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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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2
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Macdonald ER, Amorim NML, Hagstrom AD, Markovic K, Simar D, Ward RE, Clifford BK. Evaluating the effect of upper-body morbidity on quality of life following primary breast cancer treatment: a systematic review and meta-analysis. J Cancer Surviv 2024; 18:1517-1547. [PMID: 37199900 PMCID: PMC11424680 DOI: 10.1007/s11764-023-01395-0] [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: 02/23/2023] [Accepted: 04/28/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE Improvements in breast cancer management continue to increase survival and life expectancy after treatment. Yet the adverse effects of treatment may persist long term, threatening physical, psychological, and social wellbeing, leading to impaired quality of life (QOL). Upper-body morbidity (UBM) such as pain, lymphoedema, restricted shoulder range of motion (ROM), and impaired function are widely reported after breast cancer treatment, but evidence demonstrating its impact on QOL is inconsistent. Therefore, the aim of the study was to conduct a systematic review and meta-analysis evaluating the effect of UBM on QOL following primary breast cancer treatment. METHODS The study was prospectively registered on PROSPERO (CRD42020203445). CINAHL, Embase, Emcare, PsycInfo, PubMed/Medline, and SPORTDiscus databases were searched for studies reporting QOL in individuals with and without UBM following primary breast cancer treatment. Primary analysis determined the standardised mean difference (SMD) in physical, psychological, and social wellbeing scores between UBM + /UBM - groups. Secondary analyses identified differences in QOL scores between groups, according to questionnaire. RESULTS Fifty-eight studies were included, with 39 conducive to meta-analysis. Types of UBM included pain, lymphoedema, restricted shoulder ROM, impaired upper-body function, and upper-body symptoms. UBM + groups reported poorer physical (SMD = - 0.99; 95%CI = - 1.26, - 0.71; p < 0.00001), psychological (SMD = - 0.43; 95%CI = - 0.60, - 0.27; p < 0.00001), and social wellbeing (SMD = - 0.62; 95%CI = - 0.83, - 0.40; p < 0.00001) than UBM - groups. Secondary analyses according to questionnaire showed that UBM + groups rated their QOL poorer or at equal to, UBM - groups across all domains. CONCLUSIONS Findings demonstrate the significant, negative impact of UBM on QOL, pervading physical, psychological, and social domains. IMPLICATIONS FOR CANCER SURVIVORS Efforts to assess and minimise the multidimensional impact of UBM are warranted to mitigate impaired QOL after breast cancer.
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Affiliation(s)
- Eliza R Macdonald
- School of Health Sciences, Department of Exercise Physiology, UNSW, Sydney, Sydney, Australia.
| | - Nadia M L Amorim
- Centre for Inflammation, Faculty of Science, School of Life Sciences, Centenary Institute and University of Technology Sydney, Sydney, NSW, Australia
| | - Amanda D Hagstrom
- School of Health Sciences, Department of Exercise Physiology, UNSW, Sydney, Sydney, Australia
| | - Katarina Markovic
- School of Health Sciences, Department of Exercise Physiology, UNSW, Sydney, Sydney, Australia
| | - David Simar
- School of Health Sciences, Department of Exercise Physiology, UNSW, Sydney, Sydney, Australia
| | - Rachel E Ward
- School of Health Sciences, Department of Exercise Physiology, UNSW, Sydney, Sydney, Australia
| | - Briana K Clifford
- School of Health Sciences, Department of Exercise Physiology, UNSW, Sydney, Sydney, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland (UQ), Brisbane, Australia
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3
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Klein I, Friger M, David MB, Shahar D. Risk factors for long-term arm morbidities following breast cancer treatments: A systematic review. Oncotarget 2023; 14:921-942. [PMID: 38039404 PMCID: PMC10691815 DOI: 10.18632/oncotarget.28539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/16/2023] [Indexed: 12/03/2023] Open
Abstract
PURPOSE To examine the risk factors for arm morbidity following breast cancer treatments, taking a broad view of all types of physical morbidity, including prolonged pain, lymphedema, decreased range of motion, and functional limitations. METHODS A systematic literature review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. Studies exploring the risk factors for prolonged arm morbidity following breast cancer surgery and treatments were included. The studies were assessed independently according to pre-eligibility criteria, following data extraction and methodological quality assessment. RESULTS 1,242 articles were identified. After removing duplicates, the full texts of 1,153 articles were examined. Sixty-nine of these articles met the criteria and were included in the review. These 69 articles identified 29 risk factors for arm morbidity following treatments for breast cancer. The risk of bias was evaluated using NIH study quality assessment tools. The studies reviewed were published between 2001 and 2021 and included a total of 22,886 patients who were followed up for between three months and 10 years. CONCLUSIONS The main risk factors for long-term morbidity are removal of lymph nodes from the axilla, body mass index >30, having undergone a mastectomy, the stage of the disease, radiation therapy, chemotherapy, infection and trauma to the affected arm after surgery. An understanding of the risk factors for prolonged arm morbidity after surgery can help doctors and therapists in making personalized decisions about the need and timing of rehabilitation treatments.
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Affiliation(s)
- Ifat Klein
- Department of Physical Therapy, Assuta Medical Center, Ramat Hahayal, Tel Aviv 6971028, Israel
- Department of Epidemiology, Biostatistics and Community Health Sciences, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Michael Friger
- Department of Epidemiology, Biostatistics and Community Health Sciences, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Merav Ben David
- Department of Physical Therapy, Assuta Medical Center, Ramat Hahayal, Tel Aviv 6971028, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Danit Shahar
- Department of Epidemiology, Biostatistics and Community Health Sciences, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
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4
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Brunelle CL, Taghian AG. Breast Cancer–Related Lymphedema: the Prospective Surveillance Model, Early Intervention Strategies, and Role of Complete Decongestive Therapy. CURRENT BREAST CANCER REPORTS 2023. [DOI: 10.1007/s12609-023-00471-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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5
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Snijders RAH, Brom L, Theunissen M, van den Beuken-van Everdingen MHJ. Update on Prevalence of Pain in Patients with Cancer 2022: A Systematic Literature Review and Meta-Analysis. Cancers (Basel) 2023; 15:591. [PMID: 36765547 PMCID: PMC9913127 DOI: 10.3390/cancers15030591] [Citation(s) in RCA: 74] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
Experiencing pain and insufficient relief can be devastating and negatively affect a patient's quality of life. Developments in oncology such as new treatments and adjusted pain management guidelines may have influenced the prevalence of cancer pain and severity in patients. This review aims to provide an overview of the prevalence and severity of pain in cancer patients in the 2014-2021 literature period. A systematic literature search was performed using the databases PubMed, Embase, CINAHL, and Cochrane. Titles and abstracts were screened, and full texts were evaluated and assessed on methodological quality. A meta-analysis was performed on the pooled prevalence and severity rates. A meta-regression analysis was used to explore differences between treatment groups. We identified 10,637 studies, of which 444 studies were included. The overall prevalence of pain was 44.5%. Moderate to severe pain was experienced by 30.6% of the patients, a lower proportion compared to previous research. Pain experienced by cancer survivors was significantly lower compared to most treatment groups. Our results imply that both the prevalence of pain and pain severity declined in the past decade. Increased attention to the assessment and management of pain might have fostered the decline in the prevalence and severity of pain.
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Affiliation(s)
- Rolf A. H. Snijders
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research & Development, 3511 DT Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), 3511 DT Utrecht, The Netherlands
| | - Linda Brom
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research & Development, 3511 DT Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), 3511 DT Utrecht, The Netherlands
| | - Maurice Theunissen
- Centre of Expertise for Palliative Care, Maastricht University Medical Centre+ (MUMC+), 6229 HX Maastricht, The Netherlands
- Department of Anaesthesiology and Pain Management, Maastricht University Medical Centre+ (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Marieke H. J. van den Beuken-van Everdingen
- Centre of Expertise for Palliative Care, Maastricht University Medical Centre+ (MUMC+), 6229 HX Maastricht, The Netherlands
- Department of Anaesthesiology and Pain Management, Maastricht University Medical Centre+ (MUMC+), 6229 HX Maastricht, The Netherlands
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6
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McEvoy MP, Gomberawalla A, Smith M, Boccardo FM, Holmes D, Djohan R, Thiruchelvam P, Klimberg S, Dietz J, Feldman S. The prevention and treatment of breast cancer- related lymphedema: A review. Front Oncol 2022; 12:1062472. [PMID: 36561522 PMCID: PMC9763870 DOI: 10.3389/fonc.2022.1062472] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
Background Breast cancer- related lymphedema (BCRL) affects about 3 to 5 million patients worldwide, with about 20,000 per year in the United States. As breast cancer mortality is declining due to improved diagnostics and treatments, the long-term effects of treatment for BCRL need to be addressed. Methods The American Society of Breast Surgeons Lymphatic Surgery Working Group conducted a large review of the literature in order to develop guidelines on BCRL prevention and treatment. This was a comprehensive but not systematic review of the literature. This was inclusive of recent randomized controlled trials, meta-analyses, and reviews evaluating the prevention and treatment of BCRL. There were 25 randomized clinical trials, 13 systemic reviews and meta-analyses, and 87 observational studies included. Results The findings of our review are detailed in the paper, with each guideline being analyzed with the most recent data that the group found evidence of to suggest these recommendations. Conclusions Prevention and treatment of BCRL involve a multidisciplinary team. Early detection, before clinically apparent, is crucial to prevent irreversible lymphedema. Awareness of risk factors and appropriate practice adjustments to reduce the risk aids are crucial to decrease the progression of lymphedema. The treatment can be costly, time- consuming, and not always effective, and therefore, the overall goal should be prevention.
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Affiliation(s)
- Maureen P. McEvoy
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, Bronx, NY, United States,*Correspondence: Maureen P. McEvoy,
| | - Ameer Gomberawalla
- Department of Surgery, Advocate Medical Group, Oak Lawn, IL, United States
| | - Mark Smith
- Department of Plastic Surgery, Northwell Health System, New Hyde Park, NY, United States
| | | | - Dennis Holmes
- Department of Surgery, Los Angeles Center for Women’s Health, Los Angeles, CA, United States
| | - Risal Djohan
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, United States
| | - Paul Thiruchelvam
- Department of Breast Surgery, Imperial College, London, United Kingdom
| | - Suzanne Klimberg
- Department of Surgery, University of Texas Medical Branch(UTMB) Cancer Center, Galveston, TX, United States
| | - Jill Dietz
- Department of Surgery, University Hospital Cleveland Medical Center, Cleveland, OH, United States
| | - Sheldon Feldman
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, Bronx, NY, United States
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Pajero Otero V, García Delgado E, Martín Cortijo C, Toribio Rubio V, Guijarro Cano MJ, Calvo Bóveda C, Martín-Arriscado Arroba C, Avendaño Coy J. Development and Evaluation of a Satisfaction Questionnaire About Therapeutic Textile Devices Used for Breast Cancer-Related Lymphedema. Lymphat Res Biol 2021; 20:203-212. [PMID: 33902319 DOI: 10.1089/lrb.2020.0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: There is a need for an appropriate instrument to measure the satisfaction of patients about therapeutic textile devices used for breast cancer-related lymphedema (BCRL). Methods and Results: A new satisfaction questionnaire about therapeutic textile devices used for BCRL was developed and psychometrically tested. An approach to criterion validity by contrast of hypothesis was made. Different average scores were expected depending on the type of therapeutic textile device: Kinesio taping, compression garment, and multilayer low-stretch bandage. Items were analyzed in nine phases: apparent validity, missing responses, internal consistency, factor analysis, reproducibility, confirmation of factor analysis, contrast of hypothesis, variability, and time for completion. One hundred fifty women were sampled in a consecutive order. A final questionnaire was drafted that fulfilled the validation hypothesis, including 20 items that explored 4 dimensions: mood, patient comfort, patient compliance, and perceived benefits. The total Cronbach's α was 0.87. The intraclass correlation coefficient was 0.93 for test-retest and 0.91 for inter-rater. Neither ceiling nor floor effects were observed. The average burden for the respondent and interviewer was 5.6 (standard deviation [SD] = 3.8) and 2.2 (SD = 1.3) minutes, respectively. Conclusion: This preliminary analysis supports the content validity, reliability, and validity of construct of the questionnaire.
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Affiliation(s)
- Violeta Pajero Otero
- Department of Rehabilitation, 12 de Octubre University Hospital, Madrid, Spain.,Department of Physical Medicine and Rehabilitation, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University, Madrid, Spain.,Member of InveCuid +12 Research Group, imas12, Madrid, Spain
| | - Esther García Delgado
- Department of Rehabilitation, 12 de Octubre University Hospital, Madrid, Spain.,Department of Physical Medicine and Rehabilitation, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University, Madrid, Spain
| | - Concepción Martín Cortijo
- Department of Rehabilitation, 12 de Octubre University Hospital, Madrid, Spain.,Department of Physical Medicine and Rehabilitation, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University, Madrid, Spain
| | - Virginia Toribio Rubio
- Department of Rehabilitation, 12 de Octubre University Hospital, Madrid, Spain.,Department of Physical Medicine and Rehabilitation, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University, Madrid, Spain
| | - María Jesús Guijarro Cano
- Department of Rehabilitation, 12 de Octubre University Hospital, Madrid, Spain.,Department of Physical Medicine and Rehabilitation, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University, Madrid, Spain
| | | | | | - Juan Avendaño Coy
- Member of Toledo Physiotherapy Research Group (GIFTO), Castilla-La Mancha University, Toledo, Spain.,Faculty of Nursing and Physiotherapy, Castilla-La Mancha University, Toledo, Spain
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8
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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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Lang AE, Kim SY, Dickerson CR, Milosavljevic S. Measurement of objective shoulder function following breast cancer surgery: a scoping review. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1851439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Angelica E. Lang
- School of Rehabilitation Sciences, University of Saskatchewan, Saskatoon, Canada
| | - Soo Y. Kim
- School of Rehabilitation Sciences, University of Saskatchewan, Saskatoon, Canada
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10
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Shah C, Zambelli-Weiner A, Delgado N, Sier A, Bauserman R, Nelms J. The impact of monitoring techniques on progression to chronic breast cancer-related lymphedema: a meta-analysis comparing bioimpedance spectroscopy versus circumferential measurements. Breast Cancer Res Treat 2020; 185:709-740. [PMID: 33245458 PMCID: PMC7921068 DOI: 10.1007/s10549-020-05988-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 10/20/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Chronic breast cancer-related lymphedema (BCRL) is a potentially serious complication following treatment. Monitoring for progression to BCRL may allow for earlier detection and intervention, reducing the rate of progression to chronic BCRL. Therefore, the purpose of this meta-analysis is to evaluate the impact of monitoring techniques on the incidence of chronic BCRL among patients monitored by bioimpedance spectroscopy (BIS) and circumference as compared to background rates. METHODS Eligible peer-reviewed studies from PubMed, CINHAL, or Google Scholar that were published in English from 2013 onward and conducted in North America, Europe, or Oceania. Incidence rates abstracted from studies were classified by BCRL monitoring method: background (no standardized BIS or circumference assessments), BIS or circumference. A random-effects model was used to calculate a pooled annualized estimate of BCRL incidence while accounting for clinical and methodological heterogeneity. Subgroup analyses examined differences in duration of follow-up as well as breast and axillary surgery. RESULTS 50 studies were included, representing over 67,000 women. The annualized incidence of BCRL was 4.9% (95% CI: 4.3-5.5) for background studies (n = 35), 1.5% (95% CI: 0.6-2.4) for BIS-monitored studies (n = 7), and 7.7% (95% CI: 5.6-9.8) for circumference-monitored studies (n = 11). The cumulative BCRL incidence rate in BIS-monitored patients was 3.1% as compared to 12.9% with background monitoring (69% reduction) and 17.0% with circumference-monitored patients (81% reduction). CONCLUSIONS Evidence suggests that monitoring with BIS allowing for early intervention significantly reduces the relative risk of chronic BCRL with a 69% and 81% reduction compared to background and circumference, respectively. Circumference monitoring did not appear to provide a benefit with respect to chronic BCRL incidence. Based on these results, BIS should be considered for BCRL screening in order to detect subclinical BCRL and reduce rates of chronic BCRL, particularly in high-risk patients.
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Affiliation(s)
- Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
| | | | | | - Ashley Sier
- TTi Health Research and Economics, Westminster, MD, USA
| | | | - Jerrod Nelms
- TTi Health Research and Economics, Westminster, MD, USA
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11
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Kim BK, Park BW, Hur MH, Lee HB, Park MH, Jeong J, Lee HJ, Lee J, Kim D, Sun WY. Omission of axillary lymph node dissection in patients who underwent total mastectomy with 1 or 2 metastatic lymph nodes. Ann Surg Treat Res 2020; 98:283-290. [PMID: 32528907 PMCID: PMC7263889 DOI: 10.4174/astr.2020.98.6.283] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/09/2020] [Accepted: 04/09/2020] [Indexed: 02/06/2023] Open
Abstract
Purpose Sentinel lymph node biopsy (SLNB) is the standard axillary procedure in early breast cancer patients. In a randomized trial, the survival rates were not different when axillary lymph node dissection (ALND) was omitted in patients with 1 or 2 lymph node metastases who underwent breast conserving surgery. This study aimed to compare the outcomes in patients who underwent total mastectomy (TM) with 1 or 2 metastatic nodes according to the types of axillary surgery. Methods In total, 79,058 patients registered in the Korean Breast Cancer Society database who underwent TM were included in the analysis. The inclusion criteria were history of TM and SLNB, pathologic T stage 1 or 2, clinically negative axillary lymph nodes, 1 or 2 metastatic axillary lymph nodes, no radiation therapy, and no neoadjuvant therapy. We divided the patients into the SLNB only and SLNB + ALND groups. The groups were matched by propensity scores. We retrospectively analyzed the differences in the overall survival (OS) between the 2 groups. Results A total of 883 patients were matched in a 1:4 ratio for the SLNB only and SLNB + ALND groups in the cohort from 1999 to 2014. There were no significant differences in OS between the 2 groups (P = 0.413). Subgroup analysis revealed a significant survival benefit in the SLNB + ALND group in the T2 subgroup (P = 0.013). Conclusion OS did not differ between the 2 groups in early breast cancer patients with 1 or 2 metastatic axillary lymph nodes who underwent TM. Omission of ALND may be considered in selected patients.
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Affiliation(s)
- Bong Kyun Kim
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byeong-Woo Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Min Hee Hur
- Department of Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Han-Byoel Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Min Ho Park
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyouk Jin Lee
- Breast-Thyroid Center, Saegyaero Hospital, Busan, Korea
| | - Jina Lee
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dongju Kim
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woo Young Sun
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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12
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De Groef A, De Vrieze T, Dams L, Penen F, Van der Gucht E, Van Assche B, Verhaeghe V, Devoogdt N. Reliability and validity of a Dutch Lymphoedema Questionnaire: Cross-cultural validation of the Norman Questionnaire. Eur J Cancer Care (Engl) 2020; 29:e13242. [PMID: 32410258 DOI: 10.1111/ecc.13242] [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: 09/16/2019] [Revised: 02/05/2020] [Accepted: 04/16/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To perform the cross-cultural validation process of the Dutch Norman Questionnaire (NQ), a questionnaire for the detection and characterisation of breast-cancer related lymphoedema (BCRL) using self-reported signs and symptoms. METHODS Test-retest reliability and construct (including convergent, divergent and known-groups validity), face and content validity were examined in breast cancer patients with (n = 30) and without (n = 30) lymphoedema. For concurrent validity, first, agreement between the diagnostic item of the NQ and a clinical diagnosis were analysed. Second, correlations between NQ scores and clinical arm volume assessment were tested. RESULTS Test-retest reliability was found to be strong to very strong (ICC 0.79-0.96) in the lymphoedema group and moderate to very strong ( ICC 0.64-0.99) in the non-lymphoedema group. Seventeen out of 20 hypotheses on convergent and divergent validity were accepted. There was good face, content and known-groups validity as well. For concurrent validity, agreement between evaluation methods was only 0.462. Moderate correlations were found between 6 out of 9 symptom scores (r = 0.422-0.630) of the NQ and clinical assessment. CONCLUSION The Dutch NQ is a reliable and valid questionnaire for the characterisation of BCRL using self-reported signs and symptoms. Only moderate agreement for the detection of BCRL was found.
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Affiliation(s)
- An De Groef
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
| | - Tessa De Vrieze
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
| | - Lore Dams
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
| | - Frauke Penen
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Elien Van der Gucht
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Brecht Van Assche
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Vincent Verhaeghe
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Vascular Surgery and Department of Physical Medicine and Rehabilitation, Center for Lymphoedema, UZ Leuven - University Hospitals Leuven, Leuven, Belgium
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Manual Therapy as Treatment for Chronic Musculoskeletal Pain in Female Breast Cancer Survivors: A Systematic Review and Meta-Analysis. J Manipulative Physiol Ther 2020; 42:503-513. [PMID: 31864435 DOI: 10.1016/j.jmpt.2018.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/13/2018] [Accepted: 12/19/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The purpose of this systematic review was to investigate the effectiveness of manual therapy (MT) for chronic musculoskeletal pain (CMP) in the upper limbs and thorax of female breast cancer survivors and to investigate the changes in the quality of life and function of these patients. METHODS Systematic searches were performed in the databases MEDLINE/PubMed, Cumulative Index of Nursing and Allied Health/EBSCO, Web of Science, and Physiotherapy Evidence Database, through March 2018, to identify randomized controlled trials investigating whether MT was effective to treat CMP pain in female breast cancer survivors (PROSPERO number CDR42017074175). RESULTS The database searches retrieved 1562 titles, and after screening, 5 papers were included for full analysis. The manual therapy techniques described in the included studies involved myofascial induction, myofascial release, classic massage, ischemic compression of trigger points, and myofascial therapy. A meta-analysis, using a fixed-effects model, found that MT decreased CMP intensity (standardized mean difference: 0.32; 95% CI 0.06-0.57), but no significant difference was observed in quality of life after the MT intervention in comparison with a control condition (standardized mean difference: 0.14; 95% CI 0.17-0.46). CONCLUSION Current evidence suggests that MT is considered effective for treating CMP in the upper limbs and thorax of female breast cancer survivors.
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SOYLU AYSE, TUNA ARZU. LENFÖDEM ve BAKIMINDA HEMŞİRE DENEYİMİ: LENFÖDEM ÜZERİNE BİR İNCELEME. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2020. [DOI: 10.17517/ksutfd.560240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Bozdemir H, Aygin D. The Study of Validity and Reliability of the SPOFIA Scale in Patients With Postoperative Breast Cancer. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2019; 13:1178223419883833. [PMID: 31673226 PMCID: PMC6804360 DOI: 10.1177/1178223419883833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 09/30/2019] [Indexed: 11/25/2022]
Abstract
Introduction and aim: This study investigates the validity and reliability of the Subjective Perception of Post-Operative Functional Impairment of the Arm (SPOFIA) scale in patients with postoperative breast cancer. Materials and methods: Research was designed as a methodological type. Required permissions were taken from the ethics committee, relevant institutions, and researchers who developed the SPOFIA scale. Data were collected as a research in Kocaeli University hospital, between November 2017 and October 2018. For the Turkish SPOFIA scale’s validity, data were collected from 142 patients. In the study, Patient Information Form, SPOFIA, and 36-item Short-Form Health Survey (SF-36) Quality-of-Life Questionnaire were used. In the analysis of data, descriptive statistical methods were used, and in the analysis of the validity of the scale, test-retest and Cronbach alpha reliability coefficient was used. Results: As a result of the analysis, we obtained Kendall W = 0.107, P > 0.05; correlation with SF-36 was P < .05, reliability studies test-retest analysis was P > .05, and Cronbach alpha reliability coefficient was 0.739. It was determined that the SPOFIA scale was valid and reliable for Turkish patients and that the subjective findings of the patients could be used as individual follow-up in longitudinal monitoring. Conclusions: As a result, it was determined that the SPOFIA scale was reliable in the patient follow-up of breast cancer women.
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Affiliation(s)
- Havva Bozdemir
- Health Science İnstitute, Sakarya University, Sakarya, Turkey
| | - Dilek Aygin
- Nursing Department, Faculty of Health Sciences, Sakarya University, Sakarya, Turkey
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Wang K, Yee C, Tam S, Drost L, Chan S, Zaki P, Rico V, Ariello K, Dasios M, Lam H, DeAngelis C, Chow E. Prevalence of pain in patients with breast cancer post-treatment: A systematic review. Breast 2018; 42:113-127. [DOI: 10.1016/j.breast.2018.08.105] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/08/2018] [Accepted: 08/27/2018] [Indexed: 12/12/2022] Open
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Robbeson C, Hugenholtz-Wamsteker W, Meeus M, Devoogdt N, Nijs J, De Groef A. Screening of physical distress in breast cancer survivors: Concurrent validity of the Distress Thermometer and Problem List. Eur J Cancer Care (Engl) 2018; 28:e12880. [DOI: 10.1111/ecc.12880] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 01/15/2018] [Accepted: 06/08/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Conny Robbeson
- Department of Physiotherapy, Physiology & Anatomy; Faculty of Physical Education and Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
- European College for Lymphology & Oncology; De Berekuyl/CSI-the Netherlands; Harderwijk The Netherlands
- WillU Fysio; Dinteloord The Netherlands
| | - Willemijn Hugenholtz-Wamsteker
- Department of Physiotherapy, Physiology & Anatomy; Faculty of Physical Education and Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
- European College for Lymphology & Oncology; De Berekuyl/CSI-the Netherlands; Harderwijk The Netherlands
- Procare Fysiotherapie & Trainingscentrum; Gorinchem The Netherlands
| | - Mira Meeus
- European College for Lymphology & Oncology; De Berekuyl/CSI-the Netherlands; Harderwijk The Netherlands
- Pain in Motion International Research Group, www.paininmotion.be
- Department of Rehabilitation Sciences and Physiotherapy; Faculty of Medicine & Health Sciences; Ghent University; Ghent Belgium
- Department of Rehabilitation Sciences and Physiotherapy; Faculty of Medicine & Health Sciences; University of Antwerp; Antwerp Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences; Lymphoedema Centre; University Hospitals Leuven; KU Leuven - University of Leuven; Leuven Belgium
| | - Jo Nijs
- Department of Physiotherapy, Physiology & Anatomy; Faculty of Physical Education and Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
- European College for Lymphology & Oncology; De Berekuyl/CSI-the Netherlands; Harderwijk The Netherlands
- Pain in Motion International Research Group, www.paininmotion.be
- Department of Physical Medicine and Rehabilitation/Physiotherapy; University Hospital Brussels; Brussels Belgium
| | - An De Groef
- Department of Rehabilitation Sciences; KU Leuven - University of Leuven; Leuven Belgium
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The reliability and validity of Lymphedema Quality of Life Questionnaire-Arm in Turkish patients with upper limb lymphedema related with breast cancer. Turk J Phys Med Rehabil 2018; 64:205-212. [PMID: 31453513 DOI: 10.5606/tftrd.2018.2843] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/27/2018] [Indexed: 01/04/2023] Open
Abstract
Objectives This study aims to adapt Lymphedema Quality of Life Questionnaire-Arm (LYMQOL) into Turkish and to test its reliability and validity in Turkish patients with upper limb lymphedema related with breast cancer. Patients and methods Between June 2015 and November 2015, the Turkish LYMQOL-Arm was obtained using forward-backward translation method and administered to a total of 135 female patients (mean age 51.8±9.8 years; range, 31 to 82 years) with upper limb lymphedema with European Organization for Research and Treatment of Cancer-QoL Breast Cancer-specific version (EORTC QLQ-BR23) and Functional Assessment of Cancer Therapy-Breast-4 (FACT-B+4) questionnaires. A test-retest interval of seven-days was used to assess the reliability. The validation studies were carried-out by means of construct-validity using Spearman's rank correlation-coefficient. Internal consistency and test-retest-reliability were assessed using Cronbach's alpha and intra-class correlation-coefficient (ICC), respectively. Results 135 patients completed the questionnaire with upper limb lymphedema related with breast cancer completed the questionnaires. The mean lymphedema duration was 21.1±28.7 (median: 6) months. Internal consistency and reliability of the Turkish LYMQOL-Arm was good with Cronbach's alpha (0.88-0.90) and test-retest ICC (0.45-0.71). External construct validity was highly confirmed by expected correlations with comparator scales, EORTCQLQ-BR23 and FACT-B+4 (p<0.01). Conclusion The Turkish version of the LYMQOL-Arm is a valid and reliable tool for evaluating QoL in female patients with upper limb lymphedema related with breast cancer.
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Clinical Implementation of the Clinical Practice Guidelines for Diagnosing Upper-Quadrant Lymphedema Secondary to Cancer. REHABILITATION ONCOLOGY 2018. [DOI: 10.1097/01.reo.0000000000000115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Abstract
BACKGROUND Lymphedema occurs commonly in cancer survivors. It is crucial to properly assess cancer patients in order to distinguish lymphedema from general edema and to initiate evidence based treatment. PURPOSE To provide evidence based recommendations for screening, evaluating, and treating lymphedema and to establish the role of the nurse in the care of patients with lymphedema. METHODOLOGY Comprehensive overview with narrative literature review of evidence based lymphedema diagnosis and treatment. FINDINGS Cancer-related edema represents numerous complex conditions. A variety of interventions are needed to address prevention, early detection, patient education, and effective treatment. CONCLUSION Lymphedema treatment is complex and multimodal, and is provided by an interdisciplinary team of properly trained professionals. Nurses play a major role in evaluating, treating and educating patients on the signs and symptoms of cancer-related edema and patient self-management. CLINICAL IMPLICATIONS Evidence-based assessment and treatment should be initiated early to improve outcomes and quality of life in patients with cancer-related lymphedema.
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Kozak D, Głowacka-Mrotek I, Nowikiewicz T, Siedlecki Z, Hagner W, Sowa M, Zegarski W. Analysis of Undesirable Sequelae of Sentinel Node Surgery in Breast Cancer Patients - a Prospective Cohort Study. Pathol Oncol Res 2017; 24:891-897. [PMID: 28918579 PMCID: PMC6132823 DOI: 10.1007/s12253-017-0306-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 09/04/2017] [Indexed: 12/02/2022]
Abstract
Use of sentinel lymph node biopsy limits the frequency and severity of sequelae of surgical treatment. However, the procedure itself may not be completely free of complications. The goal of this work was to analyze prospectively the occurrence of undesirable sequelae in patients undergoing sentinel lymph node biopsy as an isolated intervention in the axillary fossa. This prospective observational study was conducted on a group of 104 women. Patients were examined on five occasions: one day before the procedure, one day after the procedure, one month, three months, and six months after the procedure. At every stage of the study they were assessed for tactile sensation, range of motion in the shoulder joint, upper limb circumference, sensation abnormalities, winged scapula sign, and pain severity according to Visual Analogue Scale (VAS). In the study group we observed statistically significant differences, such as limited mobility in the shoulder joint (p ≤ 0.01), gradual increase in limb circumference on the operated side (p < 0.01) and pain (p ≤ 0.01). Despite relatively low invasiveness of the procedure, sentinel lymph node biopsy is not entirely devoid of the risk of undesirable sequelae.
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Affiliation(s)
- Dominika Kozak
- Department of Surgical Oncology, Oncology Center in Bydgoszcz, Collegium Medicum of the Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Iwona Głowacka-Mrotek
- Department of Rehabilitation, Collegium Medicum of the Nicolaus Copernicus University in Torun, Maria Curie-Skłodowskiej Street 9, 85-094, Bydgoszcz, Poland.
| | - Tomasz Nowikiewicz
- Department of Surgical Oncology, Oncology Center in Bydgoszcz, Collegium Medicum of the Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Zygmunt Siedlecki
- Department of Neurosurgery, Collegium Medicum of the Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Wojciech Hagner
- Department of Rehabilitation, Collegium Medicum of the Nicolaus Copernicus University in Torun, Maria Curie-Skłodowskiej Street 9, 85-094, Bydgoszcz, Poland
| | - Magdalena Sowa
- Department of Surgical Oncology, Oncology Center in Bydgoszcz, Collegium Medicum of the Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
- Department of Laser Therapy and Physiotherapy, Collegium Medicum of the Nicolaus Copernicus University in Bydgoszcz, Bydgoszcz, Poland
| | - Wojciech Zegarski
- Department of Surgical Oncology, Oncology Center in Bydgoszcz, Collegium Medicum of the Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
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McLaughlin SA, Staley AC, Vicini F, Thiruchelvam P, Hutchison NA, Mendez J, MacNeill F, Rockson SG, DeSnyder SM, Klimberg S, Alatriste M, Boccardo F, Smith ML, Feldman SM. Considerations for Clinicians in the Diagnosis, Prevention, and Treatment of Breast Cancer-Related Lymphedema: Recommendations from a Multidisciplinary Expert ASBrS Panel : Part 1: Definitions, Assessments, Education, and Future Directions. Ann Surg Oncol 2017; 24:2818-2826. [PMID: 28766232 DOI: 10.1245/s10434-017-5982-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Indexed: 12/21/2022]
Affiliation(s)
| | | | - Frank Vicini
- Radiation Oncology, UCLA School of Medicine, Los Angeles, USA
| | | | - Nancy A Hutchison
- Courage Kenny Rehabilitation Institute of AllinaHealth, Minneapolis, MN, USA
| | | | - Fiona MacNeill
- Association of Breast Surgery Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - Stanley G Rockson
- Center for Lymphatic and Venous Disorders, Stanford University School of Medicine, Stanford, CA, USA
| | - Sarah M DeSnyder
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Francesco Boccardo
- Department of Surgery, Unit of Lymphatic Surgery - S. Martino University Hospital, University of Genoa, Genoa, Italy
| | - Mark L Smith
- Hofstra Northwell School of Medicine, Northwell Health Cancer Institute, Lake Success, NY, USA
| | - Sheldon M Feldman
- Division of Breast Surgery and Breast Surgical Oncology, Department of Surgery, Montefiore Medical Center, The University Hospital for the Albert Einstein College of Medicine, New York, NY, USA
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Levenhagen K, Davies C, Perdomo M, Ryans K, Gilchrist L. Diagnosis of Upper Quadrant Lymphedema Secondary to Cancer: Clinical Practice Guideline From the Oncology Section of the American Physical Therapy Association. Phys Ther 2017; 97:729-745. [PMID: 28838217 PMCID: PMC5803775 DOI: 10.1093/ptj/pzx050] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 05/01/2017] [Indexed: 01/20/2023]
Abstract
The Oncology Section of the American Physical Therapy Association (APTA) developed a clinical practice guideline to aid the clinician in diagnosing secondary upper quadrant cancer-related lymphedema. Following a systematic review of published studies and a structured appraisal process, recommendations were written to guide the physical therapist and other health care clinicians in the diagnostic process. Overall clinical practice recommendations were formulated based on the evidence for each diagnostic method and were assigned a grade based on the strength of the evidence for different patient presentations and clinical utility. In an effort to maximize clinical applicability, recommendations were based on the characteristics as to the location and stage of a patient's upper quadrant lymphedema.
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Affiliation(s)
- Kimberly Levenhagen
- Saint Louis University, Doisy College of Health Sciences, Department of Physical Therapy & Athletic Training, St Louis, Missouri
| | - Claire Davies
- Rehabilitation Services Baptist Health Lexington, Lexington, Kentucky
| | - Marisa Perdomo
- University of Southern California, Division of Biokinesiology and Physical Therapy, Los Angeles, California
| | - Kathryn Ryans
- Doctor of Physical Therapy Program, Mercy College, Dobbs Ferry, New York
| | - Laura Gilchrist
- St Catherine University, Doctor of Physical Therapy Program, 601 25th Avenue South, Minneapolis, MN 55454
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An Executive Summary of the Clinical Practice Guideline: Diagnosis of Upper-Quadrant Lymphedema Secondary to Cancer. REHABILITATION ONCOLOGY 2017. [DOI: 10.1097/01.reo.0000000000000075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Levenhagen K, Davies C, Perdomo M, Ryans K, Gilchrist L. Diagnosis of Upper-Quadrant Lymphedema Secondary to Cancer: Clinical Practice Guideline From the Oncology Section of APTA. REHABILITATION ONCOLOGY 2017; 35:E1-E18. [PMID: 28748128 PMCID: PMC5497787 DOI: 10.1097/01.reo.0000000000000073] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The Oncology Section of APTA developed a clinical practice guideline to aid the clinician in diagnosing secondary upper-quadrant cancer-related lymphedema. METHODS Following a systematic review of published studies and a structured appraisal process, recommendations were written to guide the physical therapist and other health care clinicians in their diagnostic process. Overall, clinical practice recommendations were formulated on the basis of the evidence for each diagnostic method and were assigned a grade based on the strength of the evidence for different patient presentations and clinical utility. RECOMMENDATIONS In an effort to make these clinically applicable, recommendations were based on the characteristics as to the location and stage of a patient's upper-quadrant lymphedema.
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Affiliation(s)
- Kimberly Levenhagen
- Department of Physical Therapy & Athletic Training, Doisy College of Health Sciences, Saint Louis University, St Louis, MO
| | - Claire Davies
- Certified Lymphedema Therapist-Lymphology Association of North America (CLT-LANA), Rehabilitation Services, Baptist Health Lexington, Lexington, KY
| | - Marisa Perdomo
- Certified Lymphedema Therapist-Foldi (CLT-Foldi), Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
| | - Kathryn Ryans
- Doctor of Physical Therapy Program, Mercy College, Dobbs Ferry, NY
| | - Laura Gilchrist
- Doctor of Physical Therapy Program, St Catherine University, Minneapolis, MN
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Dantas de Oliveira NP, Guedes TSR, Holanda AM, Reis MA, da Silva CP, Rocha e Silva BL, Maia de Almeida GC, de Souza DLB. Functional Disability in Women Submitted to Breast Cancer Treatment. Asian Pac J Cancer Prev 2017; 18:1207-1214. [PMID: 28610403 PMCID: PMC5555524 DOI: 10.22034/apjcp.2017.18.5.1207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The objective of the study presented herein was to verify the prevalence of functional disability and its associated factors in women submitted to breast cancer treatment. A cross-sectional study was carried out, in 101 women diagnosed with malignant breast cancer neoplasm, who underwent cancer treatment at least 12 months before the study, and remained under clinical monitoring. Functional disability was measured by the DASH instrument. Data collection included variables related to socioeconomic characteristics, life habits, health conditions, clinical tumor characteristics and therapeutic approach. Bivariate analysis was carried out by Pearson’s chi-square test or Fisher’s exact test, calculating the prevalence ratio with a 95% confidence interval. Multivariate analysis utilized Poisson’s Regression with robust variance. A statistical significance of 0.05 was considered. Prevalence of functional disability in the studied sample was 22.8% (CI95% 13.9-31.6). Functional disability was statistically significantly associated with age (p = 0.035) and access to health services (p = 0.028). It was concluded that younger patients suffered higher impact of breast cancer treatment on disability. Regarding access to health services, women that received public clinical monitoring reported higher occurrences of functional disability. This pointed towards the necessity of more organized, less bureaucratic, and effective health services in the assistance network, directed to the minimization of the impacts of cancer treatment on health and life conditions of breast cancer survivors.
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Herberger K, Blome C, Heyer K, Ellis F, Münter KC, Augustin M. Quality of life in patients with primary and secondary lymphedema in the community. Wound Repair Regen 2017; 25:466-473. [PMID: 28370792 DOI: 10.1111/wrr.12529] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 01/31/2017] [Indexed: 10/19/2022]
Abstract
Lymphedema is a complex and burdensome medical problem and requires continuous specific therapy. The aim of this cross-sectional study of community lymphedema care in the metropolitan area of Hamburg, Germany, was to evaluate health-related quality of life (QoL) in lymphedema patients. Generic as well as disease-specific health-related QoL was assessed using EQ-5D and FLQA-LK, respectively. Pain was assessed using a visual analogue scale (VAS). About 301 patients (median age of 60.5 years, 90.8% female) with lymphedema of any origin were included. About 66.4% had lymphedema, 24.1% combined lipolymphedema, and 9.5% lipoedema. Mean disease-specific QoL (FLQA-LK) was 2.4 (range 0 = no to 4 = maximum burden). The highest impairment values were observed in subscales for physical complaints, everyday life, and emotional well-being. Mean EQ-5D VAS was 70.4, mean EQ-5D score 63.3. Lymphedema was associated with major impairments in QoL, which differed for subgroups of pain, clinical severity, and comorbidity. Pain as a common problem for lymphedema patients seemed to be underestimated and undertreated. Early diagnosis and structured treatment strategies are urgently needed.
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Affiliation(s)
- Katharina Herberger
- CVderm - German Center for Health Services Research in Dermatology, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Blome
- CVderm - German Center for Health Services Research in Dermatology, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kristina Heyer
- CVderm - German Center for Health Services Research in Dermatology, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franziska Ellis
- CVderm - German Center for Health Services Research in Dermatology, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Matthias Augustin
- CVderm - German Center for Health Services Research in Dermatology, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Li J, Gao W, Yu LX, Zhu SY, Cao FL. Breast-related stereotype threat contributes to a symptom cluster in women with breast cancer. J Clin Nurs 2017; 26:1395-1404. [PMID: 28001333 DOI: 10.1111/jocn.13698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2016] [Indexed: 12/29/2022]
Affiliation(s)
- Jie Li
- School of Nursing; Shandong University; Jinan Shandong China
| | - Wei Gao
- Department of Breast Surgery; Qilu Hospital of Shandong University; Jinan Shandong China
| | - Li-Xiang Yu
- Department of Breast Surgery; The Second Hospital of Shandong University; Jinan Shandong China
| | - Song-Ying Zhu
- Department of Breast Surgery; Qilu Hospital of Shandong University; Jinan Shandong China
| | - Feng-Lin Cao
- School of Nursing; Shandong University; Jinan Shandong China
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Lymphaticovenous Anastomosis Releases the Lower Extremity Lymphedema-associated Pain. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1205. [PMID: 28203506 PMCID: PMC5293304 DOI: 10.1097/gox.0000000000001205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 12/01/2016] [Indexed: 11/26/2022]
Abstract
Background: We investigate the effectiveness of lymphaticovenous anastomosis (LVA) in releasing lymphedema-associated pain. Methods: We performed a retrospective analysis. Subjects of this study included lower extremity lymphedema patients who presented persistent and constant degrees of pain in their lower limbs. LVA was performed under local anesthesia. The preoperative lower extremity pain and postoperative lower extremity pain were surveyed using the visual analog scale on a score from 0 to 10. The circumferences of the limbs were also recorded. Results: A total of 8 patients (16 lower limbs) were included. The subjects included 1 man and 7 women, and their average age was 72 years. The average follow-up period was 17 months. The average preoperative and postoperative visual analog scale scores were 5.3 and 1.8, respectively. Moreover, 7 patients who had records of their lower extremity circumference observed an average changing rate of −4.7% in lower extremity lymphedema index after the surgery. Conclusion: LVA can release the pain in the affected limbs of lymphedema.
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Sun F, Skolny MN, Swaroop MN, Rawal B, Catalano PJ, Brunelle CL, Miller CL, Taghian AG. The need for preoperative baseline arm measurement to accurately quantify breast cancer-related lymphedema. Breast Cancer Res Treat 2016; 157:229-240. [PMID: 27154787 DOI: 10.1007/s10549-016-3821-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 05/02/2016] [Indexed: 11/30/2022]
Abstract
Breast cancer-related lymphedema (BCRL) is a feared outcome of breast cancer treatment, yet the push for early screening is hampered by a lack of standardized quantification. We sought to determine the necessity of preoperative baseline in accounting for temporal changes of upper extremity volume. 1028 women with unilateral breast cancer were prospectively screened for lymphedema by perometry. Thresholds were defined: relative volume change (RVC) ≥10 % for clinically significant lymphedema and ≥5 % including subclinical lymphedema. The first postoperative measurement (pseudo-baseline) simulated the case of no baseline. McNemar's test and binomial logistic regression models were used to analyze BCRL misdiagnoses. Preoperatively, 28.3 and 2.9 % of patients had arm asymmetry of ≥5 and 10 %, respectively. Without baseline, 41.6 % of patients were underdiagnosed and 40.1 % overdiagnosed at RVC ≥ 5 %, increasing to 50.0 and 54.8 % at RVC ≥ 10 %. Increased pseudo-baseline asymmetry, increased weight change between baselines, hormonal therapy, dominant use of contralateral arm, and not receiving axillary lymph node dissection (ALND) were associated with increased risk of underdiagnosis at RVC ≥ 5 %; not receiving regional lymph node radiation was significant at RVC ≥ 10 %. Increased pseudo-baseline asymmetry, not receiving ALND, and dominant use of ipsilateral arm were associated with overdiagnosis at RVC ≥ 5 %; increased pseudo-baseline asymmetry and not receiving ALND were significant at RVC ≥ 10 %. The use of a postoperative proxy even early after treatment results in poor sensitivity for identifying BCRL. Providers with access to patients before surgery should consider the consequent need for proper baseline, with specific strategy tailored by institution.
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Affiliation(s)
- Fangdi Sun
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street, Boston, MA, 02114, USA
| | - Melissa N Skolny
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street, Boston, MA, 02114, USA
| | - Meyha N Swaroop
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street, Boston, MA, 02114, USA
| | - Bhupendra Rawal
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02115, USA
| | - Paul J Catalano
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02115, USA
| | - Cheryl L Brunelle
- Department of Physical and Occupational Therapy, Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street, Boston, MA, 02114, USA
| | - Cynthia L Miller
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street, Boston, MA, 02114, USA
| | - Alphonse G Taghian
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street, Boston, MA, 02114, USA.
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Buragadda S, Alhusaini AA, Melam GR, Arora N. Effect of complete decongestive therapy and a home program for patients with post mastectomy lymphedema. J Phys Ther Sci 2015; 27:2743-8. [PMID: 26504284 PMCID: PMC4616085 DOI: 10.1589/jpts.27.2743] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 05/25/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Post mastectomy lymphedema is common among breast cancer survivors. It leads to physical discomfort and functional impairment. Rehabilitation forms the mainstay of treatment and is multidisciplinary. [Subjects and Methods] Sixty post mastectomy patients were allocated randomly and assigned to either a conventional treatment group (n=30) or a complete decongestive therapy (CDT) group (n=30). The conventional treatment group received manual lymphatic drainage, wore a low elastic compression garment, received glenohumeral mobilization, and performed deep breathing exercises, and the complete decongestive therapy group received CDT from a trained physiotherapist and a daily home program along with the conventional treatment, 5 days a week for 6 weeks. [Results] Arm circumference measurements were taken at five levels: the wrist, mid forearm, elbow, mid-upper arm, and axilla. The upper extremity function was evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and pain was assessed using the visual analogue scale. Measurements were taken at baseline, and at 4th and 6th weeks after the start of intervention. Within and between group comparisons showed significant improvements in the CDT group. [Conclusion] Complete decongestive therapy and a home program assists breast cancer related lymphedema survivors in regaining their lost functions. It also helps to improve their independence in daily activities, reduce their need for caregivers, and thereby improving their quality of life. Therefore, the results of this study showed that the CDT with a home program is an effective treatment for reducing post mastectomy lymphedema.
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Affiliation(s)
- Syamala Buragadda
- Department of Rehabilitation Sciences, College of Applied
Medical Sciences, King Saud University, Saudi Arabia
| | - Adel A Alhusaini
- Department of Rehabilitation Sciences, College of Applied
Medical Sciences, King Saud University, Saudi Arabia
| | - Ganeswara Rao Melam
- Department of Rehabilitation Sciences, College of Applied
Medical Sciences, King Saud University, Saudi Arabia
| | - Nisha Arora
- Department of Physical Therapy, Maharishi Markendeshwar
Institute of Physiotherapy and Rehabilitation, Maharishi Markendeshwar University,
India
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Beek MA, te Slaa A, van der Laan L, Mulder PG, Rutten HJ, Voogd AC, Luiten EJ, Gobardhan PD. Reliability of the Inverse Water Volumetry Method to Measure the Volume of the Upper Limb. Lymphat Res Biol 2015; 13:126-30. [DOI: 10.1089/lrb.2015.0011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - Paul G.H. Mulder
- Department of Amphia Academy, Amphia Hospital, Breda, The Netherlands
| | - Harm J.T. Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
- Department of Surgery, Maastricht University, Maastricht, The Netherlands
| | - Adri C. Voogd
- Department of Epidemiology, Faculty of Health Medicine and Life Sciences, Research Institute Growth and Development (GROW), Maastricht University, Maastricht, The Netherlands
- Research Department, Comprehensive Cancer Centre the Netherlands, Eindhoven, The Netherlands
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Ridner SH, Dietrich MS. Development and validation of the Lymphedema Symptom and Intensity Survey-Arm. Support Care Cancer 2015; 23:3103-12. [PMID: 25752884 DOI: 10.1007/s00520-015-2684-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 02/23/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this instrument development project was to create a self-report tool to evaluate arm lymphedema and associated symptoms in breast cancer survivors. METHODS The Lymphedema Symptom Intensity and Distress Survey-Arm (LSIDS-A) was developed and tested in three phases: phase 1-literature review and expert panel; phase 2-preliminary validation; and phase 3-final validation. RESULTS Phase 1: The most common symptoms experienced by breast cancer survivors with lymphedema were identified. A 52-item scale was developed. Phase 2: 128 community-dwelling breast cancer survivors (64 with lymphedema, 64 without lymphedema) completed the LSIDS-A. Feedback from the participants was that the format was "clear" and "made sense"; therefore, the response structure was left intact. Sixteen items were deleted leaving a 36-item revised instrument. Phase 3: Subsequent testing in a total sample of 236 breast cancer survivors with lymphedema was undertaken. The Cronbach's alpha reliability values for the overall intensity and distress scores were 0.93 and 0.94, respectively. The Kuder-Richardson values ranged from 0.66 to 0.92. Divergent validity evaluated against Marlowe-Crowne Social Desirebility Scale overall was acceptable (intensity, r s = 0.08; distress, r s = -0.12). Convergent validity was acceptable as tested with multiple instruments (e.g., Functional Assessment of Cancer Therapy-Breast +4, overall intensity r s = -0.44, overall distress r s = -.48) CONCLUSIONS: The 30-item LSIDS-A is a valid and reliable instrument that can be used to assess arm lymphedema and its associated symptoms.
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Affiliation(s)
- Sheila H Ridner
- Vanderbilt University School of Nursing, 461 21st Avenue South, Godchaux Hall, Nashville, TN, 37240, USA,
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Shaitelman SF, Cromwell KD, Rasmussen JC, Stout NL, Armer JM, Lasinski BB, Cormier JN. Recent progress in the treatment and prevention of cancer-related lymphedema. CA Cancer J Clin 2015; 65:55-81. [PMID: 25410402 PMCID: PMC4808814 DOI: 10.3322/caac.21253] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This article provides an overview of the recent developments in the diagnosis, treatment, and prevention of cancer-related lymphedema. Lymphedema incidence by tumor site is evaluated. Measurement techniques and trends in patient education and treatment are also summarized to include current trends in therapeutic and surgical treatment options as well as longer-term management. Finally, an overview of the policies related to insurance coverage and reimbursement will give the clinician an overview of important trends in the diagnosis, treatment, and management of cancer-related lymphedema.
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