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Lian Y, Sandhu S, Asefa Y, Gupta A. The Effect of Exercise on Reducing Lymphedema Severity in Breast Cancer Survivors. Cancers (Basel) 2024; 16:1367. [PMID: 38611045 PMCID: PMC11011010 DOI: 10.3390/cancers16071367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Exercise has been repeatedly shown to be safe and beneficial for cancer survivors. However, there is no normative guideline for exercise prescription, and it is still under exploration. Therefore, this literature review aims to provide some advice for the formulation of exercise prescriptions for patients with breast cancer-related lymphedema (BCRL) from the perspective of reducing lymphedema severity. A review of relevant studies published before November 2023 was conducted using three scientific databases: PubMed, Embase, and Scopus. A total of 2696 articles were found. Eventually, 13 studies fulfilled the inclusion criteria and were included in this literature review. We concluded that daily, or nearly daily, exercise at home can be recommended. Moreover, reduced lymphedema severity may not be maintained after ceasing the exercise program, so exercise should be a lifelong practice.
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Affiliation(s)
| | | | | | - Ananya Gupta
- Department of Physiology, University of Galway, H91-TK33 Galway, Ireland; (Y.L.); (S.S.); (Y.A.)
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Aguilera-Eguía RA, Gutiérrez-Arias R, Zaror C, Seron P. Effectiveness of physical exercise programmes in reducing complications associated with secondary lymphoedema to breast cancer: a protocol for an overview of systematic reviews. BMJ Open 2023; 13:e071630. [PMID: 37429694 PMCID: PMC10335487 DOI: 10.1136/bmjopen-2023-071630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/23/2023] [Indexed: 07/12/2023] Open
Abstract
INTRODUCTION Breast cancer-related lymphoedema (BCRL) is one of the most underestimated and debilitating complications associated with the treatment that women with breast cancer receive. Several systematic reviews (SRs) of different physical exercise programmes have been published, presenting disperse and contradictory clinical results. Therefore, there is a need for access to the best available and summarised evidence to capture and evaluate all the physical exercise programmes that focus on reducing BCRL. OBJECTIVE To evaluate the effectiveness of different physical exercise programmes in reducing the volume of lymphoedema, pain intensity and improving quality of life. METHOD AND ANALYSIS The protocol of this overview is reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols, and its methodology is based on Cochrane Handbook for Systematic Reviews of Interventions. Only those SRs involving physical exercise by patients with BCRL will be included, whether on its own or combined with other exercises or other physical therapy interventions.The outcomes of interest to be considered will be lymphoedema volume, quality of life, pain intensity, grip strength, range of motion, upper limb function and any adverse event. The MEDLINE/PubMed, Lilacs, Cochrane Library, PEDro and Embase databases will be searched for reports published from database inception to April 2023.Two researchers will perform study selection, data extraction and risk of bias assessment independently. Any discrepancy will be resolved by consensus, or ultimately, by a third-party reviewer. We will use Grading of Recommendations Assessment, Development and Evaluation System to assess the overall quality of the body of evidence. ETHICS AND DISSEMINATION The results of this overview will be published in peer-reviewed scholarly journals and the scientific dissemination will take place in national or international conferences. This study does not require approval from an ethics committee, as it does not directly collect information from patients. PROSPERO REGISTRATION NUMBER CRD42022334433.
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Affiliation(s)
- Raúl Alberto Aguilera-Eguía
- Departamento de Salud Pública, Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepcion, Chile
- Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ruvistay Gutiérrez-Arias
- Departamento de Apoyo en Rehabilitación Cardiopulmonar Integral, Instituto Nacional del Tórax, Santiago, Chile
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Santiago, Chile
| | - Carlos Zaror
- Pediatric Dentist and Orthodontic, Universidad de La Frontera, Temuco, Chile
| | - Pamela Seron
- CIGES, Universidad de La Frontera, Temuco, Chile
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Mackie H, Suami H, Thompson BM, Ngo Q, Heydon-White A, Blackwell R, Koelmeyer LA. Retrograde Lymph Flow in the Lymphatic Vessels in Limb Lymphedema. J Vasc Surg Venous Lymphat Disord 2022; 10:1101-1106. [PMID: 35714902 DOI: 10.1016/j.jvsv.2022.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/01/2022] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Retrograde movement of lymph due to damaged and/or incompetent valves in the lymphatic vessels has been considered a pathological feature of lymphedema. This study aimed to determine the prevalence of retrograde lymph flow and the characteristics of patients with this condition using indocyanine green (ICG) lymphography. METHODS An audit of 679 patients with upper or lower limb swelling who underwent ICG lymphography was undertaken over a 4-year period. Harvey's technique was applied to identify retrograde flow in the lymph collecting vessel during ICG lymphography. The characteristics of patients with retrograde lymph flow were recorded. RESULTS Twenty-one patients (3.7%, lower limb: n=19, upper limb: n=2) were identified as having retrograde flow in lymph collecting vessels out of 566 confirmed lymphedema patients (lower limb: n=275, upper limb: n=291). Of the two patients with upper limb lymphedema, one had a short segment of retrograde lymph flow in the forearm. The other patient with upper limb lymphedema and one patient with lower limb lymphedema were previously diagnosed with Lymphedema-Distichiasis Syndrome. Of the remaining 18 patients with lower limb lymphedema and retrograde lymph flow, nine had initiating insect bites with lymphangitis and three had palpable benign enlarged inguinal lymph nodes evident prior to lower limb swelling onset. None had cancer-related lower limb lymphedema. CONCLUSIONS Retrograde lymph flow with valve incompetence in the lymph collecting vessels was a rare finding in upper limb lymphedema and a relatively uncommon in lower limb lymphedema, contradicting conventional understanding of pathological changes in lymphedema. ICG lymphography identified anticipated retrograde lymph flow in two patients with Lymphedema-Distichiasis. In the remaining patients, retrograde lymph flow may have resulted from toxic or asymptomatic lymphangitis but no association with secondary cancer-related lymphedema. These findings have implication for conservative management as well as lymphovenous anastomosis surgery where both ends of a transected lymph collecting vessel would be potential targets for anastomoses.
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Affiliation(s)
- Helen Mackie
- Australian Lymphoedema Education, Research and Treatment (ALERT), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia; Mount Wilga Private Hospital, 66 Rosamond Street, Hornsby, NSW, Australia
| | - Hiroo Suami
- Australian Lymphoedema Education, Research and Treatment (ALERT), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.
| | - Belinda M Thompson
- Australian Lymphoedema Education, Research and Treatment (ALERT), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Quan Ngo
- Australian Lymphoedema Education, Research and Treatment (ALERT), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia; Department of Plastic Surgery, Liverpool Hospital, Liverpool, NSW Australia
| | - Asha Heydon-White
- Australian Lymphoedema Education, Research and Treatment (ALERT), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Robbie Blackwell
- Australian Lymphoedema Education, Research and Treatment (ALERT), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Louise A Koelmeyer
- Australian Lymphoedema Education, Research and Treatment (ALERT), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
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Naczk A, Huzarski T, Doś J, Górska-Doś M, Gramza P, Gajewska E, Naczk M. Impact of Inertial Training on Muscle Strength and Quality of Life in Breast Cancer Survivors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3278. [PMID: 35328964 PMCID: PMC8951502 DOI: 10.3390/ijerph19063278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 12/10/2022]
Abstract
The aim of the study was to evaluate the impact of inertial training on the muscle strength, on breast-cancer-related lymphedema, and on quality of life in breast cancer survivors. After a mastectomy, 24 women (age, 66.2 ± 10.6 years) were randomized to a training (n = 12) or control group (n = 12). The training group performed inertial training twice per week for 6 weeks with a training load of about 70% of the maximal force. Before and after training, we tested the maximum force of shoulder flexors, extensors, abductors, and adductors; body composition; breast-cancer-related lymphedema; and disabilities of the arm, shoulder, and hand. Inertial training significantly improved the strength in all tested muscles (from 32 to 68%; effect size (ES) from 0.89 to 1.85 in the impaired limb and from 31 to 64%; ES from 0.86 to 1.57 in the unimpaired limb). However, changes in the control group were not significant. Quality of life improved following treatment; the disabilities of the arm, shoulder, and hand score decreased significantly by 24.5% (ES from—0.29 to 1.38), p ≤ 0.05 in the training group and by 3.99% (ES from −0.49 to 1.14) in the control group p > 0.05. Breast-cancer-related lymphedema and body composition did not change significantly after the intervention in either group. We recommend inertial training for increasing muscle strength and improving quality of life in breast cancer survivors.
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Affiliation(s)
- Alicja Naczk
- Faculty of Physical Culture in Gorzow Wielkopolski, University School of Physical Education in Poznan, 66-400 Gorzow Wielkopolski, Poland; (A.N.); (J.D.); (M.G.-D.)
| | - Tomasz Huzarski
- Institute of Medical Sciences, Collegium Medicum, University of Zielona Gora, 65-417 Zielona Gora, Poland;
| | - Janusz Doś
- Faculty of Physical Culture in Gorzow Wielkopolski, University School of Physical Education in Poznan, 66-400 Gorzow Wielkopolski, Poland; (A.N.); (J.D.); (M.G.-D.)
- Department of Oncological Physiotherapy, Greater Poland Cancer Centre, 61-866 Poznan, Poland
| | - Magdalena Górska-Doś
- Faculty of Physical Culture in Gorzow Wielkopolski, University School of Physical Education in Poznan, 66-400 Gorzow Wielkopolski, Poland; (A.N.); (J.D.); (M.G.-D.)
| | - Piotr Gramza
- Association of Lubusz Innovation Network, 66-400 Gorzow Wielkopolski, Poland;
| | - Ewa Gajewska
- Department of Developmental Neurology, Poznan University of Medical Sciences, 60-355 Poznan, Poland;
| | - Mariusz Naczk
- Institute of Health Sciences, Collegium Medicum, University of Zielona Gora, 65-417 Zielona Gora, Poland
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White BN, Lu IM, Kao LS, Dixon JB, Weiler MJ, Frank ND, Binkley J, Subhedar P, Okoli J, Buhariwalla K, Suarez-Ligon A, Gabram-Mendola SGA. An infrared 3D scanning device as a novel limb volume measurement tool in breast cancer patients. World J Surg Oncol 2020; 18:278. [PMID: 33109204 PMCID: PMC7592580 DOI: 10.1186/s12957-020-02043-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/02/2020] [Indexed: 12/24/2022] Open
Abstract
Abstract Background Lymphedema is a common complication of breast cancer treatment that affects one in five breast cancer survivors, yet there is no reliable method to detect lymphedema in the subclinical range. The objective of this study was to determine the feasibility and reliability of using an infrared 3D scanning device (ISD) as a peri-operative limb volume measurement tool. Methods Fifteen patients were analyzed based on inclusion criteria. Peri-operative measurements were obtained using tape measure and an ISD. Volumes were calculated using a standard algorithm for tape measure and a custom algorithm for ISD measurements. Linear regression models were used to assess ISD and tape measurement volume and circumference correlation. One-way ANOVA was used to compare change in percent difference at set time points post-operatively (2–3 weeks, 4–6 weeks, and 7–12 weeks) for both ISD and tape measure. t tests for unequal variances with the Bonferroni correction were performed among these groups. Results There is a positive linear correlation (R2 = 0.8518) between absolute volume measurements by the ISD and tape measure. Analyses over 2–10 weeks post-operatively showed that the ISD was able to detect volume changes in both the unaffected and the affected arm. Furthermore, the affected arm tended to have a greater increase in volume in the majority of patients, indicating these patients could be at risk for lymphedema. Conclusions Technology utilizing infrared 3D scanners can reliably measure limb volume pre- and post-treatment similarly to tape measure in a small sample of patients. Further research using 3D scanning technology with a longer follow up is warranted.
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Affiliation(s)
- Bernadette N White
- Emory University School of Medicine and Grady Memorial Hospital Avon Comprehensive Breast Center, Atlanta, GA, USA
| | - Iris M Lu
- Georgia Institute of Technology, Atlanta, GA, USA
| | - LeslieAnn S Kao
- Emory University School of Medicine and Grady Memorial Hospital Avon Comprehensive Breast Center, Atlanta, GA, USA
| | | | | | | | - Jill Binkley
- TurningPoint Breast Cancer Rehabilitation, Atlanta, GA, USA
| | - Preeti Subhedar
- Emory University School of Medicine and Grady Memorial Hospital Avon Comprehensive Breast Center, Atlanta, GA, USA
| | - Joel Okoli
- Morehouse School of Medicine, Atlanta, GA, USA
| | | | | | - Sheryl G A Gabram-Mendola
- Emory University School of Medicine and Grady Memorial Hospital Avon Comprehensive Breast Center, Atlanta, GA, USA.
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Lu IM, Dixon JB. Assessment of Upper Extremity Swelling Among Breast Cancer Survivors with a Commercial Infrared Sensor. Lymphat Res Biol 2019; 17:424-433. [DOI: 10.1089/lrb.2018.0010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Iris M. Lu
- Bioinformatics Program, School of Biology, Georgia Institute of Technology, Atlanta, Georgia
| | - J. Brandon Dixon
- Bioinformatics Program, School of Biology, Georgia Institute of Technology, Atlanta, Georgia
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia
- Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
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Frid M, Strang P, Friedrichsen MJ, Johansson K. Lower Limb Lymphedema: Experiences and Perceptions of Cancer Patients in the Late Palliative Stage. J Palliat Care 2019. [DOI: 10.1177/082585970602200102] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Lower limb lymphedema (LLL) is a common but neglected problem in palliative cancer patients. No studies have focused on these patients’ experiences of lymphedema. The aims of this study were to explore patients’ experiences regarding LLL and how they manage to deal with this in the late palliative stage. Methods: Thirteen patients with cancer-related LLL were included to satisfy a maximum variation sampling strategy. Interviews were analyzed using a qualitative phenomenographic method. Results: LLL influenced the patients’ thoughts about the future. Body image was often strongly influenced. Interactions with other persons were perceived as both positive and negative, and a range of coping strategies were expressed. Conclusion: LLL can exert a considerable influence on the physical experiences and the psychosocial situation of cancer patients in palliative care. Areas in need of increased education, attention, and further research are highlighted.
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Affiliation(s)
- Marianne Frid
- Physiotherapy Unit, Karolinska University Hospital, and Research Unit, Stockholms Sjukhem Foundation, Stockholm
| | - Peter Strang
- Research Unit, Stockholms Sjukhem Foundation, and Karolinska Institute, SSH, Stockholm
| | - Maria J. Friedrichsen
- Research Unit, Stockholms Sjukhem Foundation, Stockholm, and Department of Welfare and Care, Palliative Care, Faculty of Health Sciences, Campus Norrköping, Norrköping
| | - Karin Johansson
- Department of Health Science, Lund University, and Lymphedema Unit, Lund University Hospital, Lund, Sweden
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Baumann FT, Reike A, Hallek M, Wiskemann J, Reimer V. Does Exercise Have a Preventive Effect on Secondary Lymphedema in Breast Cancer Patients Following Local Treatment? - A Systematic Review. Breast Care (Basel) 2018; 13:380-385. [PMID: 30498426 DOI: 10.1159/000487428] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Secondary lymphedema (SL) is a possible side effect of breast cancer treatment. Current data describe a positive influence of exercise on upper lymphedema. This systematic review evaluates studies examining a potential preventive effect of exercise on SL incidence. Methods A systematic literature search of PubMed, LIVIVO, and the Cochrane Library was performed. Results 8 randomized controlled trials were included in the review. 3 studies investigated the effect of strength training, and 5 the effect of combined exercise therapy. 5 studies included participants without lymphedema at study entry, and 3 studies included both patients with and without lymphedema. The partly significant results showed that progressive strength training as well as combined dynamic exercise therapies consisting of physiotherapy, physical therapy, and/or kinesiotherapy are safe and can prevent SL. Onset as well as diagnosis of lymphedema were significantly decreased in 5 studies in the exercise group. Conclusion All 8 studies included indicate a potential preventive effect of exercise on SL; however, further research is needed.
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Affiliation(s)
- Freerk T Baumann
- Department I of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University Hospital of Cologne, Cologne, Germany
| | - Alexandra Reike
- Department I of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University Hospital of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University Hospital of Cologne, Cologne, Germany
| | - Joachim Wiskemann
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
| | - Vanessa Reimer
- Department I of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University Hospital of Cologne, Cologne, Germany
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Ly CL, Kataru RP, Mehrara BJ. Inflammatory Manifestations of Lymphedema. Int J Mol Sci 2017; 18:ijms18010171. [PMID: 28106728 PMCID: PMC5297803 DOI: 10.3390/ijms18010171] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/06/2017] [Accepted: 01/12/2017] [Indexed: 12/22/2022] Open
Abstract
Lymphedema results from lymphatic insufficiency leading to a progressive inflammatory process that ultimately manifests as discomfort, recurrent infections, and, at times, secondary malignancy. Collectively, these morbidities contribute to an overall poor quality of life. Although there have been recent advances in microsurgical interventions, a conservative palliative approach remains the mainstay of treatment for this disabling disease. The absence of a cure is due to an incomplete understanding of the pathophysiological changes that result in lymphedema. A histological hallmark of lymphedema is inflammatory cell infiltration and recent studies with animal models and clinical biopsy specimens have suggested that this response plays a key role in the pathology of the disease. The purpose of this report is to provide an overview of the ongoing research in and the current understanding of the inflammatory manifestations of lymphedema.
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Affiliation(s)
- Catherine L Ly
- The Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
| | - Raghu P Kataru
- The Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
| | - Babak J Mehrara
- The Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
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Tomasello B, Malfa GA, Strazzanti A, Gangi S, Di Giacomo C, Basile F, Renis M. Effects of physical activity on systemic oxidative/DNA status in breast cancer survivors. Oncol Lett 2016; 13:441-448. [PMID: 28123580 DOI: 10.3892/ol.2016.5449] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 09/02/2016] [Indexed: 11/06/2022] Open
Abstract
Physical activity offers a paradoxical hormetic effect and a health benefit to cancer survivors; however, the biochemical mechanisms have not been entirely elucidated. Despite the well-documented evidence implicating oxidative stress in breast cancer, the association between health benefits and redox status has not been investigated in survivors who participate in dragon boating. The present study investigated the plasmatic systemic oxidative status (SOS) in breast cancer survivors involved in two distinct physical training exercises. A total of 75 breast cancer survivors were allocated to one of three groups: Control (resting), dragon boat racing and walking group; the latter is a type of aerobic conditioning exercise often advised to cancer patients. Various biochemical oxidative stress markers were examined, including oxidant status (hydroperoxide levels, lipid oxidation) and antioxidant status (enzymatic activities of superoxide dismutase and glutathione peroxidase, reduced glutathione levels and antioxidant capability). In addition, the individual DNA fragmentation and DNA repair capability of nucleotide excision repair (NER) systems were examined by comet assays. According to the results, all patients exhibited high levels of oxidative stress. Physical activity maintained this oxidative stress condition but simultaneously had a positive influence on the antioxidant component of the SOS, particularly in the dragon boat racing group. DNA fragmentation, according to the levels of single- and double-strand breaks, were within the normal range in the two survivor groups that were involved in training activities. Radiation-induced damage was not completely recognised or repaired by NER systems in any of the patients, probably leading to radiosensitivity and/or susceptibility of patients to cancer. These findings suggest that physical activity, particularly dragon boat racing, that modulates SOS and DNA repair capability could represent a strategy for enhancing the quality of life and improving the long-term health benefits for breast cancer survivors.
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Affiliation(s)
- Barbara Tomasello
- Department of Drug Sciences, Section of Biochemistry, University of Catania, I-95125 Catania, Italy
| | - Giuseppe Antonio Malfa
- Department of Drug Sciences, Section of Biochemistry, University of Catania, I-95125 Catania, Italy
| | - Angela Strazzanti
- Department of Surgery, University of Catania, I-95124 Catania, Italy
| | - Santi Gangi
- Department of Surgery, University of Catania, I-95124 Catania, Italy
| | - Claudia Di Giacomo
- Department of Drug Sciences, Section of Biochemistry, University of Catania, I-95125 Catania, Italy
| | - Francesco Basile
- Department of Surgery, University of Catania, I-95124 Catania, Italy
| | - Marcella Renis
- Department of Drug Sciences, Section of Biochemistry, University of Catania, I-95125 Catania, Italy
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Borthwick Y, Paul L, Sneddon M, McAlpine L, Miller C. Reliability and validity of the figure-of-eight method of measuring hand size in patients with breast cancer-related lymphoedema. Eur J Cancer Care (Engl) 2013; 22:196-201. [DOI: 10.1111/ecc.12024] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | - L. Paul
- Nursing & Health Care, School of Medicine; University of Glasgow; Glasgow; UK
| | - M. Sneddon
- Nursing & Health Care, School of Medicine; University of Glasgow; Glasgow; UK
| | - L. McAlpine
- Physiotherapy Area; Beatson West of Scotland Cancer Centre; Glasgow; UK
| | - C. Miller
- School of Mathematics and Statistics; University of Glasgow; Glasgow; UK
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Quirion E. Recognizing and treating upper extremity lymphedema in postmastectomy/lumpectomy patients: a guide for primary care providers. ACTA ACUST UNITED AC 2011; 22:450-9. [PMID: 20854636 DOI: 10.1111/j.1745-7599.2010.00542.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To provide an overview of the lymphatics, physiology of lymphedema (LE), incidence, risks, and costs as well as a guide for the primary care provider on how to recognize the symptoms of LE, a review of current published treatment recommendations, and advice about making a referral to appropriate LE specialists. DATA SOURCES Selected studies on diagnosing and treating LE in breast cancer patients following mastectomy/lumpectomy and evidence-based treatment guidelines. CONCLUSIONS LE is the most common complication related to breast cancer treatment with an occurrence estimated between 10% and 60% depending on the parameters used for measurement. Most commonly, LE occurs within the first 3 years after breast cancer treatment, but the remaining cases happen beyond this period of time and can occur after many years. This means that significant numbers of patients with LE can present to primary care clinicians. IMPLICATIONS FOR PRACTICE A patient who is treated for breast cancer will be followed for a time by the oncology team, but eventually, that patient will be discharged from the oncology practice and will be seen in primary care. Risk factors for developing LE include treatment-related (number of nodes removed and radiation to axilla), disease-related (stage and location of tumor), and patient-related (younger age, obesity, and comorbid conditions) factors. A systematic evaluation of any patient presenting with LE will assure accurate diagnosis and prompt treatment.
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13
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Norman SA, Localio AR, Kallan MJ, Weber AL, Torpey HAS, Potashnik SL, Miller LT, Fox KR, DeMichele A, Solin LJ. Risk factors for lymphedema after breast cancer treatment. Cancer Epidemiol Biomarkers Prev 2010; 19:2734-46. [PMID: 20978176 PMCID: PMC2976830 DOI: 10.1158/1055-9965.epi-09-1245] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND As cancer treatments evolve, it is important to reevaluate their effect on lymphedema risk in breast cancer survivors. METHODS A population-based random sample of 631 women from metropolitan Philadelphia, Pennsylvania, diagnosed with incident breast cancer in 1999 to 2001, was followed for 5 years. Risk factor information was obtained by questionnaire and medical record review. Lymphedema was assessed with a validated questionnaire. Using Cox proportional hazards models, we estimated the relative incidence rates [hazard ratios (HR)] of lymphedema with standard adjusted multivariable analyses ignoring interactions, followed by models including clinically plausible treatment interactions. RESULTS Compared with no lymph node surgery, adjusted HRs for lymphedema were increased following axillary lymph node dissection [ALND; HR, 2.61; 95% confidence interval (95% CI), 1.77-3.84] but not sentinel lymph node biopsy (SLNB; HR, 1.04; 95% CI, 0.58-1.88). Risk was not increased following irradiation [breast/chest wall only: HR, 1.18 (95% CI, 0.80-1.73); breast/chest wall plus supraclavicular field (+/- full axilla): HR, 0.86 (95% CI, 0.48-1.54)]. Eighty-one percent of chemotherapy was anthracycline based. The HR for anthracycline chemotherapy versus no chemotherapy was 1.46 (95% CI, 1.04-2.04), persisting after stratifying on stage at diagnosis or number of positive nodes. Treatment combinations involving ALND or chemotherapy resulted in approximately 4- to 5-fold increases in HRs for lymphedema [e.g., HR of 4.16 (95% CI, 1.32-12.45) for SLNB/chemotherapy/no radiation] compared with no treatment. CONCLUSION With standard multivariable analyses, ALND and chemotherapy increased lymphedema risk whereas radiation therapy and SLNB did not. However, risk varied by combinations of exposures. IMPACT Treatment patterns should be considered when counseling and monitoring patients for lymphedema.
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Affiliation(s)
- Sandra A Norman
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA 19104-6021, USA.
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Lee TS, Kilbreath SL, Sullivan G, Refshauge KM, Beith JM. Patient Perceptions of Arm Care and Exercise Advice After Breast Cancer Surgery. Oncol Nurs Forum 2009; 37:85-91. [DOI: 10.1188/10.onf.85-91] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Norman SA, Localio AR, Potashnik SL, Simoes Torpey HA, Kallan MJ, Weber AL, Miller LT, Demichele A, Solin LJ. Lymphedema in breast cancer survivors: incidence, degree, time course, treatment, and symptoms. J Clin Oncol 2009; 27:390-7. [PMID: 19064976 PMCID: PMC2645852 DOI: 10.1200/jco.2008.17.9291] [Citation(s) in RCA: 252] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Accepted: 09/16/2008] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To examine the incidence, degree, time course, treatment, and symptoms of lymphedema in breast cancer survivors. METHODS We conducted a 5-year, population-based prospective study of 631 randomly selected Philadelphia and Delaware County, Pennsylvania female residents with incident breast cancer who were diagnosed from 1999 to 2001. Using a questionnaire previously validated against physical therapists' measurement-based clinical criteria, we assigned a score indicating the degree of lymphedema (none, mild, or moderate/severe) to each month of follow-up based on the respondent's perceived differences in hand/arm size. Standard survival analysis methods permitted maximum use of follow-up. RESULTS Five-year cumulative incidence of lymphedema was 42 (42%) per 100 women. Among the 238 affected women, lymphedema first occurred within 2 years of diagnosis in 80% and within 3 years in 89%. Among 433 women observed for 3 years, 23% reported no more than mild lymphedema, 12% reported moderate/severe lymphedema, and 2% reported chronically moderate/severe lymphedema. Women with mild lymphedema were more than three times more likely to develop moderate/severe lymphedema than women with no lymphedema. Thirty-seven percent of women with mild lymphedema and 68% with moderate/severe lymphedema received treatment. Increasing proportions of women with increasing degree of lymphedema reported symptoms (eg, jewelry too tight, tired/thick/heavy arm). Symptoms present before the first occurrence of lymphedema were associated with a higher probability of later lymphedema (eg, hazard ratio for jewelry too tight = 7.37; 95% CI, 4.26 to 12.76). CONCLUSION Lymphedema after breast cancer is common but mostly mild. Subtle differences in self-reported hand/arm size and symptoms can be early signs of progressing lymphedema.
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Affiliation(s)
- Sandra A Norman
- Department of Medicine, Division of Hematology/Oncology, Center for Clinical Epidemiologyand Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6021, USA.
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Thomas-MacLean RL, Hack T, Kwan W, Towers A, Miedema B, Tilley A. Arm Morbidity and Disability After Breast Cancer: New Directions for Care. Oncol Nurs Forum 2008; 35:65-71. [DOI: 10.1188/08.onf.65-71] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Paskett ED, Naughton MJ, McCoy TP, Case LD, Abbott JM. The epidemiology of arm and hand swelling in premenopausal breast cancer survivors. Cancer Epidemiol Biomarkers Prev 2007; 16:775-82. [PMID: 17416770 PMCID: PMC4771019 DOI: 10.1158/1055-9965.epi-06-0168] [Citation(s) in RCA: 177] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Breast cancer survivors suffer from lymphedema of the arm and/or hand. Accurate estimates of the incidence and prevalence of lymphedema are lacking, as are the effects of this condition on overall quality of life. METHODS Six hundred twenty-two breast cancer survivors (age, <or=45 years at diagnosis) were followed with semiannual questionnaires for 36 months after surgery to determine the incidence of lymphedema, prevalence of persistent swelling, factors associated with each, and quality of life. RESULTS Of those contacted and eligible for the study, 93% agreed to participate. Fifty-four percent reported arm or hand swelling by 36 months after surgery, with 32% reporting persistent swelling. Swelling was reported to occur in the upper arm (43%), the hand only (34%), and both arm and hand (22%). Factors associated with an increased risk of developing swelling included having a greater number of lymph nodes removed [hazards ratio (HR), 1.02; P < 0.01], receiving chemotherapy (HR, 1.76; P = 0.02), being obese (HR, 1.51 versus normal weight; P = 0.01), and being married (HR, 1.36; P = 0.05). Factors associated with persistent swelling were having more lymph nodes removed (odds ratio, 1.03; P = 0.01) and being obese (odds ratio, 2.24 versus normal weight; P < 0.01). Women reporting swelling had significantly lower quality of life as measured by the functional assessment of cancer therapy-breast total score and the SF-12 physical and mental health subscales (P < 0.01 for each). CONCLUSIONS Lymphedema occurs among a substantial proportion of young breast cancer survivors. Weight management may be a potential intervention for those at greatest risk of lymphedema to maintain optimal health-related quality of life among survivors.
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Affiliation(s)
- Electra D Paskett
- Ohio State University Comprehensive Cancer Center, A356 Starling-Loving Hall, 320 West 10th Avenue, Columbus, OH 43210, USA.
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Gil KM, Mishel MH, Belyea M, Germino B, Porter LS, Clayton M. Benefits of the uncertainty management intervention for African American and White older breast cancer survivors: 20-month outcomes. Int J Behav Med 2007. [PMID: 17228986 DOI: 10.1207/s15327558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
In a 2 x 2 randomized block repeated measure design, this study evaluated the follow-up efficacy of the uncertainty management intervention at 20 months. The sample included 483 recurrence-free women (342 White, 141 African American women; mean age = 64 years) who were 5-9 years posttreatment for breast cancer. Women were randomly assigned to either the intervention or usual care control condition. The intervention was delivered during 4 weekly telephone sessions in which survivors were guided in the use of audiotaped cognitive-behavioral strategies and a self-help manual. Repeated measures MANOVAs evaluating treatment group, ethnic group, and treatment by ethnic interaction effects at 20 months indicated that training in uncertainty management resulted in improvements in cognitive reframing, cancer knowledge, and a variety of coping skills. Importantly, the 20-month outcomes also demonstrated benefits for women in the intervention condition in terms of declines in illness uncertainty and stable effects in personal growth over time.
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Affiliation(s)
- Karen M Gil
- Department of Psychology, University of North Carolina at Chapel Hill, NC 27599, USA.
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Bicego D, Brown K, Ruddick M, Storey D, Wong C, Harris SR. Exercise for women with or at risk for breast cancer-related lymphedema. Phys Ther 2006; 86:1398-405. [PMID: 17012644 DOI: 10.2522/ptj.20050328] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- Deanna Bicego
- School of Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Ridner SH. Pretreatment lymphedema education and identified educational resources in breast cancer patients. PATIENT EDUCATION AND COUNSELING 2006; 61:72-9. [PMID: 16533679 DOI: 10.1016/j.pec.2005.02.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2004] [Revised: 01/25/2005] [Accepted: 02/18/2005] [Indexed: 05/07/2023]
Abstract
OBJECTIVE In 1998, the American Cancer Society (ACS) Lymphedema Workshop, called for a three phase approach to patient lymphedema education: (1) pretreatment, (2) postoperatively, and (3) continuing education. The objectives of this study were: to compare recalled pretreatment lymphedema education before and after the 1998 ACS call; compare recalled lymphedema pretreatment education between women with and without breast cancer treatment-related lymphedema; and identify breast cancer survivors perceived sources of lymphedema education. METHODS One hundred and forty-nine breast cancer survivors (74 with lymphedema and 75 without lymphedema) were asked: (1) Prior to having breast cancer treatment did anyone talk to you about your risk for lymphedema? If yes, who? (2) Prior to having breast cancer treatment did anyone talk to you about ways to decrease your risk for lymphedema? If yes, who? (3) If you want to learn more about lymphedema occurring after breast cancer treatment who would you ask or where would you look for information? RESULTS Individuals with lymphedema consistently recalled receiving less education and a decline in recalled risk reduction education in the lymphedema group occurred after 1998. DISCUSSION Barriers exist to the integration of ACS suggested pretreatment lymphedema educational protocols and risk reduction education may influence risk of developing lymphedema. CONCLUSION Pretreatment lymphedema education may improve breast cancer survivor's recall of educational information received about lymphedema. PRACTICE IMPLICATIONS Healthcare providers must be well versed about breast cancer treatment-related lymphedema and communicate this knowledge to patients on a consistent basis.
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Affiliation(s)
- Sheila H Ridner
- Vanderbilt University School of Nursing, 461 21st Ave. South, Nashville, TN 37240, USA.
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Gil KM, Mishel MH, Belyea M, Germino B, Porter LS, Clayton M. Benefits of the uncertainty management intervention for African American and White older breast cancer survivors: 20-month outcomes. Int J Behav Med 2006; 13:286-94. [PMID: 17228986 DOI: 10.1207/s15327558ijbm1304_3] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
In a 2 x 2 randomized block repeated measure design, this study evaluated the follow-up efficacy of the uncertainty management intervention at 20 months. The sample included 483 recurrence-free women (342 White, 141 African American women; mean age = 64 years) who were 5-9 years posttreatment for breast cancer. Women were randomly assigned to either the intervention or usual care control condition. The intervention was delivered during 4 weekly telephone sessions in which survivors were guided in the use of audiotaped cognitive-behavioral strategies and a self-help manual. Repeated measures MANOVAs evaluating treatment group, ethnic group, and treatment by ethnic interaction effects at 20 months indicated that training in uncertainty management resulted in improvements in cognitive reframing, cancer knowledge, and a variety of coping skills. Importantly, the 20-month outcomes also demonstrated benefits for women in the intervention condition in terms of declines in illness uncertainty and stable effects in personal growth over time.
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Affiliation(s)
- Karen M Gil
- Department of Psychology, University of North Carolina at Chapel Hill, NC 27599, USA.
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Clayton MF, Mishel MH, Belyea M. Testing a model of symptoms, communication, uncertainty, and well-being, in older breast cancer survivors. Res Nurs Health 2006; 29:18-39. [PMID: 16404732 DOI: 10.1002/nur.20108] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Among older, long-term breast cancer survivors, symptoms from previous treatment can generate uncertainty about whether they represent co-morbid conditions, recurrence, or normal aging. This uncertainty can result in emotional distress and thoughts of recurrence. Communication with health care providers may help women reduce uncertainty and improve both emotional and cognitive well-being. To assess the influence of symptoms, uncertainty, and communication with providers on well-being, data from 203 Caucasian and African American survivors, 5-9 years post treatment, were tested using structural equation modeling. Symptoms, age, and uncertainty had the strongest influence on well-being, regardless of race. There was an unexpected positive association between patient-provider communication and thoughts of recurrence. Descriptive analysis revealed that 52% of women were unable to achieve their desired decision-making role with health care providers.
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Affiliation(s)
- Margaret F Clayton
- College of Nursing, University of Utah, Salt Lake City, Utah 84112-5880, USA
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Mishel MH, Germino BB, Gil KM, Belyea M, Laney IC, Stewart J, Porter L, Clayton M. Benefits from an uncertainty management intervention for African-American and Caucasian older long-term breast cancer survivors. Psychooncology 2005; 14:962-78. [PMID: 15712339 DOI: 10.1002/pon.909] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In a randomized controlled design, this study tested the efficacy of a theoretically based uncertainty management intervention delivered to older long-term breast cancer survivors. The sample included 509 recurrence-free women (360 Caucasian, 149 African-American women) with a mean age of 64 years (S.D.=8.9 years) who were 5-9 years post-treated for breast cancer. Women were randomly assigned to either the intervention or usual care control condition. The intervention was delivered during four weekly telephone sessions, in which study nurses guided cancer survivors in the use of audiotaped cognitive-behavioral strategies to manage uncertainty about recurrence, and a self-help manual designed to help women understand and manage long-term treatment side effects and other symptoms. Treatment outcome data on uncertainty management were gathered at pre-intervention and 10-months afterward. Repeated measures MANOVA evaluating treatment group, ethnic group, and treatment by ethnic interaction effects indicated that training in uncertainty management resulted in improvements in cognitive reframing, cancer knowledge, patient-health care provider communication, and a variety of coping skills. Results are discussed in terms of the importance of theory-based interventions for cancer survivors that target triggers of uncertainty about recurrence and in terms of ethnic differences in response to the intervention.
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Affiliation(s)
- Merle H Mishel
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Abstract
OBJECTIVES To describe the clinical features and histologic subtypes of cutaneous melanoma; to review the diagnosis, clinical, and pathologic staging of melanoma and the associated prognostic factors; and to review the treatment and management of AJCC stage I and II melanoma. DATA SOURCES Scientific and review articles, textbooks, and clinical practice. CONCLUSIONS Management of melanoma depends on accurate diagnosis, staging, and interpretation of prognostic factors. The treatment of choice for stage I and II melanoma is surgery, ranging from simple excision to lymph node dissection. IMPLICATIONS FOR NURSING PRACTICE Familiarity with the clinical features of melanoma assists nurses in the screening and early detection of melanoma. Knowledge of AJCC staging guides education regarding treatment and lifelong surveillance.
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Affiliation(s)
- Lynne A Lamb
- Department of Internal Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA
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Abstract
PURPOSE/OBJECTIVES To review the normal physiology of the blood capillary-interstitial-lymphatic vessel interface, describe the pathophysiology of lymphedema secondary to treatment for breast cancer, and summarize the physiologic bases of the current National Lymphedema Network (NLN) risk reduction guidelines. DATA SOURCES Journal articles, anatomy and physiology textbooks, published research data, and Web sites. DATA SYNTHESIS Lymphedema occurring after treatment for breast cancer significantly affects physical, psychological, and sexual functioning. About 28% of breast cancer survivors develop lymphedema. When arterial capillary filtration exceeds lymphatic transport capacity, lymphedema occurs. NLN risk reduction guidelines may decrease lymphedema risk. CONCLUSION Lymphedema is chronic and disfiguring. Most NLN risk reduction guidelines, although not evidence-based, are based on sound physiologic principles. Evidence-based research of the effectiveness of NLN risk reduction guidelines is indicated. IMPLICATIONS FOR NURSING Until evidence-based research contradicts NLN's risk reduction guidelines, nurses should inform patients with breast cancer about their risk for lymphedema, guidelines to reduce that risk, and the physiologic rationale for the guidelines.
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Affiliation(s)
- Sheila H Ridner
- School of Nursing,Vanderbilt University, Nashville, TN, USA.
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