages by physiotherapists and comfortableness of bandages according to patients and physiotherapists were also evaluated using a questionnaire.
Results
The demographic and clinical properties were similar between the groups. There were significant improvements in the volumes, excess volumes, ultrasonographic measures, functional scores, and QoL scores in both groups at the end of treatment. The improvements were sustained at two months of follow-up.
Conclusion
The 3MTM CobanTM 2 layer bandaging as a part of CDT twice a week for a period of three weeks can significantly reduce the volume and improve the disability and impaired QoL, similar to conventional short-stretch multi-layer bandages. In addition, treatment with this layer system enables a time-efficient, easy, and comfortable application of bandaging with increased mobility of the upper extremity.
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Self-care practices, patient education in women with breast cancer-related lymphedema. Turk J Phys Med Rehabil 2021; 67:187-195. [PMID: 34396069 PMCID: PMC8343163 DOI: 10.5606/tftrd.2021.5022] [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] [Received: 07/04/2019] [Accepted: 04/01/2020] [Indexed: 11/28/2022] Open
Abstract
Objectives
This study aims to evaluate self-care practices, sociodemographic and clinical factors that affect self-care and patient education among women with breast cancer-related lymphedema (BCRL).
Patients and methods
This descriptive, cross-sectional study included a total of 102 women with BCRL (median age: 59 years; range, 35 to 80 years) who received lymphedema (LE) treatment at least once between July 2014 and May 2016. A Sociodemographic and Clinical Characteristics Form and the Lymphedema Self-care Survey were used to collect data via face-to-face interviews.
Results
The median LE self-care practices score for women was 10 (range, 5 to 14). A total of 39.1% of the women implemented regular self-care. A statistically significant relationship was found between the score for perceived benefit of LE self-care and the score for self-care practice. No statistically significant difference was found among the self-care scores of the women with LE in terms of sociodemographic and clinical factors, except for education status. A total of 90.2% of the women with LE received self-care education, mostly from a physical therapy specialist and a physiotherapist. There was a statistically significant difference among self-care scores between patients who were educated and uneducated about LE.
Conclusion
It is recommended that healthcare professionals should educate patients diagnosed with breast cancer to reduce LE risk and promote the implementation of self-care practices following the breast cancer surgery. Interventions should be made to increase the perceived benefits and reduce the perceived barriers and burden towards self-care behaviors to prevent and manage LE.
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Koelmeyer LA, Thompson BM, Mackie H, Blackwell R, Heydon-White A, Moloney E, Gaitatzis K, Boyages J, Suami H. Personalizing Conservative Lymphedema Management Using Indocyanine Green-Guided Manual Lymphatic Drainage. Lymphat Res Biol 2020; 19:56-65. [PMID: 33270517 DOI: 10.1089/lrb.2020.0090] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The Australian Lymphoedema Education, Research and Treatment Program (ALERT) at Macquarie University in Sydney, Australia is one of the flagship programs of Australia's first fully integrated academic health sciences centre, MQ Health. The aim of this study was to describe our findings of compensatory drainage demonstrated by indocyanine green (ICG) lymphography in cancer-related upper and lower limb lymphedema and how this may be translated into clinical practice. Methods and Results: Retrospective data from 339 patients aged between 18 and 90 years with secondary cancer-related unilateral or bilateral lymphedema of the upper or lower limb who underwent ICG lymphography assessment at the ALERT clinic between February 2017 and March 2020 were analyzed. In patients with upper limb lymphedema, the ipsilateral axilla was the most frequent drainage region (74.9%), followed by clavicular (41.8%) and parasternal (11.3%). For patients with mild upper limb lymphedema, 94.4% drained to the ipsilateral axilla. No patients drained to the ipsilateral inguinal region. For lower limb lymphedema, drainage to the ipsilateral inguinal was most common (52.3%), followed by contralateral inguinal (30.7%), popliteal (26.1%), and gluteal (21.6%) regions. Three main patterns of superficial lymphatic compensation were identified based on which anatomical structure carried lymph fluid. Manual lymphatic drainage (MLD) was used to facilitate movement of the dye. A light/effleurage technique was sufficient to move the dye through patent lymphatic vessels; a slow and firmer technique was required to move the dye through areas of bridging dermal backflow. Conclusion: The introduction of ICG lymphography to our program and its use in guiding personalized conservative management plans, including facilitative MLD techniques, has translated into clinical practice and changed research and educational priorities within the ALERT program.
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Affiliation(s)
- Louise A Koelmeyer
- Department of Clinical Medicine, Faculty of Medicine, Health & Human Sciences, Australian Lymphoedema Education, Research and Treatment Centre, Macquarie University, Sydney, Australia
| | - Belinda M Thompson
- Department of Clinical Medicine, Faculty of Medicine, Health & Human Sciences, Australian Lymphoedema Education, Research and Treatment Centre, Macquarie University, Sydney, Australia
| | - Helen Mackie
- Department of Clinical Medicine, Faculty of Medicine, Health & Human Sciences, Australian Lymphoedema Education, Research and Treatment Centre, Macquarie University, Sydney, Australia.,Mount Wilga Private Hospital, Hornsby, New South Wales, Australia
| | - Robbie Blackwell
- Department of Clinical Medicine, Faculty of Medicine, Health & Human Sciences, Australian Lymphoedema Education, Research and Treatment Centre, Macquarie University, Sydney, Australia
| | - Asha Heydon-White
- Department of Clinical Medicine, Faculty of Medicine, Health & Human Sciences, Australian Lymphoedema Education, Research and Treatment Centre, Macquarie University, Sydney, Australia
| | - Emma Moloney
- Department of Clinical Medicine, Faculty of Medicine, Health & Human Sciences, Australian Lymphoedema Education, Research and Treatment Centre, Macquarie University, Sydney, Australia
| | - Katrina Gaitatzis
- Department of Clinical Medicine, Faculty of Medicine, Health & Human Sciences, Australian Lymphoedema Education, Research and Treatment Centre, Macquarie University, Sydney, Australia
| | - John Boyages
- Department of Clinical Medicine, Faculty of Medicine, Health & Human Sciences, Australian Lymphoedema Education, Research and Treatment Centre, Macquarie University, Sydney, Australia.,Icon Cancer Centre, Wahroonga, New South Wales, Australia
| | - Hiroo Suami
- Department of Clinical Medicine, Faculty of Medicine, Health & Human Sciences, Australian Lymphoedema Education, Research and Treatment Centre, Macquarie University, Sydney, Australia
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Paskett ED, Le-Rademacher J, Oliveri JM, Liu H, Seisler DK, Sloan JA, Armer JM, Naughton MJ, Hock K, Schwartz M, Unzeitig G, Melnik M, Yee LD, Fleming GF, Taylor JR, Loprinzi C. A randomized study to prevent lymphedema in women treated for breast cancer: CALGB 70305 (Alliance). Cancer 2020; 127:291-299. [PMID: 33079411 DOI: 10.1002/cncr.33183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lymphedema affects many women who are treated for breast cancer. We examined the effectiveness of an education-only (EO) versus education plus sleeve compression/exercise intervention (lymphedema education and prevention [LEAP]) on lymphedema incidence and range of motion (ROM) in a group-randomized trial across 38 cooperative group sites. METHODS The treating institution was randomly assigned to either EO or LEAP by a study statistician. All patients at a treating institution participated in the same intervention (EO or LEAP) to minimize contamination bias. Participants completed surveys, arm volume measurements, and self-reported ROM assessments before surgery and at 12 and 18 months after surgery. Lymphedema was defined as a ≥10% difference in limb volume at any time post-surgery up to 18 months after surgery or diagnosis by a health provider. Cochran-Mantel-Haenszel tests were used to compare lymphedema-free rates between groups, stratified by lymph node surgery type. Self-reported ROM differences were compared between groups. RESULTS A total of 554 participants (56% LEAP) were included in the analyses. At 18 months, lymphedema-free rates were 58% (EO) versus 55% (LEAP) (P = .37). ROM for both arms was greater in LEAP versus EO at 12 months; by 18 months, most women reported full ROM, regardless of group. In LEAP, only one-third wore a sleeve ≥75% of the time; 50% performed lymphedema exercises at least weekly. CONCLUSION Lymphedema incidence did not differ by intervention group at 18 months. Poor adherence in the LEAP group may have contributed. However, physical therapy may speed recovery of ROM. Further research is needed to effectively reduce the incidence and severity of lymphedema in patients who have breast cancer.
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Affiliation(s)
- Electra D Paskett
- The Ohio State University Comprehensive Cancer Center, Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Columbus, Ohio
| | - Jennifer Le-Rademacher
- Department of Health Sciences Research, Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Jill M Oliveri
- The Ohio State University Comprehensive Cancer Center, Population Sciences, Columbus, Ohio
| | - Heshan Liu
- Department of Health Sciences Research, Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Drew K Seisler
- Department of Health Sciences Research, Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Jeffrey A Sloan
- Department of Health Sciences Research, Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Jane M Armer
- University of Missouri Sinclair School of Nursing, Columbia, Missouri
| | - Michelle J Naughton
- The Ohio State University Comprehensive Cancer Center, Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Columbus, Ohio
| | - Karen Hock
- The Ohio State University Comprehensive Cancer Center, Stefanie Spielman Comprehensive Breast Center Oncology Rehabilitation, Columbus, Ohio
| | - Michael Schwartz
- Department of Medicine, Division of Medical Oncology and Hematology, Mount Sinai Medical Center, Miami Beach, Florida
| | | | - Marianne Melnik
- Department of General Surgery, Division of Surgical Oncology and Breast Care Services, Spectrum Health, Grand Rapids, Michigan
| | - Lisa D Yee
- Division of Surgical Oncology, City of Hope, Duarte, California
| | - Gini F Fleming
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - John R Taylor
- Biological Sciences Division, The University of Chicago, Alliance Protocol Operations Program Office, Chicago, Illinois
| | - Charles Loprinzi
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota
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Lytvyn L, Zeraatkar D, Anbari A, Ginex P, Zoratti M, Niburski K, Sadeghirad B, Siedler M, Thabane L, Morgan R. Conservative Intervention Strategies for Adult Cancer-Related Lymphedema: A Systematic Review and Network Meta-Analysis. Oncol Nurs Forum 2020; 47:E171-E189. [DOI: 10.1188/20.onf.e171-e189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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30
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Fish ML, Grover R, Schwarz GS. Quality-of-Life Outcomes in Surgical vs Nonsurgical Treatment of Breast Cancer–Related Lymphedema. JAMA Surg 2020; 155:513-519. [DOI: 10.1001/jamasurg.2020.0230] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Morgan L. Fish
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Ritwik Grover
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
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31
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The Effectiveness of the Sport "Dragon Boat Racing" in Reducing the Risk of Lymphedema Incidence: An Observational Study. Cancer Nurs 2020; 42:323-331. [PMID: 29933309 DOI: 10.1097/ncc.0000000000000615] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Upper extremity lymphedema is a complication that often occurs in women with breast cancer as a result of surgery and/or radiotherapy. Some studies report that a boating activity known as the "dragon boat" sport can benefit these women. AIM The aim of this study was to assess whether this type of sport prevents or reduces lymphedema, its impact on quality of life (QoL), and the possible predictors of this condition. METHODS This was an observational study of 2 groups: group A (women who participated in dragon boat racing for at least 6 months) and group B (women who participated in other forms of physical exercise biweekly). Data were collected at the National Cancer Institute of Rome and the lake of Castel Gandolfo from June to October 2016. The instruments used were a questionnaire created for sociodemographic and clinical data, the European Organisation for Research and Treatment of Cancer Core Questionnaire for evaluating QoL, and a tape measure applied to estimate the local lymphedema. RESULTS One hundred women participated in the study. Lymphedema incidence in group A was 4.0% (2 of 50), whereas in group B it was 26.0% (13 of 50). Women who participated in dragon boat racing also reported a healthier lifestyle, lower body mass index, and a better QoL (set point: 61.8 group B vs 80.0 group A). CONCLUSIONS The dragon boat sport participants had more positive clinical and QoL outcomes than did the women who did not participate in that sporting activity. IMPLICATIONS FOR CLINICAL PRACTICE It would be important to make women with breast cancer aware of the practice of dragon boat racing.
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Pajero Otero V, García Delgado E, Martín Cortijo C, Romay Barrero HM, de Carlos Iriarte E, Avendaño-Coy J. Kinesio taping versus compression garments for treating breast cancer-related lymphedema: a randomized, cross-over, controlled trial. Clin Rehabil 2019; 33:1887-1897. [PMID: 31495192 DOI: 10.1177/0269215519874107] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To determine the effectiveness of Kinesio taping compared to compression garments during maintenance phase of complex decongestive therapy for breast cancer-related lymphedema. DESIGN Randomized, cross-over, controlled trial. SETTING Outpatient tertiary-level hospital rehabilitation setting. SUBJECTS Randomized sample of 30 women with breast cancer-related lymphedema. INTERVENTIONS Participants received two interventions, Kinesio taping and compression garment, both lasting four weeks, whose order was randomized by blocks. A four-week washout period was established prior to the interventions and between them. MEASUREMENTS The main outcome was the lymphedema Relative Volume Change. Secondary outcomes were range of motion of arm joints, self-perception of comfort, and lymphedema-related symptoms (pain, tightness, heaviness, and hardness). RESULTS The decrease in the Relative Volume Change was greater in the Kinesio taping intervention (-5.7%, SD = 2.0) compared to that observed using compression garments (-3.4%, SD = 2.9) (P < 0.001). The range of motion of five upper-limb movements increased after applying taping (between 5.8° and 16.7°) (P < 0.05), but not after compression (P > 0.05). In addition, taping was perceived as more comfortable by patients (between 2.4 and 3 points better than compression in four questions with a 5-point scale (P < 0.001)) and further reduced lymphedema-related symptoms compared to compression (between 0.96 and 1.40 points better in four questions with a 6-point scale (P < 0.05)). CONCLUSION Kinesio taping was more effective than compression garments for reducing the lymphedema volume, with less severe lymphedema-related symptoms, better improvement of upper-limb mobility, and more comfort.
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Affiliation(s)
- Violeta Pajero Otero
- Rehabilitation of Breast Pathology Unit, University Hospital 12 de Octubre, Madrid, Spain.,Faculty of Nursing, Physiotherapy and Chiropody, Complutense University of Madrid, Madrid, Spain
| | - Esther García Delgado
- Faculty of Nursing, Physiotherapy and Chiropody, Complutense University of Madrid, Madrid, Spain.,University Hospital 12 de Octubre, Madrid, Spain
| | - Concepción Martín Cortijo
- Faculty of Nursing, Physiotherapy and Chiropody, Complutense University of Madrid, Madrid, Spain.,University Hospital 12 de Octubre, Madrid, Spain
| | | | - Esperanza de Carlos Iriarte
- Rehabilitation of Breast Pathology Unit, University Hospital 12 de Octubre, Madrid, Spain.,Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Juan Avendaño-Coy
- Faculty of Physiotherapy and Nursing, Castilla-La Mancha University, Toledo, Spain
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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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Arinaga Y, Piller N, Sato F, Ishida T, Ohtake T, Kikuchi K, Sato-Tadano A, Tada H, Miyashita M. The 10-Min Holistic Self-Care for Patients with Breast Cancer-Related Lymphedema: Pilot Randomized Controlled Study. TOHOKU J EXP MED 2019; 247:139-147. [PMID: 30799328 DOI: 10.1620/tjem.247.139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
About 20% of patients with breast cancer are likely to develop breast cancer-related lymphedema (BCRL) following an axillary clearance, and BCRL can be refractory or irreversible to treatment. The aim of this pilot randomized controlled study was to evaluate the effectiveness of a 10-min holistic self-care program for patients with BCRL in Japan. The intervention group (n = 22) practiced the BCRL self-care program including 1) modified Japanese Radio Taiso (Rajio Taiso, national calisthenics in Japan), 2) gentle arm exercises combined with deep breathing, 3) central lymphatic drainage, and 4) skin care using a traditional lymphatic drainage technique daily for 6 months, while the control group (n = 21) received usual care from their hospitals. There was significant group*time interaction in the relative edema volume and relative volume change of the hand, with the intervention group having the better outcome. The intervention group showed significant improvement in transepidermal water loss as well as the mental health component summary score of the SF-8, most of BCRL-related symptoms, self-care time and score, frequencies of exercise, self-lymphatic drainage and skin care, and perceived adherence and effectiveness to self-care, although we were unable to exclude the possibility of the Hawthorne effect. Notably, even in the control group, the self-care was similarly increased, but the significant improvements were detected only in transepidermal water loss on the forearm and upper arm, pain and coldness. In conclusion, the patients who practiced the holistic BCRL self-care for 6 months have shown greater improvement.
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Affiliation(s)
- Yoko Arinaga
- Lymphoedema Clinical Research Unit, Department of Surgery, Flinders University
| | - Neil Piller
- Lymphoedema Clinical Research Unit, Department of Surgery, Flinders University
| | - Fumiko Sato
- Department of Oncology Nursing, Tohoku University Graduate School of Medicine
| | - Takanori Ishida
- Department of Surgical Oncology, Tohoku University Graduate School of Medicine
| | - Tohru Ohtake
- Division of Breast Surgery, Department of Surgery, Fukushima Medical University School of Medicine
| | - Katsuko Kikuchi
- Department of Dermatology, Tohoku University Graduate School of Medicine
| | | | - Hiroshi Tada
- Department of Surgical Oncology, Tohoku University Graduate School of Medicine
| | - Minoru Miyashita
- Department of Surgical Oncology, Tohoku University Graduate School of Medicine
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35
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Effectiveness and safety of a product containing diosmin, coumarin, and arbutin (Linfadren®) in addition to complex decongestive therapy on management of breast cancer-related lymphedema. Support Care Cancer 2018; 27:1471-1480. [DOI: 10.1007/s00520-018-4514-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/12/2018] [Indexed: 11/26/2022]
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36
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Shallwani SM, Towers A. Self-Management Strategies for Malignant Lymphedema: A Case Report with 1-Year and 4-Year Follow-Up Data. Physiother Can 2018; 70:204-211. [PMID: 30275645 DOI: 10.3138/ptc.2016-94] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: Malignant lymphedema is an accumulation of interstitial fluid caused by tumour infiltration or compression of lymphatic vessels. Our objective is to describe self-management strategies for malignant lymphedema using a case report. Client Description: A 50-year-old woman with advanced breast cancer was referred to our centre with a 3-month history of unexplained left-arm edema, subsequently diagnosed as malignant lymphedema caused by tumour compression of the axillary lymph nodes. Intervention: She undertook a physiotherapist-guided, modified lymphedema treatment programme, with self-management interventions including self-bandaging and exercise. Limb volumes and leisure exercise levels were measured over a 1-year period. Data were collected from her follow-up visit 4 years post-diagnosis of lymphedema. Measures and Outcome: Within the first month, the patient's excess limb volume reduced from 26.8% to 5.9% and, 1 year later, remained stable at 3%. Over time, her exercise levels increased (1-year follow-up: 33.5 MET-hours per week). At 4 years, her excess limb volume was 9.7%, and exercise levels were at 36 MET-hours per week. Implications: A woman with moderate malignant arm lymphedema caused by advanced breast cancer successfully adhered to a guided self-management programme and benefited from reduced swelling and improved self-reported physical function in the long term. This case provides oncology health professionals with knowledge about self-management options for malignant lymphedema.
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Affiliation(s)
- Shirin M Shallwani
- Lymphedema Program.,Physiotherapy Department, McGill University Health Centre.,Department of Oncology, McGill University, Montreal
| | - Anna Towers
- Lymphedema Program.,School of Rehabilitation Sciences, University of Ottawa, Ottawa
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37
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Lan M, Zhang L, Zhang Y, Yan J. The relationship among illness perception, coping and functional exercise adherence in Chinese breast cancer survivors. J Adv Nurs 2018; 75:75-84. [PMID: 30132970 DOI: 10.1111/jan.13832] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/20/2018] [Accepted: 07/18/2018] [Indexed: 01/02/2023]
Affiliation(s)
- Maolin Lan
- Affiliated Cancer Hospital & Institute of Guangzhou Medical University; Guangzhou Guangdong Province China
| | - Lijuan Zhang
- Affiliated Cancer Hospital of Sun Yat-Sen University; Guangzhou Guangdong Province China
| | - Yuening Zhang
- Zhixin Middle School; Guangzhou Guangdong Province China
| | - Jun Yan
- School of Nursing; Sun Yat-Sen University; Guangzhou Guangdong Province China
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38
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Impact of an educational program on the quality of life of patients with lymphedema: A preliminary evaluation. J Vasc Surg Venous Lymphat Disord 2018; 5:715-722.e1. [PMID: 28818227 DOI: 10.1016/j.jvsv.2017.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/04/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We report on the preliminary evaluation of a well-designed program, Living with Lymphedema. This longitudinal cohort study assessed patients' quality of life using questionnaires. Our main objective was to evaluate the satisfaction of the patients and their adherence to the program. This was done using a specific questionnaire of satisfaction as well as by noting patients' adherence to the program (number of patients attending all three consultations). The secondary objective was to assess the effect of the program on the patient's quality of life. The assessment criteria were the evolution of the Medical Outcomes Study 36-Item Short Form Health Survey and EuroQol questionnaire scores between the first (C1) and third (C3) consultations. METHODS The Living with Lymphedema program targeted all patients with lymphedema in the Grenoble (France) conurbation and within the GRANTED health care network that includes vascular medicine specialists, primary care physicians, physical therapists, and dietitians in the Alpine region of France. All studied patients were ambulatory patients. The GRANTED network took care only of the educational aspect of the disease. All patients with primary or secondary lymphedema were offered the Living with Lymphedema program, whatever their age and the location of the lymphedema (upper or lower limbs). The collection of patient data conformed to the ethical and administrative regulations of the regional health authority. Grenoble Institutional Review Board (CPP Sud-Est V; No. 5891) approval for the study was specifically obtained for this evaluation on December 24, 2012. The program was built around one-to-one consultations, group workshops, and more specialized appointments. It was complementary to the routine medical care received by the patient (not evaluated in this study). It proposed three individual "educational" consultations, seven group workshops, and two specialized consultations with a dietitian. All the consultations or workshops were led by certified professionals trained in therapeutic education. RESULTS The cohort was the 34 patients included in the program. We found a significant improvement in the physical dimension of the Medical Outcomes Study 36-Item Short Form Health Survey score (P = .01) between C1 and C3 but not for the psychic dimension. Visual analog scale scores of the ability to cope with the lymphedema showed a statistically significant improvement between C1 and C3 (P = .05). No difference was observed in adherence to compression therapy. CONCLUSIONS This therapeutic educational program showed a significant improvement in several criteria of quality of life and in the autonomy of patients with lymphedema.
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Assis MRD, Maraglia PH, Brandão MAG, Peixoto MAP. Metacognition as an educational technology in self-care learning: the case of prevention of post-surgical lymphedema of breast cancer. ESCOLA ANNA NERY 2018. [DOI: 10.1590/2177-9465-ean-2017-0440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Aim: To introduce metacognition as an educational technology for learning self-care. In order to achieve this goal, it discusses the prevention of lymphedema after breast cancer surgery. Method: Reflexion paper based on philosophical and theoretical reasoning in adition of empirical evidence to support the use of metacognition for self care learnig. It states that using metacognitive resources as educational technology may promote more effective both teaching-learning process, stimulates critical and reflexive thinking, increasing conscious and autonomous decision-making. Results: The characteristics of metacognition and self-care interpenetrate. In addition metacognition has been beneficial in other disorders and diseases. Final considerations and implications for practice: It was concluded that the metacognitive approach, used as technology, opens wide possibilities for nursing in its teaching-learning actions for self-care, making them more effective, resulting in the empowerment of women, specifically enabling clients to make decisions, making the process more conscious, deliberate and autonomous.
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Stubblefield MD. The Underutilization of Rehabilitation to Treat Physical Impairments in Breast Cancer Survivors. PM R 2018; 9:S317-S323. [PMID: 28942906 DOI: 10.1016/j.pmrj.2017.05.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/15/2017] [Accepted: 05/21/2017] [Indexed: 01/12/2023]
Abstract
Breast cancer survivors can experience multiple neuromuscular, musculoskeletal, pain, and functional disorders as a result of their cancer and its treatment. Common disorders include shoulder dysfunction, postmastectomy syndrome, chemotherapy-induced peripheral neuropathy, axillary cording, lymphedema, and a host of others. Cancer rehabilitation is a process that helps breast cancer and other survivors to obtain and maintain the highest possible physical, social, psychological, and vocational functioning within the limits created by cancer and its treatments. There are good data supporting the safety and efficacy of cancer rehabilitation in the treatment of many breast cancer-related impairments, including shoulder dysfunction and lymphedema, among others. Despite the goals and efficacy of cancer rehabilitation, there is a marked underuse of services. The reasons for this phenomenon are many, but broadly result from a lack of knowledge about cancer rehabilitation on the part of patients and referring clinicians, limited access to services, and suboptimal adherence. This article explores underutilization of cancer rehabilitation in breast cancer survivors and provides an opportunity to consider ways to improve this gap in care.
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Affiliation(s)
- Michael D Stubblefield
- Kessler Institute for Rehabilitation, National Medical Director for Cancer Rehabilitation, Select Medical, 1199 Pleasant Valley Way, West Orange, NJ 07052(∗).
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Longhurst E, Dylke ES, Kilbreath SL. Use of compression garments by women with lymphoedema secondary to breast cancer treatment. Support Care Cancer 2018; 26:2625-2632. [PMID: 29460193 DOI: 10.1007/s00520-018-4093-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 02/04/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE This aim of this study was to determine the use of compression garments by women with lymphoedema secondary to breast cancer treatment and factors which underpin use. METHODS An online survey was distributed to the Survey and Review group of the Breast Cancer Network Australia. The survey included questions related to the participants' demographics, breast cancer and lymphoedema medical history, prescription and use of compression garments and their beliefs about compression and lymphoedema. Data were analysed using principal component analysis and multivariable logistic regression. RESULTS Compression garments had been prescribed to 83% of 201 women with lymphoedema within the last 5 years, although 37 women had discontinued their use. Even when accounting for severity of swelling, type of garment(s) and advice given for use varied across participants. Use of compression garments was driven by women's beliefs that they were vulnerable to progression of their disease and that compression would prevent its worsening. Common reasons given as to why women had discontinued their use included discomfort, and their lymphoedema was stable. Participant characteristics associated with discontinuance of compression garments included their belief that (i) the garments were not effective in managing their condition, (ii) experienced mild-moderate swelling and/or (iii) had experienced swelling for greater than 5 years. CONCLUSION The prescription of compression garments for lymphoedema is highly varied and may be due to lack of underpinning evidence to inform treatment.
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Affiliation(s)
- E Longhurst
- Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe, NSW, Australia
| | - E S Dylke
- Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe, NSW, Australia
| | - S L Kilbreath
- Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe, NSW, Australia.
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Harder H, Holroyd P, Burkinshaw L, Watten P, Zammit C, Harris PR, Good A, Jenkins V. A user-centred approach to developing bWell, a mobile app for arm and shoulder exercises after breast cancer treatment. J Cancer Surviv 2017; 11:732-742. [PMID: 28741202 PMCID: PMC5671540 DOI: 10.1007/s11764-017-0630-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 07/10/2017] [Indexed: 12/03/2022]
Abstract
PURPOSE The study aim was to develop a mobile application (app) supported by user preferences to optimise self-management of arm and shoulder exercises for upper-limb dysfunction (ULD) after breast cancer treatment. METHODS Focus groups with breast cancer patients were held to identify user needs and requirements. Behaviour change techniques were explored by researchers and discussed during the focus groups. Concepts for content were identified by thematic analysis. A rapid review was conducted to inform the exercise programme. Preliminary testing was carried out to obtain user feedback from breast cancer patients who used the app for 8 weeks post surgery. RESULTS Breast cancer patients' experiences with ULD and exercise advice and routines varied widely. They identified and prioritised several app features: tailored information, video demonstrations of the exercises, push notifications, and tracking and progress features. An evidence-based programme was developed with a physiotherapist with progressive exercises for passive and active mobilisation, stretching and strengthening. The exercise demonstration videos were filmed with a breast cancer patient. Early user testing demonstrated ease of use, and clear and motivating app content. CONCLUSIONS bWell, a novel app for arm and shoulder exercises, was developed by breast cancer patients, health care professionals and academics. Further research is warranted to confirm its clinical effectiveness. IMPLICATIONS FOR CANCER SURVIVORS Mobile health has great potential to provide patients with information specific to their needs. bWell is a promising way to support breast cancer patients with exercise routines after treatment and may improve future self-management of clinical care.
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Affiliation(s)
- Helena Harder
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
| | - Patrick Holroyd
- School of Engineering and Informatics, University of Sussex, Brighton, UK
| | - Lynn Burkinshaw
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Phil Watten
- School of Engineering and Informatics, University of Sussex, Brighton, UK
| | - Charles Zammit
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Peter R Harris
- School of Psychology, University of Sussex, Brighton, UK
| | - Anna Good
- School of Psychology, University of Sussex, Brighton, UK
| | - Val Jenkins
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, UK
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Ostby PL, Armer JM, Smith K, Stewart BR. Patient Perceptions of Barriers to Self-Management of Breast Cancer-Related Lymphedema. West J Nurs Res 2017; 40:1800-1817. [PMID: 29191123 DOI: 10.1177/0193945917744351] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Breast cancer survivors are at lifetime risk for the development of breast cancer-related lymphedema, a chronic, potentially debilitating condition that requires life-long symptom management. Suboptimal self-management rates suggest that health care providers may not be offering educative-support options that are customized to patient-perceived needs. An Institutional Review Board-approved focus group ( N = 9) and mailed surveys ( N = 15) were used to identify (a) barriers to lymphedema self-management, (b) how breast cancer survivors with lymphedema defined education and support, (c) what type of education and support they had received, and (d) what kind of education and support they wanted. Physiological, psychological, and psychosocial factors were identified as barriers to successful lymphedema self-management. One of the main barriers identified was lack of education about lymphedema treatment and risk reduction. In addition, more than half defined support as "prescriptions" and "referrals"; therefore, it is unclear whether patients were exposed to support other than medical treatment.
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Zhang X, Brown JC, Paskett ED, Zemel BS, Cheville AL, Schmitz KH. Changes in arm tissue composition with slowly progressive weight-lifting among women with breast cancer-related lymphedema. Breast Cancer Res Treat 2017; 164:79-88. [PMID: 28391397 PMCID: PMC5738921 DOI: 10.1007/s10549-017-4221-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 03/23/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND Studies in breast cancer-related lymphedema (BRCL) have exclusively examined total arm volume, but not the specific tissue composition that contributes to total volume. We evaluated baseline differences in arm tissue composition [fat mass, lean mass, bone mineral content (BMC), and bone mineral density (BMD)] between the affected and unaffected arms in women with BRCL. We compared changes in arm tissue composition and self-reported lymphedema symptoms after 1 year of weight-lifting versus control. METHODS We utilized data from physical activity and lymphedema trial that included 141 women with BRCL. Arm tissue composition was quantified using dual-energy X-ray absorptiometry. The severity of lymphedema was quantified using self-report survey. Weight-lifting was performed at community fitness facilities. RESULTS At baseline, the affected arm had more fat (∆ = 89.7 g; P < 0.001) and lean mass (∆ = 149.1 g; P < 0.001), but less BMC (∆ = -3.2 g; P < 0.001) and less BMD (∆ = -5.5 mg/cm2; P = 0.04) than the unaffected arm. After 12 months of weight-lifting, composition of the affected arm was improved: lean mass (71.2 g; P = 0.01) and BMD (14.0 mg/cm2; P = 0.02) increased, arm fat percentage decreased (-1.5%; P = 0.003). Composition of the unaffected arm was only improved in lean mass (65.2 g; P = 0·04). Increases in lean mass were associated with less severe BCRL symptoms. CONCLUSIONS Among women with BRCL, slowly progressive weight-lifting could improve arm tissue composition. Changes in arm tissue composition predict changes in symptom burden. Investigating the combined effects of exercise and weight loss on arm tissue composition and BCRL symptoms may provide additional insight into the benefits of lifestyle modification on lymphedema biology.
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Affiliation(s)
- Xiaochen Zhang
- Public Health Science, Penn State College of Medicine, Penn State Cancer Institute, Room T3427, 500 University Drive, Mail code CH69, Hershey, PA, 17033, USA
| | - Justin C Brown
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Electra D Paskett
- Division of Cancer Prevention and Control, Department of INTERNAL Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Babette S Zemel
- Clinical and Translational Research Center, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrea L Cheville
- Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Kathryn H Schmitz
- Public Health Science, Penn State College of Medicine, Penn State Cancer Institute, Room T3427, 500 University Drive, Mail code CH69, Hershey, PA, 17033, USA.
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Crisóstomo R, Candeias M, Armada-da-Silva P. Venous flow during manual lymphatic drainage applied to different regions of the lower extremity in people with and without chronic venous insufficiency: a cross-sectional study. Physiotherapy 2017; 103:81-89. [DOI: 10.1016/j.physio.2015.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 12/03/2015] [Indexed: 11/25/2022]
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Self-management education interventions for patients with cancer: a systematic review. Support Care Cancer 2017; 25:1323-1355. [PMID: 28058570 DOI: 10.1007/s00520-016-3500-z] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 11/14/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE This systematic review was intended to identify the effectiveness and inclusion of essential components of self-management education interventions to support patients with cancer in developing the skills needed for effective self-management of their disease and the acute or immediate, long-term, and late harmful effects of treatments. METHODS Self-management education interventions were included if they were randomized controlled trials (RCTs) containing at least one of the eight core elements outlined by the research team. A systematic search was conducted in Ovid MEDLINE (2005 through April 2015), Embase (2005 to 2015, week 15), the Cochrane Database of Systematic Reviews (Issue 4, April 2015), CINAHL (2005 to 2015) and PsychINFO (2005 to 2015). Keywords searched include 'self-management patient education' or 'patient education'. RESULTS Forty-two RCTs examining self-management education interventions for patients with cancer were identified. Heterogeneity of interventions precluded meta-analysis, but narrative qualitative synthesis suggested that self-management education interventions improve symptoms of fatigue, pain, depression, anxiety, emotional distress and quality of life. Results for specific combinations of core elements were inconclusive. Very few studies used the same combinations of core elements, and among those that did, results were conflicting. Thus, conclusions as to the components or elements of self-management education interventions associated with the strength of the effects could not be assessed by this review. CONCLUSION Defining the core components of cancer self-management education and the fundamental elements for inclusion in supporting effective self-management will be critical to ensure consistent and effective provision of self-management support in the cancer system.
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Association Between Maximal Bench Press Strength and Isometric Handgrip Strength Among Breast Cancer Survivors. Arch Phys Med Rehabil 2016; 98:264-269. [PMID: 27543047 DOI: 10.1016/j.apmr.2016.07.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/28/2016] [Accepted: 07/13/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To characterize the relationship between 1-repetition maximum (1-RM) bench press strength and isometric handgrip strength among breast cancer survivors. DESIGN Cross-sectional study. SETTING Laboratory. PARTICIPANTS Community-dwelling breast cancer survivors (N=295). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE 1-RM bench press strength was measured with a barbell and exercise bench. Isometric handgrip strength was measured using an isometric dynamometer, with 3 maximal contractions of the left and right hands. All measures were conducted by staff with training in clinical exercise testing. RESULTS Among 295 breast cancer survivors, 1-RM bench press strength was 18.2±6.1kg (range, 2.2-43.0kg), and isometric handgrip strength was 23.5±5.8kg (range, 9.0-43.0kg). The strongest correlate of 1-RM bench press strength was the average isometric handgrip strength of both hands (r=.399; P<.0001). Mean difference analysis suggested that the average isometric handgrip strength of both hands overestimated 1-RM bench press strength by 4.7kg (95% limits of agreement, -8.2 to 17.6kg). In a multivariable linear regression model, the average isometric handgrip strength of both hands (β=.31; P<.0001) and age (β=-.20; P<.0001) were positively correlated with 1-RM bench press strength (R2=.23). CONCLUSIONS Isometric handgrip strength is a poor surrogate for 1-RM bench press strength among breast cancer survivors. 1-RM bench press strength and isometric handgrip strength quantify distinct components of muscular strength.
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Watts TE, Davies RE. A qualitative national focus group study of the experience of living with lymphoedema and accessing local multiprofessional lymphoedema clinics. J Adv Nurs 2016; 72:3147-3159. [PMID: 27400246 DOI: 10.1111/jan.13071] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2016] [Indexed: 01/22/2023]
Affiliation(s)
- Tessa E. Watts
- Department of Nursing; College of Human and Health Sciences; Swansea University; Wales UK
| | - Ruth E. Davies
- Department of Nursing; College of Human and Health Sciences; Swansea University; Wales UK
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A longitudinal analysis of chronic arm morbidity following breast cancer surgery. Breast Cancer Res Treat 2016; 157:413-25. [PMID: 27194415 DOI: 10.1007/s10549-016-3834-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
Abstract
Arm morbidity (AM) arising from breast cancer (BC) treatment can detrimentally impact quality of life; often limiting a survivor's ability to participate in valued activities. The present study explored (a) the developmental time course of AM [restricted range of motion (ROM), pain, and arm volume changes], negative affect, and perceived disability in the immediate years post-surgery, and (b) the mediating role of perceived disability on the relationship between AM and negative affect over time. In this 5-year longitudinal study, BC survivors from four Canadian oncology clinics (n = 431) completed five annual clinical assessments, where differences in ROM (shoulder abduction, external rotation) and arm volume between the affected and non-affected arm were measured. The profile of mood states (POMS), disability of arm, shoulder, hand, and McGill Pain Questionnaire-Short form were completed. Results from general linear modeling showed that AM, negative affect, and perceived disability were greatest 1-year post-surgery, declined, and with the exception of arm volume changes, were significantly lower 5 years later. Negative affect was significantly associated with restrictions in shoulder abduction and external rotation (average r = -0.15; p < 0.05) and present arm pain (average r = 0.28, p < 0.01) at most assessments. The mediating role of perceived disability on the relationship between AM and negative affect was statistically significant in a majority of assessments. Perceived disability is the underlying factor driving the relationship between AM and mood disturbance over time. Rehabilitative therapy to improve survivors' functional well-being might mitigate the negative impacts of AM on emotional health.
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Dean LT, Kumar A, Kim T, Herling M, Brown JC, Zhang Z, Evangelisti M, Hackley R, Kim J, Cheville A, Troxel AB, Schwartz JS, Schmitz KH. Race or Resource? BMI, Race, and Other Social Factors as Risk Factors for Interlimb Differences among Overweight Breast Cancer Survivors with Lymphedema. J Obes 2016; 2016:8241710. [PMID: 27433356 PMCID: PMC4940553 DOI: 10.1155/2016/8241710] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/16/2016] [Accepted: 06/06/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction. High BMI is a risk factor for upper body breast cancer-related lymphedema (BCRL) onset. Black cancer survivors are more likely to have high BMI than White cancer survivors. While observational analyses suggest up to 2.2 times increased risk of BCRL onset for Black breast cancer survivors, no studies have explored race or other social factors that may affect BCRL severity, operationalized by interlimb volume difference (ILD). Materials and Methods. ILD was measured by perometry for 296 overweight (25 > BMI < 50) Black (n = 102) or White (n = 194) breast cancer survivors (>6 months from treatment) in the WISER Survivor trial. Multivariable linear regression examined associations between social and physical factors and ILD. Results. Neither Black race (-0.26, p = 0.89) nor BMI (0.22, p = 0.10) was associated with ILD. Attending college (-4.89, p = 0.03) was the strongest factor associated with ILD, followed by having more lymph nodes removed (4.75, p = 0.01), >25% BCRL care adherence (4.10, p = 0.01), and years since treatment (0.55, p < 0.001). Discussion. Neither race nor BMI was associated with ILD among overweight cancer survivors. Education, a proxy for resource level, was the strongest factor associated with greater ILD. Tailoring physical activity and weight loss interventions designed to address BCRL severity by resource rather than race should be considered.
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Affiliation(s)
- Lorraine T. Dean
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Anagha Kumar
- MedStar Health Research Institute and MedStar Georgetown University Hospital, Division of Biostatistics, Washington, DC 20007, USA
| | - Taehoon Kim
- School of Arts & Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Matthew Herling
- The Wharton School of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Justin C. Brown
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Zi Zhang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Margaret Evangelisti
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Renata Hackley
- Recruitment, Outcomes, and Assessment Resource Core, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jiyoung Kim
- School of Arts & Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Andrea Cheville
- The Mayo Clinic, Department of Physical Medicine and Rehabilitation, Rochester, MN 55905, USA
| | - Andrea B. Troxel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - J. Sanford Schwartz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kathryn H. Schmitz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- *Kathryn H. Schmitz:
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