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Sharifi N, Ahmad S. Breast cancer-related lymphedema: A critical review on recent progress. Surg Oncol 2024; 56:102124. [PMID: 39208532 DOI: 10.1016/j.suronc.2024.102124] [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: 04/22/2024] [Revised: 08/06/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
Lymphedema is a chronic and debilitating condition characterized by an abnormal buildup of protein-rich fluid in the interstitial tissue, leading to the development of edema and tissue structural alterations. Breast cancer-related lymphedema (BCRL) remains a significant healthcare burden because it can develop within days and up to 11-years after the surgery. Specifically, axillary lymph node dissection leads to 30-50 % upper limb lymphedema, which involves the accumulation of protein-rich fluid. In this article, we provide a comprehensive/critical overview of post-mastectomy lymphedema, focusing on key aspects as diagnosis, prevention, and treatment methods. Beginning with clinical condition, the article explores the pathophysiology and risk factors associated with post-mastectomy lymphedema. It further delves into various diagnostic modalities available, highlighting the importance of early detection for optimal management of BCRL. We also examine preventive strategies, emphasizing the role of patient education, lifestyle modifications, and proactive measures in reducing the risk of lymphedema development. In terms of treatment, the article covers a wide array of interventions ranging from conservative approaches like manual lymphatic drainage and compression therapy to surgical techniques such as lymph node transfer and lymphaticovenular anastomosis. Thus, through a comprehensive synthesis of current evidence and clinical practices updates, the review aims to guide healthcare professionals in delivering preventive and effective care while improving outcomes for individuals affected by post-mastectomy lymphedema.
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Affiliation(s)
- Nasrin Sharifi
- AdventHealth Cancer Institute, Gynecologic Oncology Program, Orlando, FL, 32804, USA; Valencia College, Department of Health Sciences, Section of Human Anatomy & Physiology, Orlando, FL, 32802, USA
| | - Sarfraz Ahmad
- AdventHealth Cancer Institute, Gynecologic Oncology Program, Orlando, FL, 32804, USA.
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Desai A, Dahl V, De Castro Silva I, Clark M, Xu KY, Kesmodel SB, Goel N, Rojas KE, Crystal J, Mella-Catinchi JR. Larger recipient vein caliber during lymphatic microsurgical preventive healing approach (LYMPHA) is associated with lower lymphedema rates. Surgery 2024:S0039-6060(24)00547-6. [PMID: 39237435 DOI: 10.1016/j.surg.2024.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 06/19/2024] [Accepted: 07/18/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND The lymphatic microsurgical preventive healing approach reduces the risk of lymphedema after axillary lymph node dissection. We identified surgical factors of Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) that influence lymphedema rates focusing on the vein caliber used. METHODS A single-institution retrospective cohort study included breast cancer patients undergoing axillary lymph node dissection and LYMPHA (April 2021-November 2022) with a follow-up of at least 1 year. Lymphedema was defined as an increase of ≥10 units in the lymphedema index (measured using bioimpedance spectroscopy) from baseline. The primary outcome was the correlation between the lymphedema index of patients with a vein caliber of ≤2 mm vs > 2 mm. RESULTS Forty-eight patients with documented vein caliber were analyzed. The median baseline lymphedema index in patients with a vein caliber ≤2 mm was 2 (SD 3.04) and 2.2 (SD 2.03) for vein caliber >2 mm. (P = .57). After 1-year follow-up, the L-dex was 6.20 (SD 7.48) for vein caliber ≤2 mm and 1.60 (SD 5.85) for vein caliber >2 mm (P = .02). The L-dex difference from baseline was higher for vein caliber ≤2 mm compared to >2 mm (2.9 vs 0.10, P = .02). Larger vein caliber was associated with a lower L-dex at 3 months (P = .04) and a lesser difference from the baseline after 1 year (P = .03). This was maintained on univariate analysis and multivariate analysis controlling for radiation, chemotherapy, and number of lymph nodes excised. CONCLUSION Vein caliber >2 mm during LYMPHA axillary lymph node dissection is associated with a lower postoperative lymphedema index. These results can be enhanced by a multi-institutional study to improve standardization of this technique.
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Affiliation(s)
- Anshumi Desai
- Division of Plastic and Reconstructive Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL.
| | - Victoria Dahl
- Division of Plastic and Reconstructive Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL
| | - Iago De Castro Silva
- Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL
| | | | - Kyle Y Xu
- Division of Plastic and Reconstructive Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL
| | - Susan B Kesmodel
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL. https://twitter.com/SueKesmodelMD
| | - Neha Goel
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL
| | - Kristin E Rojas
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL. https://twitter.com/kristinrojasmd
| | - Jessica Crystal
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL
| | - Juan R Mella-Catinchi
- Division of Plastic and Reconstructive Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL
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Bhimani F, Feldman S, Cavalli A, Chen Y, Obaid L, Rachofsky C, Gupta A, Pastoriza J, Johnson K, McEvoy M. Axillary Reverse Mapping Aids in Reducing the Rates of Breast Cancer-Related Lymphedema in Underserved Ethnically Diverse Population. Ann Surg Oncol 2024; 31:5937-5946. [PMID: 38844631 DOI: 10.1245/s10434-024-15577-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 05/22/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND Breast cancer-related lymphedema (BCRL) poses a significant risk following sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND), particularly affecting ethnic minorities, with a twofold increased risk. Axillary reverse mapping (ARM), a novel technique, shows potential in reducing BCRL rates, yet its utility in ethnic minorities lacks sufficient exploration. Therefore, our study aims to investigate the utility and outcomes of ARM on BCRL in an ethnic diverse group. METHODS A retrospective chart review of ARM patients from January 2019 to July 2022 was conducted, monitoring patients over 24 months at 3-month intervals using SOZO® scores, with comparisons with preoperative baselines. RESULTS Of the 212 patients, 83% belonged to ethnic minorities. SLNB was performed in 83%, ALND in 17%, and 62.3% underwent radiation therapy. Positive lymph nodes were found in 31.6%, with 22.2% exhibiting blue nodes and 25.9% exhibiting blue lymphatics. Of identified blue nodes, 70.2% were excised, including 51.5% crossover nodes. Lymphedema occurred in 3 patients, resulting in a BCRL rate of 1.4%. Compared with an historical BCRL incidence of 40.4% following ALND in ethnic minorities, our study reported a significantly lower rate of 8% (p < 0.001). CONCLUSION The ARM procedure can significantly lower BCRL in ethnic minority groups. The combination of ARM and bioimpedance spectroscopy led to a remarkably low BCRL rate of 1.4%. Notably, none of the patients in our study developed an axillary recurrence at 24-month follow-up. Nevertheless, future studies with larger sample sizes are warranted to better understand the utility of the ARM technique in this population.
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Affiliation(s)
- Fardeen Bhimani
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Comprehensive Cancer Care, Bronx, NY, USA
| | - Sheldon Feldman
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Comprehensive Cancer Care, Bronx, NY, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Yu Chen
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Comprehensive Cancer Care, Bronx, NY, USA
| | - Liane Obaid
- Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Anjuli Gupta
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Comprehensive Cancer Care, Bronx, NY, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jessica Pastoriza
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Comprehensive Cancer Care, Bronx, NY, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kelly Johnson
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Comprehensive Cancer Care, Bronx, NY, USA
| | - Maureen McEvoy
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Comprehensive Cancer Care, Bronx, NY, USA.
- Albert Einstein College of Medicine, Bronx, NY, USA.
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Ahn HR, Jeong HE, Jeong C, Kang SY, Jung SH, Youn HJ, Kim JS. Incidence and risk factors of breast cancer-related lymphedema in Korea: a nationwide retrospective cohort study. Int J Surg 2024; 110:3518-3526. [PMID: 38477155 PMCID: PMC11175813 DOI: 10.1097/js9.0000000000001278] [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: 12/17/2023] [Accepted: 02/22/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Breast cancer-related lymphedema (BCRL) is a secondary lymphedema that occurs after breast cancer related treatments. BCRL develops from damage or dysfunction of the normally functioning lymphatic system due to surgery, radiation therapy, and rarely due to cancer recurrence. This nationwide, retrospective study was aimed at investigating the incidence and risk factors of BCRL using the database of the Korean National Health Insurance Service (NHIS). METHODS Patients with newly diagnosed breast cancer who underwent breast surgery from 1 January 2017 to 31 December 2020, were recruited. The incidence was compared by four groups according to the operation type of breast cancer [breast conserving surgery (BCS) with sentinel lymph node biopsy (S), BCS with axillary lymph node dissection (A), total mastectomy (TM) with S, modified radical mastectomy (MRM)]. The incidence rates of lymphedema were calculated by the number of incident events by the total follow-up period. Cox proportional hazard regression was used to calculate the risk of incidence of lymphedema based on a patients' characteristics, breast cancer treatment, and comorbidities. RESULTS The final cohort of operation subjects that satisfied the inclusion criteria was 34 676. BCRL occurred in 4242 patients (12.2%), and the median follow-up period was 695.4 days. The BCRL was diagnosed in the BCS with S (8.0%), BCS with A (23.5%), TM with S (10.7%), and MRM (28.5%) with an incidence of 40.8, 132.2, 55.8, and 171.8 per 1000 person-years, respectively. Young age, obesity, chemotherapy, radiotherapy, residence in metropolitan areas, and hyperlipidemia were identified as risk factors. CONCLUSION In Korea, the incidence of BCRL was found to be 12.2%, with the highest risk observed among patients who underwent MRM. Therefore, surgical oncologists should meticulously assess the appropriate surgical approach and consider providing education to patients with risk factors for BCRL, aiming to ensure effective prevention strategies.
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Affiliation(s)
- Ha Rim Ahn
- Department of Surgery, Jeonbuk National University Medical School
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Hyeong Eun Jeong
- Department of Surgery, Jeonbuk National University Medical School
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Choyun Jeong
- Department of Medical Informatics, Jeonbuk National University Medical School
| | - Sang Yull Kang
- Department of Surgery, Jeonbuk National University Medical School
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Sung Hoo Jung
- Department of Surgery, Jeonbuk National University Medical School
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Hyun Jo Youn
- Department of Surgery, Jeonbuk National University Medical School
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Jong Seung Kim
- Department of Otorhinolaryngology, Jeonbuk National University Medical School
- Department of Medical Informatics, Jeonbuk National University Medical School
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
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Lo Torto F, Kaciulyte J, Di Meglio F, Marcasciano M, Greco M, Ribuffo D. Orthotopic vascularized lymph node transfer in breast cancer-related lymphedema treatment: Functional and life quality outcomes. Microsurgery 2024; 44:e31147. [PMID: 38342994 DOI: 10.1002/micr.31147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/27/2023] [Accepted: 01/04/2024] [Indexed: 02/15/2024]
Abstract
INTRODUCTION Breast cancer-related lymphedema (BCRL) is a chronic disease that occurs up to 65% of breast cancer survivors. Traditional treatment is conservative, but new surgeries as lymphaticovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT) are at disposal. This study aims to investigate the orthotopic VLNT efficacy in BCRL. Results in terms of limbs' reduction rates and quality of life improvement are compared with the outcomes reported in Literature. PATIENTS AND METHODS During patients' selection, inclusion criteria were monolateral ISL stage II or III BCRL with pathologic lymphoscintigraphy imaging and a minimum of previous 6 months of unsuccessful conservative treatment. Bilateral lymphedema, local recurrence or systemic metastasis, acute infection of the limb and deep venous trombosis were exclusion criteria. Surgery consisted in VLNT from the gastroepiploic region to the axilla with axillary scar dissection. RESULTS From August 2019 to December 2021, 25 patients were included. At the preoperative scintigraphy exam, mean lymph transport index (TI) was 30 (range; 22.7-29.3). Nine of them (36%) were ISL stage II and 16 (64%) were stage III. Average follow-up was 13.5 months (range; 12-19 months). VLN flaps' survival rate was 100%. One year after surgery, the mean Circumferential Reduction Rate (CRR) resulted 44.62 (range; 27.4-60.3). Infections' rates presented a statistically significant reduction, from an average of 2.4 (range; 1-4) to 0.2 (range; 0-1) episodes per year. Life quality index measured with the LYMQOL questionnaire showed significant improvement after 1 year, from a mean score of 3.28 (range; 2-5) to 8.12 (range; 7-9). CONCLUSION When compared with Literature evidence, the results of the current study are in line with both VLN inset ways related to BCRL treatment. An optimal therapeutic choice should consider benefits and drawbacks of each orthotopic and heterotopic VLNT, taking into account surgeon's preference and experience and patients' related factors and expectations.
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Affiliation(s)
- Federico Lo Torto
- Unit of Plastic and Reconstructive Surgery, Department of Surgery "P. Valdoni", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Juste Kaciulyte
- Unit of Plastic and Reconstructive Surgery, Department of Surgery "P. Valdoni", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Filippo Di Meglio
- Unit of Plastic and Reconstructive Surgery, Department of Surgery "P. Valdoni", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Marco Marcasciano
- Division of Plastic Surgery, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Manfredi Greco
- Division of Plastic Surgery, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Diego Ribuffo
- Unit of Plastic and Reconstructive Surgery, Department of Surgery "P. Valdoni", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Sae-Lim C, Wu WP, Chang MC, Lai HW, Chen ST, Chou CT, Liao CY, Huang HI, Chen ST, Chen DR, Hung CL. Reliability of predicting low-burden (≤ 2) positive axillary lymph nodes indicating sentinel lymph node biopsy in primary operable breast cancer - a retrospective comparative study with PET/CT and breast MRI. World J Surg Oncol 2024; 22:12. [PMID: 38183069 PMCID: PMC10770957 DOI: 10.1186/s12957-023-03297-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/26/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) is the standard of care for axillary staging in early breast cancer patients with low-burden axillary metastasis (≤ 2 positive nodes). This study aimed to determine the diagnostic performances of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and breast magnetic resonance imaging in detecting axillary lymph node (ALN) metastases and the reliability to predict ALN burden. METHODS A total of 275 patients with primary operable breast cancer receiving preoperative PET/CT and upfront surgery from January 2001 to December 2022 in a single institution were enrolled. A total of 244 (88.7%) of them also received breast MRI. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET/CT and breast MRI were assessed. The predictive values to determine ALN burden were evaluated using radio-histopathological concordance. RESULTS PET/CT demonstrated a sensitivity of 53.4%, specificity of 82.1%, PPV of 65.5%, NPV of 73.5%, and accuracy of 70.9% for detecting ALN metastasis, and the corresponding values for MRI were 71.8%, 67.8%, 56%, 80.8%, and 69.2%, respectively. Combining PET/CT and MRI showed a significantly higher PPV than MRI (72.7% vs 56% for MRI alone, p = 0.037) and a significantly higher NPV than PET/CT (84% vs 73.5% for PET/CT alone, p = 0.041). For predicting low-burden axillary metastasis (1-2 positive nodes), the PPVs were 35.9% for PET/CT, 36.7% for MRI, and 55% for combined PET/CT and MRI. Regarding patients with 0-2 positive ALNs in imaging, who were indicated for SLNB, the predictive correctness was 96.1% for combined PET/CT and MRI, 95.7% for MRI alone, and 88.6% for PET/CT alone. CONCLUSIONS PET/CT and breast MRI exhibit high predictive values for identifying low-burden axillary metastasis in patients with operable breast cancer with ≦ 2 positive ALNs on imaging.
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Affiliation(s)
- Chayanee Sae-Lim
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Wen-Pei Wu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan
- Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Che Chang
- Department of Nuclear Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Hung-Wen Lai
- Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
- Endoscopic and Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan.
- Minimally Invasive Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan.
- Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan.
- Kaohsiung Medical University, Kaohsiung, Taiwan.
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
- Department of Surgery, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Shu-Tian Chen
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, 11221, Taiwan
| | - Chen-Te Chou
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan
- Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chiung-Ying Liao
- Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan
| | - Hsin-I Huang
- Department of Information Management, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Shou-Tung Chen
- Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Dar-Ren Chen
- Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Che-Lun Hung
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, 11221, Taiwan
- Department of Computer Science and Communication Engineering, Providence University, Taichung, Taiwan
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Barkar MA, Mikwar Z, Khalid AA, Mohammedamin AA, Aloufi AH, Abualhamail AA, Alghashim HA. Patient Satisfaction and Quality of Life After Mastectomy at King Abdulaziz Medical City, Jeddah. Cureus 2023; 15:e51029. [PMID: 38149063 PMCID: PMC10750441 DOI: 10.7759/cureus.51029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2023] [Indexed: 12/28/2023] Open
Abstract
Background Overall well-being after surgical intervention is one of the most important aspects of assessing quality of life (QOL), yet it is not well explored in the literature. In this paper, it was necessary to involve the patient's perspective of the nature of their QOL. The burden of being diagnosed with breast cancer is an adaptation to a new lifestyle, having to deal with disease stigma, interpersonal relations problems, and being limited to specific clothing. This can be very challenging for patients. This study aims to identify which patient group, based on their treatment regimen, exhibits higher levels of satisfaction and dissatisfaction compared to other groups. Methods A retrospective, cross-sectional study analyzing the QOL among female breast cancer patients who underwent mastectomy, with or without breast reconstruction, in King Abdulaziz Medical City, Jeddah, between 2009 and 2022. Patients' demographics and phone numbers were obtained from each patient's medical record file in our hospital. Phone call-based interviews were conducted to contact patients to assess their QOL, satisfaction, and regrets after surgery. We excluded patients who do not speak Arabic, are illiterate, have memory disorders, patients who underwent lumpectomy or palliative mastectomy, patients with metastatic stage 4 cancer at the time of diagnosis, patients who are males, and patients who passed away. Results A total of 2,309 patients were screened during the period aforementioned; a total of 346 patients met our inclusion criteria. All of whom are female participants with a current mean age of 52.3 ± 11.5 years. There were 301 (86.99%) participants reported being satisfied, while only 45 (13.01%) participants reported being unsatisfied with surgery outcomes. Although the majority of participants were satisfied after mastectomy, many of them still struggled with psychological, social, and/or emotional challenges. These challenges can have a significant impact on a patient's overall well-being and QOL and must be addressed to provide patients with the highest quality of care possible. Conclusion The study findings highlight the significant impact of mastectomy on patients' lives. It is important to consider individual patient experiences and circumstances when evaluating treatment outcomes and patient satisfaction. We observed that patient satisfaction may vary depending on several factors, including patients' baseline satisfaction. Those factors may be psychological, such as body image issues, low self-esteem, the feeling of losing a body part, and fear of recurrence or metastasis. Other factors may be postoperative-related complications, including lymphedema, redundant skin, chronic pain, and operation scar. Additionally, factors may be socially related, such as loss of confidence, social withdrawal, embarrassment, inability to buy prostheses, being limited to specific clothes, and occupational impact.
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Affiliation(s)
- Mussab A Barkar
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- College of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Zaher Mikwar
- Department of General Surgery, Department of Surgery, King Abdulaziz Medical City, Jeddah, SAU
| | - Adil A Khalid
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- College of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Ali A Mohammedamin
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- College of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Abdulrahman H Aloufi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- College of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Abdulmajeed A Abualhamail
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- College of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Hamad A Alghashim
- College of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
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Friedman R, Spiegel DY, Kinney J, Willcox J, Recht A, Singhal D. Quantifying radiation in the axillary bed at the site of lymphedema surgical prevention. Breast Cancer Res Treat 2023:10.1007/s10549-023-06988-y. [PMID: 37382815 DOI: 10.1007/s10549-023-06988-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/24/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE Immediate lymphatic reconstruction (ILR) is a procedure known to reduce the risk of lymphedema in patients undergoing axillary lymph node dissection (ALND). However, patients who receive adjuvant radiotherapy are at increased risk of lymphedema. The aim of this study was to quantify the extent of radiation at the site of surgical prevention. METHODS We recently began deploying clips at the site of ILR to identify the site during radiation planning. A retrospective review was performed to identify breast cancer patients who underwent ILR with clip deployment and adjuvant radiation therapy from October 2020 to April 2022. Patients were excluded if they had not completed radiotherapy. The exposure and dose of radiation received by the site was determined and recorded. RESULTS In a cohort of 11 patients, the site fell within the radiation field in 7 patients (64%) and received a median dose of 4280 cGy. Among these 7 patients, 3 had sites located within tissue considered at risk of oncologic recurrence and the remaining 4 sites received radiation from a tangential field treating the breast or chest wall. The median dose to the ILR site for the 4 patients whose sites were outside the radiation fields was 233 cGy. CONCLUSION Our findings suggest that even when the site of surgical prevention was not within the targeted radiation field during treatment planning, it remains susceptible to radiation. Strategies for limiting radiation at this site are needed.
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Affiliation(s)
- Rosie Friedman
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, Suite 5A, Boston, MA, 02215, USA
| | - Daphna Y Spiegel
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - JacqueLyn Kinney
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, Suite 5A, Boston, MA, 02215, USA
| | - Julia Willcox
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Abram Recht
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Dhruv Singhal
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, Suite 5A, Boston, MA, 02215, USA.
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Guliyeva G, Huayllani MT, Boczar D, Avila FR, Lu X, Forte AJ. Age as a risk factor for breast cancer-related lymphedema: a systematic review. J Cancer Surviv 2023; 17:246-253. [PMID: 33486706 DOI: 10.1007/s11764-021-00994-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/15/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Breast cancer-related lymphedema (BCRL) has been widely reported in the medical literature. Various patient characteristics, including age, have been investigated as possible risk factors for this disease entity, but the existence and direction of the cause-and-effect relationship are still unclear. In this review, we aimed to evaluate the effect of age on development of BRCL. METHODS PubMed, Scopus, and Ovid MEDLINE were searched for relevant articles, which were found to be published between 1974 and 2020. RESULTS Twenty-six studies involving 19,396 patients were selected. The average age of patients was 54.9. 26 studies were included in the final analysis, and 13 articles reported no association between age and BCRL development. CONCLUSIONS Though studies presented different findings, the majority did not identify age as a risk factor for development of lymphedema. However, the level of evidence of individual studies was low. In this article, we call attention to the need for uniform design of lymphedema studies and diagnosis. IMPLICATIONS FOR CANCER SURVIVORS All patients should be informed and screened regularly for lymphedema during and after the treatment independent of their age.
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Affiliation(s)
- Gunel Guliyeva
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Maria T Huayllani
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Daniel Boczar
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Francisco R Avila
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Xiaona Lu
- Section of Plastic Surgery, Yale University, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Antonio Jorge Forte
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
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10
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Hara Y, Otsubo R, Shinohara S, Morita M, Kuba S, Matsumoto M, Yamanouchi K, Yano H, Eguchi S, Nagayasu T. Lymphedema After Axillary Lymph Node Dissection in Breast Cancer: Prevalence and Risk Factors-A Single-Center Retrospective Study. Lymphat Res Biol 2022; 20:600-606. [PMID: 35357959 PMCID: PMC9810350 DOI: 10.1089/lrb.2021.0033] [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] [Indexed: 01/13/2023] Open
Abstract
Background: Lymphedema may develop when axillary lymph node dissection (ALND) injures and obstructs the lymph ducts in the upper limb. In patients with breast cancer, lymphedema is difficult to treat and can cause arm swelling, heaviness, and restricted movement. We aimed to identify the prevalence and risk factors for lymphedema after ALND in patients with breast cancer. Methods and Results: This retrospective study included 175 patients with breast cancer who underwent ALND in the Nagasaki University Hospital, Japan, between 2005 and 2018. Lymphedema was defined as symptomatic arm swelling with a >2-cm difference in the arm circumference between the affected and contralateral arms. Patients were divided into two groups according to the presence or absence of lymphedema. Surgical and pathological findings were compared between the two groups. Univariate and multivariate analyses were performed, including the chi-square test, Student's t-test, and logistic regression analysis. Lymphedema was prevalent in 20% of the study participants, and the mean time interval from surgery to development of lymphedema was 479 days. In the univariate analysis, a body mass index of >26 kg/m2, smoking, radiotherapy (RT), and dissection of >18 axillary lymph nodes (ALNs) significantly increased the risk of lymphedema. In the multivariate analysis, smoking, RT, and dissection of >18 ALNs significantly increased the risk of lymphedema. Conclusions: The prevalence of lymphedema in our study was 20%. Our findings suggest that smoking, RT, and dissection of >18 ALNs are risk factors for lymphedema. Aggressive and empiric ALND might be associated with axillary lymph duct damage.
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Affiliation(s)
- Yuki Hara
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryota Otsubo
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Address correspondence to: Ryota Otsubo, MD, PhD, Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Shota Shinohara
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Michi Morita
- Department of Surgery, Nagasaki University Hospital, Nagasaki, Japan
| | - Sayaka Kuba
- Department of Surgery, Nagasaki University Hospital, Nagasaki, Japan
| | - Megumi Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kosho Yamanouchi
- Department of Surgery, Nagasaki University Hospital, Nagasaki, Japan
| | - Hiroshi Yano
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Hospital, Nagasaki, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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11
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Zhang HZ, Zhong QL, Zhang HT, Luo QH, Tang HL, Zhang LJ. Effectiveness of six-step complex decongestive therapy for treating upper limb lymphedema after breast cancer surgery. World J Clin Cases 2022; 10:8827-8836. [PMID: 36157662 PMCID: PMC9477048 DOI: 10.12998/wjcc.v10.i25.8827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/27/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Complex decongestive therapy (CDT) is currently recommended as the standard treatment for lymphedema. CDT is a four-step detumescence therapy that can effectively treat upper limb lymphedema after breast cancer surgery, and is considered non-invasive, painless and without side effects.
AIM To determine the effectiveness of a six-step CDT involving a foam granule bandage for the treatment of upper extremity lymphedema pressure after breast cancer surgical intervention.
METHODS The study included 100 patients with upper extremity lymphedema after breast cancer surgery. The surgical methods were mastectomy plus axillary lymph node dissection and breast preservation plus sentinel lymph node biopsy. The study population was further divided into the experimental group and control group with 50 cases in each group. The control group was given conventional CDT (four-step method), which included skin care, freehand lymphatic drainage, foam granule pressurized bandage, and functional exercise. In the experimental group, a six-step CDT method was applied that involved a foam particle bandage combined with air wave pressure therapy in addition to the four steps of conventional CDT. Patients in both groups were given one course of treatment daily (20 times), and the changes in body moisture and subjective symptoms were measured before and after treatment, preoperatively and 20 times after treatment.
RESULTS No statistically significant differences in 50-Hz bioelectrical impedance and extracellular moisture ratio were observed between the two groups before treatment, suggesting comparability of the baseline data. After treatment, the 50-Hz bioelectrical impedance of the experimental group was significantly higher than that in the control group, and the extracellular moisture ratio was significantly lower than that in the control group. A comparison of the differences between the two groups before and after treatment indicated that the treatment effect in the experimental group was better than that in the control group. After 20 treatments, according to subjective evaluations, the tightness and swelling of the limbs in the experimental group were significantly reduced as compared with those in the control group.
CONCLUSION The six-step CDT method can effectively reduce lymphedema, promote lymphatic circulation, and alleviate the subjective symptoms of patients, and thereby improve the quality of life and treatment compliance among patients.
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Affiliation(s)
- Hui-Zhen Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
| | - Qiao-Ling Zhong
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
| | - Hui-Ting Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
| | - Qing-Hua Luo
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
| | - Hai-Lin Tang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
| | - Li-Juan Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
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12
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Koelmeyer LA, Gaitatzis K, Dietrich MS, Shah CS, Boyages J, McLaughlin SA, Taback B, Stolldorf DP, Elder E, Hughes TM, French JR, Ngui N, Hsu JM, Moore A, Ridner SH. Risk factors for breast cancer-related lymphedema in patients undergoing 3 years of prospective surveillance with intervention. Cancer 2022; 128:3408-3415. [PMID: 35797441 PMCID: PMC9542409 DOI: 10.1002/cncr.34377] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 12/30/2022]
Abstract
Background To evaluate risk factors (treatment‐related, comorbidities, and lifestyle) for breast cancer–related lymphedema (BCRL) within the context of a Prospective Surveillance and Early Intervention (PSEI) model of care for subclinical BCRL. Methods The parent randomized clinical trial assigned patients newly diagnosed with breast cancer to PSEI with either bioimpedance spectroscopy (BIS) or tape measurement (TM). Surgical, systemic and radiation treatments, comorbidities, and lifestyle factors were recorded. Detection of subclinical BCRL (change from baseline of either BIS L‐Dex ≥6.5 or tape volume ≥ 5% and < 10%) triggered an intervention with compression therapy. Volume change from baseline ≥10% indicated progression to chronic lymphedema and need for complex decongestive physiotherapy. In this secondary analysis, multinomial logistic regressions including main and interaction effects of the study group and risk factors were used to test for factor associations with outcomes (no lymphedema, subclinical lymphedema, progression to chronic lymphedema after intervention, progression to chronic lymphedema without intervention). Post hoc tests of significant interaction effects were conducted using Bonferroni‐corrected alphas of .008; otherwise, an alpha of .05 was used for statistical significance. Results The sample (n = 918; TM = 457; BIS = 461) was female with a median age of 58.4 years. Factors associated with BCRL risk included axillary lymph node dissection (ALND) (p < .001), taxane‐based chemotherapy (p < .001), regional nodal irradiation (RNI) (p ≤ .001), body mass index >30 (p = .002), and rurality (p = .037). Mastectomy, age, hypertension, diabetes, seroma, smoking, and air travel were not associated with BCRL risk. Conclusions Within the context of 3 years of PSEI for subclinical lymphedema, variables of ALND, taxane‐based chemotherapy, RNI, body mass index >30, and rurality increased risk. The Prospective Surveillance and Early Intervention Model promotes identification and treatment of subclinical lymphedema, facilitating prevention of chronic lymphedema and risk reduction. Axillary lymph node dissection, taxane‐based chemotherapy, regional nodal irradiation, body mass index >30, and rurality are critical risk factors within the context of the Prospective Surveillance and Early Intervention Model for some patients.
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Affiliation(s)
- Louise A Koelmeyer
- Australian Lymphoedema Education, Research, and Treatment (ALERT) Program, Faculty Medicine, Health & Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Katrina Gaitatzis
- Australian Lymphoedema Education, Research, and Treatment (ALERT) Program, Faculty Medicine, Health & Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Mary S Dietrich
- Vanderbilt University School of Nursing, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Chirag S Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - John Boyages
- Australian Lymphoedema Education, Research, and Treatment (ALERT) Program, Faculty Medicine, Health & Human Sciences, Macquarie University, Sydney, New South Wales, Australia.,Icon Cancer Centre, Sydney, New South Wales, Australia
| | | | - Bret Taback
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Deonni P Stolldorf
- Vanderbilt University School of Nursing, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Elisabeth Elder
- Westmead Breast Cancer Institute, Westmead, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia.,Lakeside Specialist Breast Clinic, Norwest, New South Wales, Australia
| | - T Michael Hughes
- ANU Clinical School at Sydney Adventist Hospital, Australian National University, Canberra, Australia
| | - James R French
- Westmead Breast Cancer Institute, Westmead, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia.,Lakeside Specialist Breast Clinic, Norwest, New South Wales, Australia
| | - Nicholas Ngui
- Northern Surgical Oncology, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia
| | - Jeremy M Hsu
- Westmead Breast Cancer Institute, Westmead, New South Wales, Australia.,Lakeside Specialist Breast Clinic, Norwest, New South Wales, Australia.,Macquarie University, Macquarie, Park, New South Wales, Australia
| | - Andrew Moore
- Southeast Cancer Center, Cape Girardeau, Missouri, USA
| | - Sheila H Ridner
- Vanderbilt University School of Nursing, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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13
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Sayan M, Kilic SS, Vergalasova I, Jan I, Eladoumikdachi F, Haffty B, Kumar S, Ohri N. Risk Factors for the Development of Clinical and Subclinical Lymphedema Detected by Bioimpedance Spectroscopy. Clin Breast Cancer 2022; 22:553-559. [DOI: 10.1016/j.clbc.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/15/2022] [Indexed: 11/03/2022]
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14
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Safaee M, Samani R, Ebrahimi H, Zadeh A. Evaluation of relative abundance of lymphedema after reverse axillary mapping in patients with breast cancer. Adv Biomed Res 2022; 11:36. [PMID: 35720216 PMCID: PMC9201235 DOI: 10.4103/abr.abr_281_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 11/04/2022] Open
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15
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Laustsen-Kiel CM, Lauritzen E, Langhans L, Engberg Damsgaard T. Study protocol for a 10-year prospective observational study, examining lymphoedema and patient-reported outcome after breast reconstruction. BMJ Open 2021; 11:e052676. [PMID: 34873005 PMCID: PMC8650483 DOI: 10.1136/bmjopen-2021-052676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Over the last decades, treatment of breast cancer has become increasingly more effective. Consequently, an increasing number of women are living with late effects of breast cancer treatment, including disfiguring scars, deformity or asymmetry of the breast, secondary lymphoedema and other physical and psychosocial late effects. Data from this study will provide knowledge on how to guide breast reconstruction in the future towards outcomes with fewer complications, higher long-term quality of life (QoL) and satisfaction with the aesthetic outcome. The development of secondary lymphoedema, for which the effect of breast reconstruction has yet to be established, will be thoroughly examined. METHODS AND ANALYSIS Women receiving breast reconstruction (autologous and implant based) at the Department of Plastic Surgery and Burns Treatment, Rigshospitalet, will be invited to participate. The patients will be followed for 10 years postoperatively. Demographic, health-related, oncological characteristics and treatment data will be registered. Validated assessment tools, such as the BREAST-Q and Beck Depression Inventory, will be used to measure an extensive range of clinical outcomes, including QoL, life and aesthetic satisfaction and depression. Arm range of motion will be measured with a goniometer and lymphoedema by bioimpedance spectroscopy, compared with circular arm measurements. ETHICS AND DISSEMINATION This study will be conducted according to the 5th version of the Helsinki Declaration. The regional ethical committee for Capital Region Denmark did not find the study notifiable, according to the law of the committee § 1, part 4. All data will be anonymised before its publication. This study will be conducted according to the Danish data protection regulation and is catalogued and approved by the Capital Region Head of Knowledge Centre. According to the Danish health law § 46, part 2, this study does not need the Danish Patient Safety Authority's approval. The findings of this study will be submitted to international peer-reviewed journals.
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Affiliation(s)
| | - Elisabeth Lauritzen
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
| | - Linnea Langhans
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
| | - Tine Engberg Damsgaard
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
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16
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Admoun C, Mayrovitz H. Choosing Mastectomy vs. Lumpectomy-With-Radiation: Experiences of Breast Cancer Survivors. Cureus 2021; 13:e18433. [PMID: 34729260 PMCID: PMC8555933 DOI: 10.7759/cureus.18433] [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: 09/08/2021] [Accepted: 10/02/2021] [Indexed: 11/26/2022] Open
Abstract
Background Annually about 280,000 women are diagnosed with breast cancer. Treatment options depend on age, comorbidities, tumor stage, grade, size, and other factors. Often, patients must decide between two surgical treatment options: mastectomy or lumpectomy-with-radiation herein simply called a lumpectomy. Since both offer similar survival outcomes, the choice ultimately is the patient’s. However, most rely on inputs from doctors, family, friends, personal research, and other actions. We believe decision-making processes for future patients will be aided if experiences of prior breast cancer survivors are known. This study’s aim is to provide such information. Methods Feedback from prior breast cancer survivors was obtained using a 19-question survey distributed online to multiple breast cancer support groups. It focused on issues relevant to choosing between the two surgical options including, post-surgical complications, breast reconstruction, chronic pain, cosmetics, and surgery-choice satisfaction. Results Respondents (N=1606) had a median age of 49 years (range 26 to 88 years) and had a median body mass index (BMI) of 26.6 Kg/m2. There were 978 mastectomy patients (60.9%) and 628 lumpectomy patients (39.1%). With regard to post-surgical reconstruction, 64.2% of mastectomy respondents and 13.5% of lumpectomy respondents decided to undergo breast cancer reconstruction following breast cancer surgery. Almost all (99.8%) of lumpectomy respondents had radiation side-effects; with skin irritation and thickening and chest wall tenderness being the most common. Among mastectomy patients, 94.3% had one or more complications; loss-or-changes in nipple or breast sensation, uneven breasts, chest wall tenderness, and breast swelling were the most common complications. Post-surgical pain lasting six months or more was experienced by a smaller percentage of mastectomy vs. lumpectomy patients (64.1% vs. 78%, p <0.00001). Mastectomy patients were also less likely to have pain that was persistent and present up to the time of the survey (35.4% vs. 46.0%, p=0.0002). With respect to cosmetic outcomes, mastectomy patients vs. lumpectomy patients were less likely to be either satisfied or very satisfied (52.2% vs. 62.7%, p=0.00004). Overall satisfaction of surgical treatment was 70.9% for mastectomy patients and 68.6% for lumpectomy patients. Conclusion Based on the experiences of these breast cancer survivors, mastectomy is associated with less chronic pain frequency and lower incidence of post-surgical side effects compared to lumpectomy. However, mastectomy is associated with lower cosmetic satisfaction. Breast cancer survivors that underwent a lumpectomy, reported being more satisfied with cosmetic outcomes but almost all reported radiation side-effects with skin thickening listed as the most common. Lumpectomy was also associated with higher chronic pain frequency compared to mastectomy. The overall surgical treatment satisfaction reported by mastectomy and lumpectomy respondents was similar. The composite findings will provide information that will aid future breast cancer patients in making a decision between having a mastectomy or a lumpectomy.
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Affiliation(s)
- Claudia Admoun
- Surgical Oncology, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Harvey Mayrovitz
- Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, USA
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17
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Tamam N, Al-Mugren KS, Alrebdi HI, Sulieman A, Abdelbasset WK. Evaluating the Quality of Life and Sleep Quality in Saudi Women with Breast Cancer-Related Lymphedema: A Cross-Sectional Correlational Study. Integr Cancer Ther 2021; 20:15347354211046192. [PMID: 34541909 PMCID: PMC8450611 DOI: 10.1177/15347354211046192] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Among the different cancers found in women, breast cancer is the most common. Breast cancer-related lymphedema is a serious health complication affecting the quality of life and sleep quality. This study evaluates the quality of life and sleep quality among Saudi women with different stages of lymphedema following the treatment of breast cancer. Methods This cross-sectional correlational study included 163 Saudi women with breast cancer-related lymphedema (Stages I-III), aged 28 to 56 years. From the patients identified for this study, women who suffered from mental and psychological dysfunctions or other malignant disorders were excluded. Copies of structured questionnaires were given to each participant during their visits to outpatient physiotherapy clinics. Quality of life was assessed using a valid questionnaire (EORTC QLQ-C30), while sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The differences between the different lymphedema stages have been assessed. Results Of the total number of participants 27 women had been diagnosed with stage I lymphedema, 84 women had been diagnosed with stage II lymphedema, and 52 women had been diagnosed with stage III lymphedema. All participants have shown low scores on both EORTC QLQ-C30 and PSQI. While analyzing the differences between the 3 stages of lymphedema with the Kruskal–Wallis test, noteworthy statistical differences between the 3 stages of lymphedema (P < .05) have been found. The Stage III lymphedema patients have been shown the lowest quality of life values in all scales when compared with the stage I and stage II lymphedema patients. For PSQI scores, the stage III lymphedema patients worse values than the stage I and stage II lymphedema patients (P < .05). Conclusion and Recommendations Both quality of life and quality of sleep have significantly decreased in Saudi women with different stages of breast cancer-related lymphedema. Quality of life and quality of sleep are the worst in stage III lymphedema patients. Future research should consider repeat and enlarge these results as well as assess the risk factors that affect the quality of life and quality of sleep among Saudi women suffering from breast cancer-related lymphedema.
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Affiliation(s)
- Nissren Tamam
- Department of Physics, College of Science, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - K S Al-Mugren
- Department of Physics, College of Science, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - H I Alrebdi
- Department of Physics, College of Science, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Abdelmoneim Sulieman
- Department of Radiology and Medical Imaging, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Walid Kamal Abdelbasset
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia.,Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
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18
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Gowda AU, Nie J, Mets E, Alperovich M, Avraham T. Risk Factors for Lymphedema After Breast Conservation Therapy and Oncoplastic Reduction. Ann Plast Surg 2021; 87:248-252. [PMID: 33346532 DOI: 10.1097/sap.0000000000002630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lymphedema is a known complication after the surgical management of breast cancer, yet the incidence is poorly defined after breast conserving therapy and oncoplastic reduction. The primary aim of this study was to define lymphedema incidence in this population. Furthermore, we sought to correlate demographic factors, surgical approach, and complementary treatment modalities with incidence. METHODS Data were collected retrospectively on patients who underwent breast conserving therapy at our institution from 2012 to 2015 with greater than 1 year of follow-up. Patients were excluded if they underwent breast surgery before treatment, completion mastectomy, delayed breast reconstruction, or delayed breast reduction. RESULTS Five hundred and eighty-four patients met study criteria with a 11% lymphedema rate. Patients developing lymphedema had higher preoperative body mass index (P = 0.02), larger breast mass resection volume (P < 0.01), higher rate of axillary dissection (P < 0.01), increased rate of adjuvant whole-breast radiation (P = 0.03), supraclavicular radiation (P < 0.01), axillary radiation (P < 0.01), and neoadjuvant medical therapy (P < 0.01). Multivariate analysis showed breast specimen mass, axillary radiation, and neoadjuvant medical therapy, which were associated with lymphedema (P < 0.05). There was no difference in lymphedema incidence between partial mastectomy and oncoplastic reduction cohorts with independent multivariate analyses for each showing axillary radiation and neoadjuvant medical therapy were significantly associated with lymphedema (P < 0.05), although breast specimen mass was not. CONCLUSIONS Elevated preoperative body mass index, radiation, axillary dissection, and neoadjuvant medical therapy are associated with an increased risk of lymphedema after breast conserving surgery. Oncoplastic reconstruction is not a risk factor for lymphedema.
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Affiliation(s)
- Arvind U Gowda
- From the Department of Surgery, Yale University School of Medicine, New Haven, CT
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19
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Chagpar AB. Debate: Postmastectomy Radiation Therapy in T1/2N1 Disease. Ann Surg Oncol 2021; 28:5456-5460. [PMID: 34324110 DOI: 10.1245/s10434-021-10500-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/08/2021] [Indexed: 12/28/2022]
Abstract
Although postmastectomy radiation therapy is known to reduce local recurrence in patients with T1/2N1 breast cancer, some have postulated that not all patients require this treatment. In this era of genomic analyses and personalized therapy, clinicians have debated whether the toxicity of post-mastectomy radiation therapy (PMRT) can be avoided for some subsets of patients. However, the data in this regard remain controversial, particularly as surgeons de-escalate the surgical management of the axilla. Several ongoing clinical trials may provide a glimpse into optimal management in this scenario. However, the "right" answer to this debate currently remains unclear.
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Affiliation(s)
- Anees B Chagpar
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
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20
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Isik A, Soran A, Grasi A, Barry N, Sezgin E. Lymphedema after Sentinel Lymph Node Biopsy: Who is at Risk? Lymphat Res Biol 2021; 20:160-163. [PMID: 34191608 DOI: 10.1089/lrb.2020.0093] [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] [Indexed: 11/12/2022] Open
Abstract
Aim: Sentinel lymph node biopsy (SLNB) is the accepted approach to stage the clinically negative axilla. The incidence of lymphedema (LE) after SLNB is about 5%. We hypothesize that patients undergoing axillary excision of >5 lymph nodes (LNs) are at increased risk of developing LE. Methods and Results: A single institution prospective breast cancer database was retrospectively reviewed from January 2013 to December 2017, to identify patients who underwent SLNB and were diagnosed with LE. Inclusion criteria was (1) de novo breast cancer, (2) SLNB in clinically node negative patients, and (3) no preoperative diagnosis LE of an extremity. Exclusion criteria was history of axillary lymph node dissection. Age, body mass index, tumor-node-metastasis status, surgery type, neoadjuvant or adjuvant chemotherapy, radiotherapy, and hormone therapy were analyzed. Of the 3325 patients identified, 2940 patients met the inclusion criteria and were included in the final analysis. Median follow-up time was 24 months. Forty-seven (2%) patients were diagnosed with LE, and nine patients (19%) had >5 LNs excised. LE was diagnosed in 3.7% of patients who had >5 LNs excised versus 1.4% of patients with ≤5 LNs excised. Incidence of LE was higher in patients with >5 LNs excision (p = 0.006). Conclusion: Our study showed that patients have a higher likelihood of developing LE when >5 LNs are excised.
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Affiliation(s)
- Arda Isik
- Department of Breast Surgery, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania, USA
| | - Atilla Soran
- Department of Breast Surgery, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania, USA
| | - Ariel Grasi
- Department of Breast Surgery, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania, USA
| | - Noran Barry
- Department of Breast Surgery, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania, USA
| | - Efe Sezgin
- Department of Food Engineering, Laboratory of Nutrigenomics and Epidemiology, Izmir Institute of Technology, Urla, Izmir, Turkey
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Lin Y, Xu Y, Wang C, Song Y, Huang X, Zhang X, Cao X, Sun Q. Loco-regional therapy and the risk of breast cancer-related lymphedema: a systematic review and meta-analysis. Breast Cancer 2021; 28:1261-1272. [PMID: 34106427 DOI: 10.1007/s12282-021-01263-8] [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: 12/25/2020] [Accepted: 05/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND This meta-analysis was designed to assess the association between two loco-regional therapies, regional nodal irradiation (RNI) and axillary lymph node dissection (ALND), and breast cancer-related lymphoedema (BCRL). METHODS We searched PubMed, Science Direct, Embase, and BMJ databases for clinical studies published between January 1, 2010 and January 1, 2020, which assessed risk factors and incidence/prevalence of BCRL. Two investigators independently selected articles to extract relative data and calculate corresponding exact binomial 95% confidence intervals (CIs). In total, 93 articles were reviewed, from which 19 studies were selected. The extracted data were pooled using a random-effects mixed model. RESULTS The incidence of lymphedema in the selected studies ranged from 3% to 36.7%, with a pooled incidence of 14.29% (95% CI 13.79-14.79). The summary odds ratio/risk ratio (OR/RR) of ALND vs. no-ALND was 3.67 (95% CI 2.25-5.98) with a heterogeneity (I2) of 81% (P < 0.00001). After excluding the studies with an abnormally high risk of lymphedema from self-reporting, the summary hazard ratio (HR) was 2.99 (95% CI 2.44-3.66) with no heterogeneity (I2 = 0%, P = 0.83). The summary OR/RR of patients with vs. without radiotherapy (RT) was 1.82 (95% CI 0.92-3.59), but the RR of RT to breast/chest vs. both axillary and supraclavicular areas was 2.66 (95% CI 0.73-9.70). CONCLUSION Regional nodal irradiation has a significantly higher risk for developing lymphedema than irradiation of the breast/chest wall. Axillary dissection and axillary RT have a similar risk for early-onset of breast cancer-related lymphoedema, although the risk trends higher for axillary dissection.
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Affiliation(s)
- Yan Lin
- Department of Breast Disease, Peking Union Medical College Hospital, Peking Union Medical College, 1 Shuaifuyuan, Wangfujing, Beijing, 100730, China
| | - Ying Xu
- Department of Breast Disease, Peking Union Medical College Hospital, Peking Union Medical College, 1 Shuaifuyuan, Wangfujing, Beijing, 100730, China
| | - Changjun Wang
- Department of Breast Disease, Peking Union Medical College Hospital, Peking Union Medical College, 1 Shuaifuyuan, Wangfujing, Beijing, 100730, China
| | - Yu Song
- Department of Breast Disease, Peking Union Medical College Hospital, Peking Union Medical College, 1 Shuaifuyuan, Wangfujing, Beijing, 100730, China
| | - Xin Huang
- Department of Breast Disease, Peking Union Medical College Hospital, Peking Union Medical College, 1 Shuaifuyuan, Wangfujing, Beijing, 100730, China
| | - Xiaohui Zhang
- Department of Breast Disease, Peking Union Medical College Hospital, Peking Union Medical College, 1 Shuaifuyuan, Wangfujing, Beijing, 100730, China
| | - Xi Cao
- Department of Breast Disease, Peking Union Medical College Hospital, Peking Union Medical College, 1 Shuaifuyuan, Wangfujing, Beijing, 100730, China
| | - Qiang Sun
- Department of Breast Disease, Peking Union Medical College Hospital, Peking Union Medical College, 1 Shuaifuyuan, Wangfujing, Beijing, 100730, China.
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McEvoy MP, Ravetch E, Patel G, Fox J, Feldman S. Prevention of Breast Cancer-Related Lymphedema. Clin Breast Cancer 2021; 21:128-142. [PMID: 33771439 DOI: 10.1016/j.clbc.2021.02.009] [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: 09/23/2020] [Revised: 01/25/2021] [Accepted: 02/20/2021] [Indexed: 01/15/2023]
Abstract
Tremendous progress has been made over the past several decades in the treatment of breast cancer. Mortality and recurrence rates continue to decline. Our ability to tailor patient- and tumor-specific treatments has rapidly advanced. The vast majority of our patients can safely have breast conservation. Unfortunately, for many patients, survivorship is burdened by ongoing quality-of-life issues. Most breast cancer patients are asymptomatic at presentation, and the onus is on us to preserve this. Surgery, radiation, and systemic therapy can result in long-term toxicities that can be amplified with multimodality approaches. We must strive to apply minimally effective therapies rather than a maximally tolerated approach. Breast cancer-related lymphedema (BCRL) is a particularly dreaded chronic complication. This review strives to give the reader a better understanding of BCRL and shed light on wisely choosing an integration of treatment modalities that minimizes BCRL risk. Key literature on emerging concepts is highlighted.
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Affiliation(s)
- Maureen P McEvoy
- Breast Surgery Division, Montefiore Einstein Center for Cancer Care, Bronx, NY.
| | - Ethan Ravetch
- Breast Surgery Division, Montefiore Einstein Center for Cancer Care, Bronx, NY
| | - Gunj Patel
- Breast Surgery Division, Montefiore Einstein Center for Cancer Care, Bronx, NY
| | - Jana Fox
- Breast Surgery Division, Montefiore Einstein Center for Cancer Care, Bronx, NY
| | - Sheldon Feldman
- Breast Surgery Division, Montefiore Einstein Center for Cancer Care, Bronx, NY
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Sun J, Mathias BJ, Laronga C, Sun W, Zhou JM, Fulp WJ, Kiluk JV, Lee MC. Impact of Axillary Dissection Among Patients With Sentinel Node-Positive Breast Cancer Undergoing Mastectomy. J Natl Compr Canc Netw 2021; 19:40-47. [PMID: 33406495 DOI: 10.6004/jnccn.2020.7597] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 05/26/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Results of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial supports omission of completion axillary lymph node dissection (CLND) after breast-conservation surgery with a positive sentinel lymph node biopsy (SLNB). We hypothesized that CLND also does not impact outcomes in women with clinically node-negative (cN0), pathologically node-positive breast cancer undergoing mastectomy. MATERIALS AND METHODS A single-institution retrospective review was performed of patients with SLN-positive breast cancer treated from July 1999 through May 2018. Clinicopathologic and outcome data were collected. Patients with SLNBs were compared with those receiving SLNB and CLND. The Kruskal-Wallis, chi-square, and Fisher exact tests were used to assess for differences between continuous and categorical variables. The log-rank test was used for time-to-event analyses, and Cox proportional hazards models were fit for locoregional and distant recurrence and overall survival (OS). RESULTS Of 329 patients with SLN-positive breast cancer undergoing mastectomy, 60% had CLND (n=201). Median age at diagnosis was 53 years (interquartile range [IQR], 46-62 years). The median number of SLNs sampled was 3 (IQR, 2-4), and the median number of positive SLNs was 1 (IQR, 1-2). Patients receiving CLND had higher tumor grades (P=.02) and a higher proportion of hormone receptor negativity (estrogen receptor, 19%; progesterone receptor, 27%; both P=.007). A total of 44 patients (22%) had increased N stage after CLND. Median follow-up was 51 months (IQR, 29-83 months). No association was found between CLND and change in OS and locoregional or distant recurrence. Completion of postmastectomy radiotherapy was associated with improved OS (P=.04). CONCLUSIONS CLND is not significantly correlated with reduced recurrence or improved OS among patients who have cN0, SLN-positive breast cancer treated with mastectomy. CLND was significantly correlated with receipt of adjuvant systemic therapy. Completion of postmastectomy radiotherapy was associated with improved OS.
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Affiliation(s)
- James Sun
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Brittany J Mathias
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, Florida.,Now with Mercy Clinic Breast Surgery - Coletta, Oklahoma City, Oklahoma
| | - Christine Laronga
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Weihong Sun
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Jun-Min Zhou
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida; and
| | - William J Fulp
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida; and.,Now with Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - John V Kiluk
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, Florida
| | - M Catherine Lee
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, Florida
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Schaverien MV, Chang EI. Combined deep inferior epigastric artery perforator flap with vascularized groin lymph node transplant for treatment of breast cancer-related lymphedema. Gland Surg 2021; 10:460-468. [PMID: 33634003 DOI: 10.21037/gs.2020.02.14] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
For survivors of breast cancer lymphedema is their greatest survivorship burden. Modern surgical techniques to treat lymphedema are effective at reducing limb volume, symptoms of lymphedema, episodes of cellulitis, and improving patient quality of life. Physiologic procedures, including lymphovenous bypass (LVB) and vascularized lymph node transplant (VLNT), restore physiological lymphatic function within the affected extremity. In patients with post-mastectomy breast cancer-related upper extremity lymphedema that desire breast reconstruction, microvascular abdominal flap breast reconstruction can be combined with superficial inguinal (groin) VLNT to provide breast reconstruction and treatment of lymphedema in a single operation. This article reviews the indications, preoperative assessment, surgical technique, outcomes, and tips and pearls for performing this procedure.
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Affiliation(s)
- Mark V Schaverien
- Division of Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Edward I Chang
- Division of Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Coroneos CJ, Woodward WA, Wong FC, Caudle AS, Shaitelman SF, Kuerer HM, Schaverien MV. Anatomy and physiology of the sentinel lymph nodes of the upper extremity: Implications for axillary reverse mapping in breast cancer. J Surg Oncol 2020; 123:846-853. [PMID: 33333583 DOI: 10.1002/jso.26343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/29/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study characterizes the physiological drainage of the normal upper extremity using single-photon emission computed tomography/computed tomography (SPECT/CT) lymphoscintigraphy axillary reverse lymphatic mapping (ARM). METHODS A consecutive series of patients assessed with SPECT/CT lymphoscintigraphy ARM of the upper extremity were included. Anatomical localization of the axillary sentinel lymph nodes (SLN) was completed in normal axillae in relation to consistent anatomic landmarks. Retrospective case note analysis was performed to collect patient demographic data. RESULTS A total of 169 patients underwent SPECT/CT lymphoscintigraphy, and imaging of 182 normal axillae was obtained. All patients (100%) had an axillary SLN identified: 19% had a single contrast-enhanced SLN in the axilla and the remainder had multiple. The SLN(s) of the upper extremity was located in the upper outer quadrant (UOQ) of the axilla in 97% of cases (177 axillae). When the SLN(s) was found in the UOQ of the axilla, second-tier lymph nodes were found predominantly in the upper inner quadrant (50% of cases). CONCLUSIONS The upper extremity SLN(s) is located in a constant region of the axilla. This study provides the most complete investigation to date and results can be directly applied clinically to ARM techniques and adjuvant radiation planning.
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Affiliation(s)
- Christopher J Coroneos
- Division of Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wendy A Woodward
- Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Franklin C Wong
- Division of Diagnostic Imaging, Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Abigail S Caudle
- Division of Surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Simona F Shaitelman
- Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Henry M Kuerer
- Division of Surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mark V Schaverien
- Division of Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Leray H, Malloizel-Delaunay J, Lusque A, Chantalat E, Bouglon L, Chollet C, Chaput B, Garmy-Susini B, Yannoutsos A, Vaysse C. Body Mass Index as a Major Risk Factor for Severe Breast Cancer-Related Lymphedema. Lymphat Res Biol 2020; 18:510-516. [DOI: 10.1089/lrb.2019.0009] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hélène Leray
- Service de Chirurgie Gynécologique Oncologique, CHU-Toulouse, Institut Universitaire de Toulouse-Oncopole, Toulouse, France
| | | | - Amélie Lusque
- Service de Biostatistique, Institut Claudius Regaud, Institut Universitaire de Toulouse-Oncopole, Toulouse, France
| | - Elodie Chantalat
- Service de Chirurgie Gynécologique Oncologique, CHU-Toulouse, Institut Universitaire de Toulouse-Oncopole, Toulouse, France
| | - Léonard Bouglon
- Service de Médecine Vasculaire, CHU-Toulouse, Toulouse, France
| | - Charlotte Chollet
- Service de Chirurgie Gynécologique Oncologique, CHU-Toulouse, Institut Universitaire de Toulouse-Oncopole, Toulouse, France
| | - Benoit Chaput
- Service de Chirurgie Plastique et des Brûlés, CHU-Toulouse, Toulouse, France
| | | | - Alexandra Yannoutsos
- Service de Médecine Vasculaire, CHU-Toulouse, Toulouse, France
- Service de Médecine Vasculaire, Hôpital Paris Saint-Joseph, Paris, France
| | - Charlotte Vaysse
- Service de Chirurgie Gynécologique Oncologique, CHU-Toulouse, Institut Universitaire de Toulouse-Oncopole, Toulouse, France
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Kwan JYY, Famiyeh P, Su J, Xu W, Kwan BYM, Jones JM, Chang E, Yip KW, Liu FF. Development and Validation of a Risk Model for Breast Cancer-Related Lymphedema. JAMA Netw Open 2020; 3:e2024373. [PMID: 33175175 PMCID: PMC7658732 DOI: 10.1001/jamanetworkopen.2020.24373] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
IMPORTANCE Approximately 1 in 5 patients with breast cancer who undergo axillary lymph node dissection will develop lymphedema. To appropriately triage and monitor these patients for timely diagnosis and treatment, robust risk models are required. OBJECTIVE To evaluate the prognostic value of mammographic breast density in estimating lymphedema severity. DESIGN, SETTING, AND PARTICIPANTS This prognostic study collected data from July 16, 2018, to March 3, 2020, from the electronic health records of patients of the Cancer Rehabilitation and Survivorship Program at the Princess Margaret Cancer Centre in Toronto, Ontario, Canada. Participants included women who had completed curative treatment for a first diagnosis of breast cancer and who were referred to the program. Also included were a sample of patients in the general breast oncology population who were receiving follow-up care at the center during the same period but who were not referred to the program. All patients attended follow-up appointments at the Princess Margaret Cancer Centre from January 1, 2016, to May 1, 2018. The cohort was randomly split 2:1 to group patients into a training cohort and a validation cohort. EXPOSURES Participant demographic and clinical characteristics included age, sex, body mass index (BMI), medical history, cancer characteristics, and cancer treatment. MAIN OUTCOMES AND MEASURES Spearman correlation coefficient between measured and predicted volume of lymphedema was calculated. Area under the curve (AUC) values were generated for predicting the occurrence of at least mild lymphedema (volume, >200 mL) and severe lymphedema (volume, >500 mL) at the time of initial lymphedema diagnosis. RESULTS A total of 373 female patients (median [interquartile range] age, 52.3 [45.9-60.1] years) were eligible for this analysis. Multivariate linear regression identified 3 patient factors (age, BMI, and mammographic breast density), 1 cancer factor (number of pathological lymph nodes), and 1 treatment factor (axillary lymph node dissection) as independent prognostic variables. In validation testing, Spearman correlation revealed a statistically significant moderate correlation (coefficient, 0.42; 95% CI, 0.26-0.56; P < .001) between measured volume and predicted volume of lymphedema. The AUC values were 0.72 (95% CI, 0.60-0.83) for predicting the occurrence of mild lymphedema and 0.83 (95% CI, 0.74-0.93) for severe lymphedema. CONCLUSIONS AND RELEVANCE This prognostic study found that patients with low breast density appeared to be at a higher risk of developing severe lymphedema. The finding suggests that by combining breast density with established risk factors a multivariate linear regression model could be used to predict the development of lymphedema and provide volumetric estimates of lymphedema severity in patients with breast cancer.
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Affiliation(s)
- Jennifer Yin Yee Kwan
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Research Institute, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Petra Famiyeh
- Research Institute, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jie Su
- Biostatistics Division, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Wei Xu
- Biostatistics Division, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Benjamin Yin Ming Kwan
- Department of Diagnostic Radiology, School of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Jennifer M. Jones
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Eugene Chang
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Kenneth W. Yip
- Research Institute, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Fei-Fei Liu
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Research Institute, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Oladeru OT, Dunn SA, Vanbenthuysen LT, Depauw N, Ho AY. New Frontiers in Hypofractionation for Regional Nodal Irradiation in Breast Cancer. CURRENT BREAST CANCER REPORTS 2020. [DOI: 10.1007/s12609-020-00385-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nassif TM, Brunelle CL, Gillespie TC, Bernstein MC, Bucci LK, Naoum GE, Taghian AG. Breast Cancer-Related Lymphedema: a Review of Risk Factors, Radiation Therapy Contribution, and Management Strategies. CURRENT BREAST CANCER REPORTS 2020. [DOI: 10.1007/s12609-020-00387-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Sen EI, Arman S, Zure M, Yavuz H, Sindel D, Oral A. Manual Lymphatic Drainage May Not Have an Additional Effect on the Intensive Phase of Breast Cancer-Related Lymphedema: A Randomized Controlled Trial. Lymphat Res Biol 2020; 19:141-150. [PMID: 33058746 DOI: 10.1089/lrb.2020.0049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Breast cancer-related lymphedema (BCRL) is a potentially debilitating complication of breast cancer and its treatment. The aim of this study was to determine the efficacy of manual lymphatic drainage (MLD) added to multilayer compressive bandage treatment in addition to an exercise program, on arm volume, subjective symptoms, upper limb functions, and health-related quality of life (HRQoL) in patients with BCRL. Methods: This prospective, randomized, single-blind interventional trial involved 54 patients with BCRL. Eligible patients were randomly allocated to a complex decongestive therapy (CDT) group (n = 27) and a standard therapy (ST) group (n = 27). Both groups participated in a 15-session program (every weekday for 3 weeks) that included compressive multilayer bandaging and exercise training. The patients who were allocated to the CDT group received MLD before bandaging in addition to the ST. Bilateral arm circumferences were measured using a measuring tape at six reference points. Subjective symptoms, such as discomfort, heaviness, and swelling severity were measured using a visual analog scale (VAS). Upper limb functions and HRQoL were assessed using the Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) and Lymphedema Functioning, Disability, and Health Questionnaire (Lymph-ICF), respectively. Results: The excess arm volume, percent change of excess arm volume, Quick-DASH scores, and Lymph-ICF subscale scores significantly decreased (p < 0.001) in both treatment groups. However, there was no significant difference between the two groups (p > 0.05) in terms of changes in these outcomes. The VAS discomfort (p = 0.015) and VAS heaviness (p = 0.014) scores decreased significantly in the CDT group compared to the ST group. Conclusion: The study findings indicated that both treatment approaches were effective in patients with BRCL. However, no additional effect of MLD was found with regard to percent reduction in arm volume in the intensive treatment period of BRCL.
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Affiliation(s)
- Ekin Ilke Sen
- Department of Physical Medicine and Rehabilitation, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sina Arman
- Department of Physical Medicine and Rehabilitation, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Mert Zure
- Department of Physical Medicine and Rehabilitation, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Hadi Yavuz
- Department of Physical Medicine and Rehabilitation, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Dilsad Sindel
- Department of Physical Medicine and Rehabilitation, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Aydan Oral
- Department of Physical Medicine and Rehabilitation, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
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Mathias BJ, Sun J, Sun W, Zhou JM, Fulp WJ, Laronga C, Lee MC, Kiluk JV. Surgeon Bias in the Management of Positive Sentinel Lymph Nodes. Clin Breast Cancer 2020; 21:74-79. [PMID: 32917535 DOI: 10.1016/j.clbc.2020.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/21/2020] [Accepted: 07/20/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The standard of care for clinically node-negative (cN0) patients following positive sentinel lymph node biopsy (SLNB) was completion axillary lymph node dissection (CALND). Publication of ACOSOG Z0011 in 2010 changed this standard for patients undergoing lumpectomy. Clinicians have since expanded this practice to mastectomy patients, and ongoing prospective studies are seeking to validate this practice. Here, we evaluate patient and tumor characteristics that led surgeons to forego a second surgery for CALND in cN0 mastectomy patients with positive SLNB. PATIENTS AND METHODS A single institution, retrospective review of cN0 patients with invasive primary breast cancer and positive SLNB from 2010 to 2016 was performed. Patients with T4 disease, positive preoperative axillary biopsy, prior neoadjuvant therapy or axillary surgery were excluded. Patients with positive SLNB undergoing CALND were compared with patients for whom CALND was omitted. Statistical analysis was performed using Kruskal-Wallis tests for continuous variables and χ2 tests or Fischer exact tests for categorical variables. RESULTS Of 259 patients with positive SLNB, 180 (69.4%) patients underwent mastectomy. CALND was performed at the time of mastectomy in 54 (30%) patients, at time of second operation in 22 (12.2%) patients, and not performed in 104 (57%) patients. Delayed CALND was significantly associated with younger age, larger tumors, increased number of positive sentinel nodes, invasive lobular carcinoma, extranodal extension, and lymphovascular invasion. CONCLUSIONS The management of cN0 patients with positive SLNB that do not meet ACOSOG Z0011 criteria is evolving and is influenced by tumor and patient characteristics in an attempt to balance the morbidity of CALND with the low rate of local regional recurrence.
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Affiliation(s)
| | - James Sun
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Weihong Sun
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Jun-Min Zhou
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - William J Fulp
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Christine Laronga
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - M Catherine Lee
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - John V Kiluk
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
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Minami CA, King TA, Mittendorf EA. Patient preferences for locoregional therapy in early-stage breast cancer. Breast Cancer Res Treat 2020; 183:291-309. [DOI: 10.1007/s10549-020-05737-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/09/2020] [Indexed: 10/23/2022]
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Armer JM, Ballman KV, McCall L, Ostby PL, Zagar E, Kuerer HM, Hunt KK, Boughey JC. Factors Associated With Lymphedema in Women With Node-Positive Breast Cancer Treated With Neoadjuvant Chemotherapy and Axillary Dissection. JAMA Surg 2020; 154:800-809. [PMID: 31314062 DOI: 10.1001/jamasurg.2019.1742] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Most lymphedema studies include a heterogeneous population and focus on patients treated with adjuvant chemotherapy. Objective To examine factors associated with lymphedema after neoadjuvant chemotherapy (NAC) and axillary lymph node dissection in women with node-positive breast cancer. Design, Setting, and Participants This cohort study included data from 701 women 18 years or older with cT0-T4N1-2M0 breast cancer with documented axillary nodal metastasis at diagnosis who were enrolled in the American College of Surgeons Oncology Group Z1071 (Alliance for Clinical Trials in Oncology) trial, which took place from January 1, 2009, to December 31, 2012. Data analysis was performed from January 11, 2018, to November 9, 2018. Interventions All participants received NAC, breast operation, and axillary lymph node dissection. Participants underwent prospective arm measurements and symptom assessment after NAC completion and at 6-month intervals to 36 months postoperatively. Main Outcomes and Measures Factors associated with lymphedema were defined as self-reported arm heaviness or swelling (lymphedema symptoms) or an arm volume increase of 10% or more (V10) or 20% or more (V20). Results A total of 486 patients (mean [SD] age, 50.1 [10.8] years) were included in this study. Median follow-up for the 3 measures was 2.2 to 3.0 years. Cumulative lymphedema incidence at 3 years was 37.8% (95% CI, 33.1%-43.2%) for lymphedema symptoms, 58.4% (95% CI, 53.2%-64.1%) for V10, and 36.9% (95% CI, 31.9%-42.6%) for V20. Increasing body mass index (hazard ratio [HR], 1.04; 95% CI, 1.01-1.06) and NAC for 144 days or longer (HR, 1.48; 95% CI, 1.01-2.17) were associated with lymphedema symptoms. The V20 incidence was higher among patients who received NAC for 144 days or longer (HR, 1.79; 95% CI, 1.19-2.68). The V10 incidence was highest in patients with 30 nodes or more removed (HR, 1.70; 95% CI, 1.15-2.52) and increased with number of positive nodes (HR, 1.03; 95% CI, 1.00-1.06). On multivariable analysis, obesity was significantly associated with lymphedema symptoms (HR, 1.03; 95% CI, 1.01-1.06), and NAC length was significantly associated with V20 (HR, 1.74; 95% CI, 1.15-2.62). Conclusions and Relevance In this study, longer NAC duration and obesity were associated with increased lymphedema incidence, suggesting that patients in these groups may benefit from enhanced prospective lymphedema surveillance.
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Affiliation(s)
- Jane M Armer
- Ellis Fischel Cancer Center, Sinclair School of Nursing, University of Missouri, Columbia
| | - Karla V Ballman
- Alliance Statistics and Data Center, Weill Cornell Medicine, New York, New York
| | - Linda McCall
- Alliance Statistics and Data Center, Duke University, Durham, North Carolina
| | - Pamela L Ostby
- Ellis Fischel Cancer Center, Sinclair School of Nursing, University of Missouri, Columbia
| | - Eris Zagar
- Ellis Fischel Cancer Center, Sinclair School of Nursing, University of Missouri, Columbia
| | - Henry M Kuerer
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Judy C Boughey
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
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Hauerslev KR, Madsen AH, Overgaard J, Damsgaard TE, Christiansen P. Long-term follow-up on shoulder and arm morbidity in patients treated for early breast cancer. Acta Oncol 2020; 59:851-858. [PMID: 32285717 DOI: 10.1080/0284186x.2020.1745269] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: A prospective study on shoulder and arm morbidity was conducted in Denmark in 2003-2005. This study demonstrated that sentinel lymph node biopsy was associated with better outcomes than axillary lymph node dissection 18 months after surgery. We here aimed to describe subjective symptoms and objective findings in these patients 10+ years after they underwent breast cancer surgery and to assess how symptoms and findings developed during this period.Material and methods: Participants in the prospective study completed a questionnaire and underwent an objective, bilateral examination of their shoulder and arm morbidity, which included measurement of arm volume, range of motion, and sensibility.Results: Seventy participants completed follow-up. Thirty-four (49%) had one or more functional impairments, and 64% had one or more subjective loco regional symptoms like pain, swelling of the arm, and decreased shoulder mobility. Objective evaluation showed 34 ml's of increased arm volumes and 3-25% had severe reduced shoulder mobility on the operated side. Compared to the findings at 18 months postoperatively, small but significant differences in occurrence of subjective findings were observed. A significant progression regarding most objective findings was revealed.Conclusion: More than 11 years after breast cancer surgery, the majority of participants complained of one or more subjective symptoms of shoulder and arm morbidity. Objective findings were mild or modest in most cases. During the prolonged follow-up period of 10 years, a worsening in symptoms and objective findings was observed.HIGHLIGHTSShoulder and arm morbidity in relation to breast cancer treatment seems to progress beyond 10 years.The most frequent symptoms were pain, swelling or heaviness of the arm, and decreased shoulder mobility.The objective evaluation showed higher arm volumes and reduced shoulder mobility on the operated side.Objective findings are mild and modest but may affect activities of daily living, and most participants with late symptoms stated that this was a daily problem.
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Affiliation(s)
- Katrine Rye Hauerslev
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Peer Christiansen
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
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Introduction of the Lymphedema Action Plan (LeAP): Clinical Advancement in Proactive Lymphedema Care. REHABILITATION ONCOLOGY 2019. [DOI: 10.1097/01.reo.0000000000000145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Upper-Limb Morbidity in Patients Undergoing a Rehabilitation Program After Breast Cancer Surgery: A 10-Year Follow-up Study. REHABILITATION ONCOLOGY 2019. [DOI: 10.1097/01.reo.0000000000000131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Simon M, Vignes S. [General practitioner questionnaire concerning upper limb lymphedema after breast cancer]. JOURNAL DE MÉDECINE VASCULAIRE 2019; 44:3-8. [PMID: 30770083 DOI: 10.1016/j.jdmv.2018.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION In France, breast cancer is the most frequent cancer in women. Lymphedema, the main complication, is poorly known. The objective of this study was to assess the state of knowledge of upper limb lymphedema (risk factors, complications, treatment) after treatment of breast cancer among general practitioners from the Haute-Normandie and Île-de-France regions. MATERIALS AND METHODS A cross-sectional study with 23 closed questions was sent by email to 490 practicing doctors. RESULTS One hundred and sixty-two questionnaires (33%) could be analyzed. Among the participating physicians (men: 55%), 46% were aged over 50 and 75% were from the Haute-Normandie region; 86% of them followed at least 5 women who had breast cancer. Risk factors for lymphedema were: axillary dissection (89%), risk reduction with sentinel lymph node (82%), radiotherapy (81%), mastectomy (45%) and overweight/obesity (42%). For 54% of physicians, lymphedema appeared within 6 months after cancer treatment and was diagnosed upon examination (clinical signs, perimeter measurements) in 78%, without the need for radiological examinations (100%). Physicians with more than 10 years of experience searched for more lymphedema (86% vs. 62%, P<0.0001). Prescriptions included: elastic compression during the day (77%), manual lymphatic drainage (74%), overnight compression (36%) and consultation in a specialized lymphology department (8%). Six percent of physicians had never managed lymphedema and 22% sent patients to an oncologist. Advice given was: prevention of infectious risk (80%), weight loss (42%), avoidance of sports involving the affected limb (22%), and regular arm elevation (14%). Physicians recommended avoiding blood sampling (75%), measuring blood pressure (66%) on the limb ipsilateral to cancer, while 20% did not prohibit any action on the limb. CONCLUSION Lymphedema knowledge in general practitioners is generally adequate although the number of women followed by each of them was low. It seems necessary to optimize the training of generalists on lymphedema in order to improve patient management.
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Affiliation(s)
- M Simon
- Unité de Lymphologie, site constitutif du Centre national de référence des maladies vasculaires rares (lymphœdèmes primaires), hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France
| | - S Vignes
- Unité de Lymphologie, site constitutif du Centre national de référence des maladies vasculaires rares (lymphœdèmes primaires), hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France.
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Mobarakeh ZS, Mokhtari-Hesari P, Lotfi-Tokaldany M, Montazeri A, Heidari M, Zekri F. Combined decongestive therapy and reduction of pain and heaviness in patients with breast cancer-related lymphedema. Support Care Cancer 2019; 27:3805-3811. [PMID: 30729334 DOI: 10.1007/s00520-019-04681-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 01/28/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE We aimed to determine the effectiveness of combined decongestive therapy (CDT) and the minimum sessions required to significantly reduce pain and heaviness in patients with breast cancer-related lymphedema. METHODS A sample of 169 patients with breast cancer-related lymphedema underwent CDT, 5 days/week for a total of 3 to 4 weeks. Self-reported pain and heaviness was quantified on a separate visual analog scale (VAS) prior to CDT and after 3, 5, 7, 10, and 15 sessions. Scores derived from VASs were categorized into three categories: mild (score < 4), moderate (score = 4-6), and severe (score > 6). Downward transition for at least one category in severity of each parameter was considered as an improvement. Repeated measure analysis of variance was conducted to test the effect of time on the severities of pain and heaviness while age, afflicted side with lymphedema, history of chemotherapy, and radiotherapy were considered as covariates. RESULTS The mean age of patients was 52.66 ± 12.20 years. In all 132 patients, out of 169 patients (71.3%) reported pain and 155 patients (83.7%) reported heaviness at baseline. However, after intervention, the cumulative percentage of patients with at least a one category reduction in pain and heaviness was 86.4% and 83%, respectively. At least seven sessions of CDT were shown to be sufficient in alleviating the severity of the symptoms in greater than 83% of patients. CONCLUSIONS The combined decongestive therapy significantly reduced the intensities of pain and heaviness in patients with breast cancer-related lymphedema.
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Affiliation(s)
- Zahra Sheikhi Mobarakeh
- Quality of life Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, No.146, South Gandi Ave, Vanak Sq, Tehran, 1517964311, Iran
| | - Parisa Mokhtari-Hesari
- Quality of life Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, No.146, South Gandi Ave, Vanak Sq, Tehran, 1517964311, Iran.,Integrative Oncology Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, No.146, South Gandi Ave, Vanak Sq, Tehran, 1517964311, Iran
| | - Masomeh Lotfi-Tokaldany
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Jalal Al Ahmad and North Kargar Cross, Tehran, 1411713138, Iran.
| | - Ali Montazeri
- Population Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Mahnaz Heidari
- Lymphedema Clinic, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, No.146, South Gandi Ave, Vanak Sq, Tehran, 1517964311, Iran
| | - Fatemeh Zekri
- Lymphedema Clinic, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, No.146, South Gandi Ave, Vanak Sq, Tehran, 1517964311, Iran
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Lee J, Choi JE, Kim SJ, Lee SB, Seong MK, Jeong J, Yoon CS, Kim BK, Sun WY. Comparative Study between Sentinel Lymph Node Biopsy and Axillary Dissection in Patients with One or Two Lymph Node Metastases. J Breast Cancer 2018; 21:306-314. [PMID: 30275859 PMCID: PMC6158162 DOI: 10.4048/jbc.2018.21.e44] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 08/12/2018] [Indexed: 12/29/2022] Open
Abstract
Purpose Sentinel lymph node biopsy (SLNB) is a standard axillary surgery in early breast cancer. If the SLNB result is positive, subsequent axillary lymph node dissection (ALND) is a routine procedure. In 2011, the American College of Surgeons Oncology Group Z0011 trial revealed that ALND may not be necessary in early breast cancer with one or two positive sentinel lymph nodes. The purpose of this study was to compare outcomes among Korean patients with one or two positive axillary lymph nodes in the final pathology who did and did not undergo ALND. Methods A total of 131,717 patients from the Korea Breast Cancer Society registry database received breast cancer surgery from January 1995 to December 2014. Inclusion criteria were T stage 1 or 2, one or two positive lymph nodes, and having received breast-conserving surgery (BCS), whole breast radiation therapy, and no neoadjuvant therapy. We analyzed the differences in disease-specific survival (DSS) and overall survival (OS) between patients who received SLNB only and those who underwent SLNB+ALND. Results A total 4,442 patients met the inclusion criteria, with 1,268 (28.6%) in the SLNB group and 3,174 (71.4%) in the SLNB+ALND group. There were no differences in DSS and OS between the two groups (p=0.378 and p=0.925, respectively). The number of patients who underwent SLNB alone for one or two positive lymph nodes increased continuously from 2004 to 2014. Conclusion Korean patients with early breast cancer and 1 or 2 positive axillary lymph nodes who received BCS plus SLNB showed no significant difference in DSS and OS regardless of whether they received ALND. The findings of this retrospective study demonstrate that omitting ALND can be considered when treating selected patients with early breast cancer who have one or two positive lymph nodes.
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Affiliation(s)
- Jina Lee
- Department of Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Daejeon, Korea
| | - Jung Eun Choi
- Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Sei Joong Kim
- Department of Surgery, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Sae Byul Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Ki Seong
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Joon Jeong
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Chan Seok Yoon
- Department of Surgery, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Bong Kyun Kim
- Department of Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Daejeon, Korea
| | - Woo Young Sun
- Department of Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Daejeon, Korea
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Gillespie TC, Sayegh HE, Brunelle CL, Daniell KM, Taghian AG. Breast cancer-related lymphedema: risk factors, precautionary measures, and treatments. Gland Surg 2018; 7:379-403. [PMID: 30175055 DOI: 10.21037/gs.2017.11.04] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Breast cancer-related lymphedema (BCRL) is a negative sequela of breast cancer treatment, and well-established risk factors include axillary lymph node dissection (ALND) and regional lymph node radiation (RLNR). BCRL affects approximately 1 in 5 patients treated for breast cancer, and it has a significant negative impact on patients' quality of life after breast cancer treatment, serving as a reminder of previous illness. This paper is a comprehensive review of the current evidence regarding BCRL risk factors, precautionary guidelines, prospective screening, early intervention, and surgical and non-surgical treatment techniques. Through establishing evidence-based BCRL risk factors, researchers and clinicians are better able to prevent, anticipate, and provide early intervention for BCRL. Clinicians can identify patients at high risk and utilize prospective screening programs, which incorporate objective measurements, patient reported outcome measures (PROM), and clinical examination, thereby creating opportunities for early intervention and, accordingly, improving BCRL prognosis. Innovative surgical techniques that minimize and/or prophylactically correct lymphatic disruption, such as axillary reverse mapping (ARM) and lymphatic-venous anastomoses (LVAs), are promising avenues for reducing BCRL incidence. Nonetheless, for those patients with BCRL who remain unresponsive to conservative methods like complete decongestive therapy (CDT), surgical treatment options aiming to reduce limb volume or restore lymphatic flow may prove to be palliative or corrective. It is only through a strong team-based approach that such a continuum of care can exist, and a multidisciplinary approach to BCRL screening, intervention, and research is therefore strongly encouraged.
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Affiliation(s)
- Tessa C Gillespie
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Hoda E Sayegh
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Cheryl L Brunelle
- Department of Physical Therapy, Massachusetts General Hospital, Boston, MA, USA
| | - Kayla M Daniell
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Alphonse G Taghian
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
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Brunelle CL, Swaroop MN, Skolny MN, Asdourian MS, Sayegh HE, Taghian AG. Hand Edema in Patients at Risk of Breast Cancer-Related Lymphedema: Health Professionals Should Take Notice. Phys Ther 2018; 98:510-517. [PMID: 29361079 PMCID: PMC6692642 DOI: 10.1093/ptj/pzy007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 01/17/2018] [Indexed: 11/14/2022]
Abstract
BACKGROUND There is little research on hand edema in the population at risk for breast cancer-related lymphedema (BCRL). OBJECTIVES Study aims included reporting potential importance of hand edema (HE) as a risk factor for progression of edema in patients treated for breast cancer at risk for BCRL, reporting risk factors for BCRL, and reporting treatment of HE. DESIGN/METHODS This was a retrospective analysis of 9 patients treated for breast cancer in Massachusetts General Hospital's lymphedema screening program who presented with isolated HE. Limb volumes via perometry, BCRL risk factors, and HE treatment are reported. RESULTS Edema was mostly isolated to the hand. Three patients had arm edema >5% on perometry; and 2 of these had edema outside the hand on clinical examination. Patients were at high risk of BCRL with an average of 2.9/5 known risk factors. Arm edema progressed to >10% in 2 high-risk patients. Treatment resulted in an average hand volume reduction of 10.2% via perometry and improvement upon clinical examination. LIMITATIONS The small sample size and lack of validated measures of subjective data were limitations. CONCLUSIONS In this cohort, patients with HE carried significant risk factors for BCRL. Two out of 9 (22%), both carrying ≥4/5 risk factors, progressed to edema >10%. Isolated HE may be a prognostic factor for edema progression in patients treated for breast cancer at risk for BCRL. Further research is warranted.
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Affiliation(s)
- Cheryl L Brunelle
- Department of Physical and Occupational Therapy, Massachusetts General Hospital, Boston, Massachusetts
| | - Meyha N Swaroop
- Department of Radiation Oncology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Melissa N Skolny
- Department of Radiation Oncology, Massachusetts General Hospital, and Harvard Medical School
| | - Maria S Asdourian
- Department of Radiation Oncology, Massachusetts General Hospital, and Harvard Medical School
| | - Hoda E Sayegh
- Department of Radiation Oncology, Massachusetts General Hospital, and Harvard Medical School
| | - Alphonse G Taghian
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 (USA),Address all correspondence to Dr Taghian at:
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Park S, Lee JE, Yu J, Paik HJ, Ryu JM, Kim I, Bae SY, Lee SK, Kim SW, Nam SJ, Kim EK, Kang E, Yang EJ. Risk Factors Affecting Breast Cancer-related Lymphedema: Serial Body Weight Change During Neoadjuvant Anthracycline Plus Cyclophosphamide Followed by Taxane. Clin Breast Cancer 2018; 18:e49-e54. [DOI: 10.1016/j.clbc.2017.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 06/11/2017] [Accepted: 06/15/2017] [Indexed: 10/19/2022]
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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: 28] [Impact Index Per Article: 4.0] [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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Gebruers N, Verbelen H, De Vrieze T, Vos L, Devoogdt N, Fias L, Tjalma W. Current and future perspectives on the evaluation, prevention and conservative management of breast cancer related lymphoedema: A best practice guideline. Eur J Obstet Gynecol Reprod Biol 2017; 216:245-253. [DOI: 10.1016/j.ejogrb.2017.07.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/02/2017] [Accepted: 07/28/2017] [Indexed: 10/19/2022]
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Ochalek K, Gradalski T, Partsch H. Preventing Early Postoperative Arm Swelling and Lymphedema Manifestation by Compression Sleeves After Axillary Lymph Node Interventions in Breast Cancer Patients: A Randomized Controlled Trial. J Pain Symptom Manage 2017; 54:346-354. [PMID: 28797867 DOI: 10.1016/j.jpainsymman.2017.04.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/23/2017] [Accepted: 04/12/2017] [Indexed: 11/30/2022]
Abstract
CONTEXT Breast cancer-related lymphedema (LE) remains one of the major long-term complications after surgery. Many reports showed the effectiveness of compression in breast cancer-related LE treatment, but randomized controlled trials evaluating compression garments for postoperative prevention are lacking. OBJECTIVES The aim of the study was to evaluate the potential role of light arm compression sleeves for reducing the incidence of early postoperative swelling and of breast cancer-related arm LE. METHODS A total of 45 women were pre-operatively randomly assigned to a group with compression of circular-knit sleeves in compression class I (15-21 mm Hg) for daily wearing (compression group [CG]; n = 23) or to a control group without compression (no CG, n = 22). Both groups underwent a standardized physical exercise program. Arm volumes were measured before surgery and one, three, six, nine, and 12 months thereafter. RESULTS At one month, postoperative swelling was reduced only in CG. After 12 months, the average change of excess volumes (edema) reached -67.6 mL in the CG vs. +114.5 mL in the no CG (P < 0.001). Significantly less edema was seen in the CG after three, six, nine, and 12 months. No significant difference between groups in health-related quality of life (measured by EORTC QLQ-C30) was observed. CONCLUSION Fifteen to 21 mm Hg compression sleeves in combination with physical activity may be a safe and efficient option to prevent postsurgical arm swelling and development of LE.
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Affiliation(s)
- Katarzyna Ochalek
- Department of Clinical Rehabilitation, Faculty of Motor Rehabilitation, University of Physical Education, Krakow, Poland; St. Lazarus Hospice, Krakow, Poland
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Parks R, Cheung K. Axillary reverse mapping in N0 patients requiring sentinel lymph node biopsy – A systematic review of the literature and necessity of a randomised study. Breast 2017; 33:57-70. [DOI: 10.1016/j.breast.2017.02.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/26/2017] [Accepted: 02/27/2017] [Indexed: 10/20/2022] Open
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Reliable prediction of postmastectomy lymphedema: The Risk Assessment Tool Evaluating Lymphedema. Am J Surg 2017; 213:1125-1133.e1. [DOI: 10.1016/j.amjsurg.2016.08.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/10/2016] [Accepted: 08/14/2016] [Indexed: 01/05/2023]
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Diagnostic Methods, Risk Factors, Prevention, and Management of Breast Cancer-Related Lymphedema: Past, Present, and Future Directions. CURRENT BREAST CANCER REPORTS 2017; 9:111-121. [PMID: 28894513 DOI: 10.1007/s12609-017-0237-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Breast cancer-related lymphedema (BCRL) is a chronic, adverse, and much feared complication of breast cancer treatment, which affects approximately 20% of patients following breast cancer treatment. BCRL has a tremendous impact on breast cancer survivors, including physical impairments and significant psychological consequences. The intent of this review is to discuss recent studies and analyses regarding the risk factors, diagnosis, prevention through early screening and intervention, and management of BCRL. RECENT FINDINGS Highly-evidenced risk factors for BCRL include axillary lymph node dissection, lack of reconstruction, radiation to the lymph nodes, high BMI at diagnosis, weight fluctuations during and after treatment, subclinical edema within and beyond 3 months after surgery, and cellulitis in the at-risk arm. Avoidance of potential risk factors can serve as a method of prevention. Through establishing a screening program by which breast cancer patients are measured pre-operatively and at follow-ups, are objectively assessed through a weight-adjusted analysis, and are clinically assessed for signs and symptoms, BCRL can be tracked accurately and treated effectively. Management of BCRL is done by a trained professional, with research mounting towards the use of compression bandaging as a first line intervention against BCRL. Finally, exercise is safe for breast cancer patients with and without BCRL and does not incite or exacerbate symptoms of BCRL. SUMMARY Recent research has shed light on BCRL risk factors, diagnosis, prevention, and management. We hope that education on these aspects of BCRL will promote an informed, consistent approach and encourage additional research in this field to improve patient outcomes and quality of life in breast cancer survivors.
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Osório F, Ferro L, Garrido L, Henriques A, Cruz J, Fangueiro R, Fougo JL, Azevedo A. Satisfaction with a therapeutic sleeve for arm lymphedema secondary to breast cancer treatment: Controlled crossover trial. Porto Biomed J 2017; 2:13-17. [PMID: 32258578 DOI: 10.1016/j.pbj.2016.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 11/28/2016] [Indexed: 11/15/2022] Open
Abstract
Highlights Secondary lymphedema is a late iatrogenic side effect of breast cancer treatment.Despite multimodal decongestive therapy in their daily life breast cancer survivors with lymphedema have few alternatives but to use a compressive sleeve.Concerned with the well-known low compliance to the daily use of traditional sleeves, we conducted a comparative study to evaluate the subjective assessment of an innovative class 1 compression sleeve.We concluded that the PRADEX® sleeve, not being worse in its compressive efficacy, is much better with regard to patient comfort. Abstract Secondary arm lymphedema is a feared late iatrogenic side effect of breast cancer survivors with a negative impact on patient's self-image and quality of life. Its reported incidence is extremely variable, from 6% to 80%, as well as the effectiveness of the multimodal decongestive lymphedema therapy.In their daily life breast cancer survivors with lymphedema have few alternatives but to use a compressive sleeve. Concerned with the well-known low compliance to the daily use of traditional sleeves, we conducted a comparative study in a subgroup of our patients with lymphedema secondary to breast cancer treatment for the subjective assessment of PRADEX®, an innovative class 1 compression sleeve. Secondarily, we aimed to assess the non-inferiority of PRADEX® regarding subjective and objective measures of the severity of lymphedema.We studied 46 women with grade 1 secondary arm lymphedema, who used their usual sleeve and PRADEX® daily for 2 weeks each, in a crossover design.The new therapeutic sleeve was classified as having a better design and a better usability and comfort (more comfortable, thinner, fresher, softer, more flexible, comfortable, resistant to dirt and easier to dress and to wear). Women's subjective opinion about the severity of lymphedema favored their usual sleeve in detriment of PRADEX®, but this subjective feeling was contradicted by objective measurements of different perimeters of the arm at the beginning and at the end of the study.We concluded that the PRADEX® sleeve, not being worse in its compressive therapeutic efficacy, is much better with regard to patient comfort.
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Affiliation(s)
- F Osório
- Breast Center, Centro Hospitalar São João, Porto, Portugal
| | - L Ferro
- Breast Center, Centro Hospitalar São João, Porto, Portugal
| | - L Garrido
- Breast Center, Centro Hospitalar São João, Porto, Portugal
| | - A Henriques
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal
| | - J Cruz
- Fibrous Material Research Group, 2C2T, University of Minho, Braga, Portugal
| | - R Fangueiro
- Fibrous Material Research Group, 2C2T, University of Minho, Braga, Portugal
| | - J L Fougo
- Breast Center, Centro Hospitalar São João, Porto, Portugal
| | - A Azevedo
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
- Clinical Research Unit, Hospital Epidemiology Center, Centro Hospitalar São João, Porto, Portugal
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Lee KT, Bang SI, Pyon JK, Hwang JH, Mun GH. Method of breast reconstruction and the development of lymphoedema. Br J Surg 2016; 104:230-237. [DOI: 10.1002/bjs.10397] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/07/2016] [Accepted: 09/06/2016] [Indexed: 11/11/2022]
Abstract
Abstract
Background
Several studies have demonstrated an association between immediate autologous or implant-based breast reconstruction and a reduced incidence of lymphoedema. However, few of these have ocused specifically on whether the reconstruction method affects the development of lymphoedema. The study evaluated the potential impact of breast reconstruction modality on the incidence of lymphoedema.
Methods
Outcomes of women with breast cancer who underwent mastectomy and immediate reconstruction using an autologous flap or a tissue expander/implant between 2008 and 2013 were reviewed. Arm or hand swelling with pertinent clinical signs of lymphoedema and excess volume compared with those of the contralateral side was diagnosed as lymphoedema. The cumulative incidence of lymphoedema was estimated by the Kaplan–Meier method. Clinicopathological factors associated with the development of lymphoedema were investigated by Cox regression analysis.
Results
A total of 429 reconstructions (214 autologous and 215 tissue expander/implant) were analysed; the mean follow-up of patients was 45·3 months. The two groups had similar characteristics, except that women in the autologous group were older, had a higher BMI, and more often had preoperative radiotherapy than women in the tissue expander/implant group. Overall, the 2-year cumulative incidence of lymphoedema was 6·8 per cent (autologous 4·2 per cent, tissue expander/implant 9·3 per cent). Multivariable analysis demonstrated that autologous reconstruction was associated with a significantly reduced risk of lymphoedema compared with that for tissue expander/implant reconstruction. Axillary dissection, a greater number of dissected lymph nodes and postoperative chemotherapy were also independent risk factors for lymphoedema.
Conclusion
The method of breast reconstruction may affect subsequent development of lymphoedema.
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Affiliation(s)
- K-T Lee
- Department of Plastic Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - S I Bang
- Department of Plastic Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - J-K Pyon
- Department of Plastic Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - J H Hwang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - G-H Mun
- Department of Plastic Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
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