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Bustos VP, Friedman R, Pardo JA, Granoff M, Fu MR, Singhal D. Tracking Symptoms of Patients With Lymphedema Before and After Power-Assisted Liposuction Surgery. Ann Plast Surg 2023; 90:616-620. [PMID: 36881732 DOI: 10.1097/sap.0000000000003430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
PURPOSE Lymphedema negatively impacts patients from a psychosocial standpoint and consequently affects patient's quality of life. Debulking procedures using power-assisted liposuction (PAL) are currently deemed an effective treatment for fat-dominant lymphedema and improves anthropometric measurements as well as quality of life. However, there have been no studies specifically evaluating changes in symptoms related to lymphedema after PAL. An understanding of how symptoms change after this procedure would be valuable for preoperative counseling and to guide patient expectations. METHODS A cross-sectional study was performed in patients with extremity lymphedema who underwent PAL from January 2018 to December 2020 at a tertiary care facility. A retrospective chart review and follow-up phone survey were conducted to compare signs and symptoms related to lymphedema before and after PAL. RESULTS Forty-five patients were included in this study. Of these, 27 patients (60%) underwent upper extremity PAL and 18 patients (40%) underwent lower extremity PAL. The mean follow-up time was 15.5±7.9 months. After PAL, patients with upper extremity lymphedema reported having resolved heaviness (44%), as well as improved achiness (79%) and swelling (78%). In patients with lower extremity lymphedema, they reported having improved all signs and symptoms, particularly swelling (78%), tightness (72%), and achiness (71%). CONCLUSIONS In patients with fat-dominant lymphedema, PAL positively impacts patient-reported outcomes in a sustained fashion over time. Continuous surveillance of postoperative studies is required to elucidate factors independently associated with the outcomes found in our study. Moreover, further studies using a mixed method approach will help us better understand patient's expectations to achieve informed decision and adequate treatment goals.
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Affiliation(s)
- Valeria P Bustos
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Rosie Friedman
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jaime A Pardo
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Melisa Granoff
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Mei R Fu
- School of Nursing-Camden, Rutgers University, Camden, NJ
| | - Dhruv Singhal
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Abbas Y, Hamdy O. Axillary reverse mapping in breast cancer: An overview. Breast Dis 2023; 42:137-146. [PMID: 37154174 DOI: 10.3233/bd-220040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Standard operative management for breast carcinoma has significantly shifted from extensive procedures to minor interventions.Although axillary dissection was a fundamental component of operative management, sentinel biopsy is an actual process for axillary staging. Axillary dissection may be postponed for cases that have negative SLNs or 1 or 2 infiltrated lymph nodes undergoing breast or axillary radiation. Contrarily, axillary dissection is still the conventional management for patients with clinically positive nodes.Arm lymphedema is a frequent and overwhelming complication of axillary dissection, with a worse impact on the patient's life.Axillary reverse mapping was recently introduced to map and conserve the lymph drain of the upper limb throughout axillary dissection or sentinel biopsy. A technique based on the theory that the breast's lymphatic drainage differs from those that drain the arm, so preserving lymphatic drainage of the upper limb can prevent lymphedema, thereby not raising the risk of axillary recurrence.Therefore, this technique is the reverse of sentinel biopsy, which remove the lymph nodes that drain the breast.
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Affiliation(s)
- Yara Abbas
- Mansoura Manchester Medical Program, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Omar Hamdy
- Surgical Oncology Unit, Oncology Center, Mansoura University, Mansoura, Egypt
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Uhm KE, Yeo SM, Yoo JS, Hwang JH. Reliability and Validity of the Korean Version of the Lymphedema Quality of Life Questionnaire in Breast Cancer-Related Lymphedema Patients. Lymphat Res Biol 2022; 21:187-193. [PMID: 35914092 DOI: 10.1089/lrb.2022.0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: This study aimed to demonstrate the reliability and validity of the Korean version of the Lymphedema Quality of Life (LYMQOL) questionnaire. Methods and Results: This study was a multicentered cross-sectional survey of patients with breast cancer-related lymphedema. The LYMQOL-arm questionnaire was translated from English to Korean. This 28-item instrument contains the overall quality of life (QOL) and is categorized into four domains: function, appearance, symptoms, and mood. In addition, the demographics and characteristics of lymphedema were assessed by reviewing the medical records. The LYMQOL-arm, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), and Breast Cancer Module 23 (EORTC QLQ-BR23) were administered. The internal consistency of the LYMQOL-arm was analyzed using Cronbach's α, and test-retest reliability was examined using the intraclass correlation coefficient (ICC). Concurrent validity was evaluated using Pearson's correlation test between the LYMQOL-arm and the EORTC QLQ instruments. A total of 62 participants were enrolled in the study. All domains of the LYMQOL-arm showed high internal consistency, and the ICC of each domain and overall QOL ranged from 0.836 to 0.956 (p < 0.001). All domains and overall QOL scores of the LYMQOL-arm significantly correlated with most of the EORTC QLQ-C30 and EORTC QLQ-BR23 scales. Furthermore, it revealed a significant association with the degree of perceived edema. Conclusions: The Korean version of the LYMQOL-arm questionnaire has proven its reliability and validity in assessing QOL in patients with breast cancer-related lymphedema.
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Affiliation(s)
- Kyeong Eun Uhm
- Department of Rehabilitation Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Seung Mi Yeo
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Sung Yoo
- Department of Rehabilitation Medicine, National Cancer Center, Goyang-si, Republic of Korea
| | - Ji Hye Hwang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Huang Z, Wu S. Acceptance of disability, coping style, perceived social support and quality of life among patients with chronic lymphedema: a cross-sectional study. Support Care Cancer 2022; 30:4099-4108. [PMID: 35072790 DOI: 10.1007/s00520-022-06855-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/19/2022] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To examine acceptance of disability, coping style, perceived social support, and quality of life and to explore the relationships between acceptance of disability, coping style, perceived social support, and quality of life among Chinese patients with chronic lymphedema. METHODS Chronic lymphedema patients were recruited from five tertiary hospitals between May and July 2020 in China. Recruited patients were assessed for quality of life (QOL), acceptance of disability (AOD), coping styles, perceived social support (PSS), and sociodemographic and disease-related factors. Multivariate linear regression models were conducted to examine the multivariate effect of AOD, coping style, PSS, and sociodemographic and disease-related factors on QOL. RESULTS A total of 163 chronic lymphedema patients were recruited. The mean score of QOL was 2.23 (SD = 0.68). AOD, number of symptoms, acceptance-resignation, avoidance, degree of pain, PSS, and educational level were found to be significant predictors of QOL. CONCLUSION Chinese patients with chronic lymphedema had moderate levels of QOL. The QOL and specific domains of patients were affected by different factors. Special attention and targeted interventions should be given to improve patients' QOL.
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Affiliation(s)
- Zehao Huang
- The Nethersol School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Horse Material Water, Shatin, New Territories, Hong Kong, Hong Kong SAR, China. .,School of Nursing, Sun Yat-Sen University, Guangzhou, China.
| | - Siyu Wu
- Foshan Hospital of Traditional Chinese Medicine, Foshan, China
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de Sire A, Inzitari MT, Moggio L, Pinto M, de Sire G, Supervia M, Petraroli A, Rubino M, Carbotti D, Succurro E, Ammendolia A, Andreozzi F. Effects of Intermittent Pneumatic Compression on Lower Limb Lymphedema in Patients with Type 2 Diabetes Mellitus: A Pilot Randomized Controlled Trial. ACTA ACUST UNITED AC 2021; 57:medicina57101018. [PMID: 34684055 PMCID: PMC8538573 DOI: 10.3390/medicina57101018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 01/13/2023]
Abstract
Background and Objectives: Diabetes mellitus type 2 (T2DM) is a chronic disease associated with fluid accumulation in the interstitial tissue. Manual lymphatic drainage (MLD) plays a role in reducing lymphoedema, like intermittent pneumatic compression (IPC). By the present pilot study, we aimed to evaluate the efficacy of a synergistic treatment with MLD and IPC in reducing lower limb lymphedema in T2DM patients. Materials and Methods: Adults with a clinical diagnosis of T2DM and lower limb lymphedema (stage II-IV) were recruited from July to December 2020. Study participants were randomized into two groups: experimental group, undergoing a 1-month rehabilitative program consisting of MLD and IPC (with a compression of 60 to 80 mmHg); control group, undergoing MLD and a sham IPC (with compression of <30 mmHg). The primary outcome was the lower limb lymphedema reduction, assessed by the circumferential method (CM). Secondary outcomes were: passive range of motion (pROM) of hip, knee, and ankle; quality of life; laboratory exams as fasting plasma glucose and HbA1c. At baseline (T0) and at the end of the 1-month rehabilitative treatment (T1), all the outcome measures were assessed, except for the Hb1Ac evaluated after three months. Results: Out of 66 T2DM patients recruited, only 30 respected the eligibility criteria and were randomly allocated into 2 groups: experimental group (n = 15; mean age: 54.2 ± 4.9 years) and control group (n = 15; mean age: 54.0 ± 5.5 years). At the intra-group analysis, the experimental group showed a statistically significant improvement of all outcome measures (p < 0.05). The between-group analysis showed a statistically significant improvement in pROM of the hip, knee, ankle, EQ-VAS, and EQ5D3L index at T1. Conclusions: A multimodal approach consisting of IPC and MLD showed to play a role in reducing lower limb lymphedema, with an increase of pROM and HRQoL. Since these are preliminary data, further studies are needed.
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Affiliation(s)
- Alessandro de Sire
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (M.T.I.); (A.P.); (A.A.)
- Correspondence: (A.d.S.); (L.M.); Tel.: +39-0961712819 (A.d.S.); +39-0961712211 (L.M.)
| | - Maria Teresa Inzitari
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (M.T.I.); (A.P.); (A.A.)
| | - Lucrezia Moggio
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (M.T.I.); (A.P.); (A.A.)
- Correspondence: (A.d.S.); (L.M.); Tel.: +39-0961712819 (A.d.S.); +39-0961712211 (L.M.)
| | - Monica Pinto
- Rehabilitation Medicine Unit, Strategic Health Services Department, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy;
| | - Giustino de Sire
- Medical Clinic “D.S.G.”, Caserta Local Health Service, 81100 Caserta, Italy;
| | - Marta Supervia
- Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Dr. Esquerdo 46, 28007 Madrid, Spain;
- Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Annalisa Petraroli
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (M.T.I.); (A.P.); (A.A.)
| | - Mariangela Rubino
- Internal Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (M.R.); (D.C.); (E.S.); (F.A.)
| | - Delia Carbotti
- Internal Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (M.R.); (D.C.); (E.S.); (F.A.)
| | - Elena Succurro
- Internal Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (M.R.); (D.C.); (E.S.); (F.A.)
| | - Antonio Ammendolia
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (M.T.I.); (A.P.); (A.A.)
| | - Francesco Andreozzi
- Internal Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (M.R.); (D.C.); (E.S.); (F.A.)
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Bona AF, Ferreira KR, Carvalho RBM, Thuler LCS, Bergmann A. Psychometric Evaluation of a Brazilian Version of the Lymphedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphedema in Patients After Cancer Treatment. Lymphat Res Biol 2021; 20:82-88. [PMID: 33780630 DOI: 10.1089/lrb.2020.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The aim of this study was to evaluate psychometric properties of the Lymphedema Functioning, Disability and Health Questionnaire for lower limb lymphedema (Lymph-ICF-LL) in Brazilian patients with secondary lower limb lymphedema after cancer treatment. Methods and Results: A diagnostic test study was performed in 30 patients with lower limb lymphedema. To assess the reliability, the intraclass correlation coefficient (ICC) was analyzed through test-retest, Cronbach alpha coefficient, magnitude of intrasubject variability by standard error of measurement (SEM), and smallest real difference (SRD). To assess the face and content validity, a specific questionnaire was applied to assess the clarity of the scoring system and comprehensiveness of questions. To assess construct validity, correlations between the final Brazilian version of the Lymph ICF-LL and the quality of life questionnaire SF-36 (36-Item Short Form Health Survey Questionnaire) were analyzed. The ICCs and general internal consistency scores of Lymph-ICF-LL were high (ICCs >0.90 and the Cronbach alpha coefficient >0.90, respectively). Measurement variability between the tests was acceptable (SEM 5.9) with SRD of 16.4. Face and content validity were considered excellent by the patients as the scoring system was clear and questions were understandable for 97% and 90% of the patients, respectively. Construct validity was classified as good and all hypotheses for assessing convergent validity were accepted (medium to strong correlation, from -0.69 to -0.84). Conclusion: The Brazilian version of the Lymph-ICF-LL is a reliable and valuable instrument for assessing Brazilian patients with secondary lower limb lymphedema associated with cancer treatment.
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Affiliation(s)
- Alberto F Bona
- Clinical Research Department, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Kamila R Ferreira
- Physical Therapy Service, Brazilian National Cancer Institute, Hospital of Cancer II, Rio de Janeiro, Brazil
| | - Raquel B M Carvalho
- Physical Therapy Service, Brazilian National Cancer Institute, Hospital of Cancer II, Rio de Janeiro, Brazil
| | - Luiz Claudio S Thuler
- Clinical Research Department, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Anke Bergmann
- Clinical Research Department, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
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Eidenberger M. Patient-Reported Outcome Measures With Secondary Lower Limb Lymphedemas: A Systematic Review. J Adv Pract Oncol 2021; 12:174-187. [PMID: 34109049 PMCID: PMC8017801 DOI: 10.6004/jadpro.2021.12.2.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Patient-reported outcome measures are measures of patients' health-related quality of life. They should be added to other lymphedema measurements. With an improved disease-free survival of secondary lower limb lymphedema, attention must focus on such assessments. Objective The objectives of this study were to locate and critically appraise suitable patient-reported outcomes measures for lower limb lymphedemas and search for existing valid translations for native German speakers. Methods A systematic literature research was conducted. 20 semantical categories for qualitative analysis were evolved. Six questionnaires available in English and some in validated translations remained for analysis. Results Lower limb lymphedema patients experience poor quality of life, and one of the most critical denominators is skin quality. To establish skin care and prevent cellulitis, patients must learn about skin problems. Only two tools asked for past infections. This is considered crucial because of knowledge building and prophylactic behavior. Questions on movement restrictions were available in one questionnaire. As these have a close connection to one's ability to perform activities of daily life, they can affect quality of life. Afflicted patients have problems with the choice and availability of clothing. Only three questionnaires asked questions about clothing or shoes. Lymphedema patients are exposed to more psychological stress than healthy subjects, but only three questionnaires covered questions about this burden. There was a lack of reporting on psychometric data (Cronbach's alpha, intraclass correlation), which hinders the external validity. Analyzed questionnaires were available in English but only one in German. Conclusions The analyzed questionnaires were in English, and only one was adapted and tested for native German speakers. For clinical practice, Devoogdt's questionnaire is recommended despite some shortcomings. There is a need for validated lymphedema questionnaires in German.
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Affiliation(s)
- Margit Eidenberger
- University of Applied Sciences for Health Professions Upper Austria, Steyr, Austria
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Beelen LM, van Dishoeck AM, Tsangaris E, Coriddi M, Dayan JH, Pusic AL, Klassen A, Vasilic D. Patient-Reported Outcome Measures in Lymphedema: A Systematic Review and COSMIN Analysis. Ann Surg Oncol 2021; 28:1656-1668. [PMID: 33249519 PMCID: PMC8693252 DOI: 10.1245/s10434-020-09346-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/25/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Lymphedema is a chronic and debilitating condition that affects many cancer survivors. Patient-reported outcome measures (PROMs) can give valuable insight into the impact of lymphedema on a patient's quality of life and can play an essential role in treatment decisions. This study aims to (1) identify PROMs used to assess health-related quality of life (HRQoL) in patients with lymphedema; and (2) assess the quality of the lymphedema-specific PROMs. METHODS We performed a systematic search to identify articles on lymphedema, quality of life, and PROMs. An overview was created of all PROMs used to assess HRQoL in patients with lymphedema. The methodological quality of the lymphedema-specific PROMs was assessed using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) criteria. RESULTS A total of 235 articles met the inclusion criteria, of which 200 described studies using one or more PROMs as an outcome measure in patients with lymphedema. The other 35 studies described the development and/or validation of a lymphedema-specific PROM. The COSMIN assessment demonstrated that none of these PROMs met all quality standards for development. CONCLUSION The use of PROMs in lymphedema is increasing; however, based on our findings, we cannot fully support the use of any of the existing instruments. A well-developed lymphedema-specific PROM, based on patient input, is needed to gain better insight into the impact of this condition, and can be used to measure the effect of possible medical and surgical treatments.
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Affiliation(s)
- Louise Marie Beelen
- Department of Surgery, Patient-Reported Outcome, Value and Experience (PROVE) Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
- Department of Plastic and Reconstructive Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - Anne-Margreet van Dishoeck
- Department of Plastic and Reconstructive Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Elena Tsangaris
- Department of Surgery, Patient-Reported Outcome, Value and Experience (PROVE) Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Joseph H Dayan
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea L Pusic
- Department of Surgery, Patient-Reported Outcome, Value and Experience (PROVE) Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Dalibor Vasilic
- Department of Plastic and Reconstructive Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Paramanandam VS, Lee MJ, Kilbreath SL, Dylke ES. Self-reported questionnaires for lymphoedema: a systematic review of measurement properties using COSMIN framework. Acta Oncol 2021; 60:379-391. [PMID: 33475033 DOI: 10.1080/0284186x.2020.1862422] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Lymphoedema may develop as a result of numerous genetic and traumatic causes; however, treatment for cancer is the most common cause of its development in more economically developed nations. This systematic review critically appraised, compared and summarised the measurement properties of lymphoedema-specific self-reported questionnaires (SRQs) measuring various patient-reported outcomes including quality of life (QOL), function, morbidity, and symptoms. METHODS Seven databases were searched to identify studies of the measurement properties of SRQs. Two review teams independently evaluated the quality of the individual studies using the risk of bias tool from the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN). Measurement properties of the SRQs presented in the studies were then rated. Study level ratings were summarised for an SRQ if they were reported in multiple studies, and their overall quality of the evidence were then graded. RESULTS Forty articles, reporting on 19 SRQs were identified from 8615 records. The focus of the 19 SRQs included eight on QOL, four on symptoms, two on function, and two on impairment. The other three SRQs were on illness perception, self-efficacy, and patient-relevant treatment benefit, respectively. Eight and three SRQs were upper limb and lower limb-specific, respectively, whereas seven questionnaires were for both upper and lower limb lymphoedema. One SRQ was developed for head and neck lymphoedema. According to the COSMIN framework, none of the SRQs reviewed had sufficient evidence to support all nine measurement properties. In lower limb questionnaires, the LYMQOL-leg has sufficient content, structural, and construct validity as well as internal consistency and reliability. For upper limb lymphoedema questionnaires, the Lymph-ICF-UL had sufficient content and construct validity as well as reliability. CONCLUSION LYMQOL-leg SRQ is recommended with confidence for evaluation of QOL of people with lower limb lymphoedema while the Lymph-ICF-UL is recommended for evaluation of the QOL of the breast cancer-related lymphoedema with some confidence. In view of the high level of the indeterminate ratings of the measurement properties of the existing SRQs, further research is desirable.
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Affiliation(s)
- Vincent Singh Paramanandam
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
- Physiotherapy Department, Tata Memorial Hospital, Mumbai, India
| | - Mi-Joung Lee
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Sharon L. Kilbreath
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Elizabeth S. Dylke
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
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Patient-reported outcomes following lymph reconstructive surgery in lower limb lymphedema: A systematic review of literature. J Vasc Surg Venous Lymphat Disord 2020; 9:811-819.e2. [PMID: 33309902 DOI: 10.1016/j.jvsv.2020.11.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/26/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Lymphedema is a chronic, progressive and burdensome disease that is known to have a substantial impact on quality of life (QOL). Hence, the assessment of QOL is an important aspect of any study which seeks to evaluate outcomes after lymph reconstructive surgery. We therefore aimed to analyze currently available patient-reported outcome measurements (PROMS) for patients with lower limb lymphedema (LLL) with regard to their psychometric properties. Furthermore, we intended to evaluate the change in QOL in patient undergoing lymphovenous anastomosis (LVA) or vascularized lymph node transfer (VLNT). METHODS A literature research of four databases on studies that included PROMS for LLL was conducted. All selected studies were assessed for validity according Consensus-based Standards for the selection of Health Measurement Instruments. Studies that used the Lymph Quality of Life Measure for Limb Lymphedema (LYMQOL) after LVA and/or VLNT were included for quantitative analysis. RESULTS In total, 988 studies were screened, of which 30 studies were included in this review. We identified six validated PROMS to assess LLL. Of those, the LYMQOL was the most commonly used questionnaire. Based on the LYMQOL, a significant improvement of QOL in LLL was noted in all studies after reconstructive lymph surgery (LVA/VLNT) regardless of lymphedema etiology, stage, or time since diagnosis. On the basis of the Consensus-based Standards for the selection of Health Measurement Instruments criteria, the Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema seems to be superior in terms of its psychometric properties. CONCLUSIONS A significant improvement in the QOL in patients with LLL after reconstructive lymph surgery can be observed. Future studies on reconstructive lymph surgery need to include both objective and congruent volume measurements, as well as data on QOL based a well-validated PROM such as the Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema.
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Ridner SH, Deng J, Doersam JK, Dietrich MS. Lymphedema Symptom Intensity and Distress Surveys-Truncal and Head and Neck, Version 2.0. Lymphat Res Biol 2020; 19:240-248. [PMID: 33181059 DOI: 10.1089/lrb.2020.0071] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: A comparison of symptom prevalence, intensity, and distress for participants with truncal lymphedema, head and neck lymphedema, and no lymphedema identified a need for a truncal-specific, lymphedema-related symptom assessment tool and a revision of the Lymphedema Symptom Intensity and Distress Survey-Head and Neck (LSIDS-H&N). The purpose of this study was to institute the development of the Lymphedema Symptom Intensity and Distress Survey-Truncal (LSIDS-T) and revise the LSIDS-H&N. Methods and Results: A comprehensive midline measure and subsequent series of analyses were used to develop the LSIDS-T and revise the initial LSIDS-H&N. Participants included 97 without lymphedema, 82 with truncal lymphedema, and 72 with head and neck lymphedema. Cluster analysis for the LSIDS-T resulted in five clusters with a total of 21 items. Cluster analysis for the LSIDS-H&N resulted in seven clusters with a total of 31 items. Key correlations in expected directions were found with the validated measures for both surveys, and correlations with the Marlowe Crown Social Desirability Scale did not indicate issues with social desirability of response. Conclusion: The 24-item LSIDS-T and the 31-item revised LSIDS-H&N v.2 are promising additions to the suite of other LSIDS measures for use in clinical environments.
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Affiliation(s)
- Sheila H Ridner
- Vanderbilt University School of Nursing, Nashville, Tennessee, USA
| | - Jie Deng
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | | | - Mary S Dietrich
- Vanderbilt University School of Nursing, Nashville, Tennessee, USA
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Russo S, Walker JL, Carlson JW, Carter J, Ward LC, Covens A, Tanner EJ, Armer JM, Ridner S, Hayes S, Taghian AG, Brunelle C, Lopez-Acevedo M, Davidson BA, Schaverien MV, Ghamande SA, Bernas M, Cheville AL, Yost KJ, Schmitz K, Coyle B, Zucker J, Enserro D, Pugh S, Paskett ED, Ford L, McCaskill-Stevens W. Standardization of lower extremity quantitative lymphedema measurements and associated patient-reported outcomes in gynecologic cancers. Gynecol Oncol 2020; 160:625-632. [PMID: 33158510 DOI: 10.1016/j.ygyno.2020.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/20/2020] [Indexed: 01/07/2023]
Abstract
Practice changing standardization of lower extremity lymphedema quantitative measurements with integrated patient reported outcomes will likely refine and redefine the optimal risk-reduction strategies to diminish the devastating limb-related dysfunction and morbidity associated with treatment of gynecologic cancers. The National Cancer Institute (NCI), Division of Cancer Prevention brought together a diverse group of cancer treatment, therapy and patient reported outcomes experts to discuss the current state-of-the-science in lymphedema evaluation with the potential goal of incorporating new strategies for optimal evaluation of lymphedema in future developing gynecologic clinical trials.
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Affiliation(s)
- Sandra Russo
- National Cancer Institute, Division of Cancer Prevention, 9609 Medical Center Drive, Rockville, MD 20892-9785, USA.
| | - Joan L Walker
- Stephen Cancer Center, OUHSC, Oklahoma City, OK 73104, USA.
| | - Jay W Carlson
- Cancer Research for Ozarks, 1235 E. Cherokee, Springfield, MO 65804, USA.
| | - Jeanne Carter
- Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY, 10022, USA.
| | - Leigh C Ward
- University of Queensland, St Lucia, Brisbane, QLD 4072, Australia.
| | - Allan Covens
- University of Toronto and Sunnybrook Health Science Centre, Toronto, ON M4N 3M5, Canada.
| | - Edward J Tanner
- Northwestern Medicine, Feinberg School of Medicine, Prentice Women's Hospital, 250 E Superior, Chicago, IL 60611, USA.
| | - Jane M Armer
- Sinclair School of Nursing, University of Missouri Health, DC 116.05, Ellis Fischel Cancer Center, 115 Business Loop 70 West, Columbia, MO 65203, USA.
| | - Sheila Ridner
- Vanderbilt University School of Nursing, 461 21st Ave South, Nashville, TN 37240, USA.
| | - Sandi Hayes
- Queensland University of Technology, School of Public Health and Biomedical Innovation, Queensland, Australia.
| | - Alphonse G Taghian
- Harvard Medical School/Massachusetts General Hospital, Radiation Oncology, Boston, MA 02114, USA.
| | - Cheryl Brunelle
- Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, MA 02114, USA.
| | - Micael Lopez-Acevedo
- The George Washington University Hospital, School of Medicine and Health Sciences, 2150 Pennsylvania Ave, NW, Washington, DC 20037, USA.
| | - Brittany A Davidson
- Duke University School of Medicine, Duke Cancer Center, 20 Duke Medical Center, Durham, NC 27710, USA.
| | - Mark V Schaverien
- The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
| | - Sharad A Ghamande
- Augusta University, Augusta Oncology, 3696 Wheeler Road, Augusta, GA 30909, USA.
| | - Michael Bernas
- TCU and UNTHSC School of Medicine, Forth Worth, TX 76207, USA.
| | | | | | - Kathryn Schmitz
- Penn State Cancer Institute, 400 University Drive, Hershey, PA 17033, USA.
| | - Barbara Coyle
- Patient Advocate, Lymphedema Advocacy Group, Minneapolis, MN, USA
| | - Jeannette Zucker
- National Lymphedema Network, 411 Lafayette Street, 6th Floor, New York, NY 10003, USA.
| | - Danielle Enserro
- NRG Oncology Statistics and Data Management Center, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
| | - Stephanie Pugh
- NRG Oncology Statistics and Data Management Center, 1600 JFK Blvd, Suite 1020, Philadelphia, PA 1903, USA.
| | - Electra D Paskett
- The Ohio State University, 1590 N High Street, Suite 525, Columbus, OH 43210, USA.
| | - Leslie Ford
- National Cancer Institute, Division of Cancer Prevention, 9609 Medical Center Drive, Rockville, MD 20892-9785, USA.
| | - Worta McCaskill-Stevens
- National Cancer Institute, Division of Cancer Prevention, 9609 Medical Center Drive, Rockville, MD 20892-9785, USA.
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Psychoneurological symptom cluster in breast cancer: the role of inflammation and diet. Breast Cancer Res Treat 2020; 184:1-9. [DOI: 10.1007/s10549-020-05808-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 07/15/2020] [Indexed: 12/20/2022]
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Douglass J, Kelly-Hope L. Comparison of Staging Systems to Assess Lymphedema Caused by Cancer Therapies, Lymphatic Filariasis, and Podoconiosis. Lymphat Res Biol 2019; 17:550-556. [PMID: 30789319 PMCID: PMC6797069 DOI: 10.1089/lrb.2018.0063] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Lymphedema is a disease of the skin and subcutaneous tissue resulting from a disturbance in lymph flow. Anyone can be affected, and causes include cancer therapy when lymph nodes are removed or irradiated, the parasitic disease lymphatic filariasis, and damage caused by exposure to irritant soils known as podoconiosis. Manifest lymphedema is progressive and a major contributor to disability, stigma, and social isolation for affected people. Although the pathogenesis of connective tissue changes in lymphedema will follow a similar course regardless of the disease of causation, several systems are used to stage progression. Disparity in these staging systems leads to inconsistency in reporting of the severity of lymphedema and prevents meta-analysis of research results. In the global health environment, integrated morbidity management for chronic illness is essential to meet the needs of affected people and to be sustainable for health care systems. Clinical descriptors for staging criteria within each system may assist clinicians in assessment and provide a format for consistency in reporting by lymphedema researchers. Methods and Results: Lymphedema staging systems used in oncology, filariasis, and podoconiosis settings were reviewed and the assessment techniques, diagnostic procedures, and clinical observations used by each system are described. The most commonly used staging systems are compared to identify similarities, and a matrix approach to lymphedema staging is proposed. Conclusion: A universal staging system would contribute to more consistent reporting of research on and clinical management of lymphedema arising from multiple causes.
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Affiliation(s)
- Janet Douglass
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Louise Kelly-Hope
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Doersam JK, Dietrich MS, Adair MA, Rhoten B, Deng J, Ridner SH. A Comparison of Symptoms Among Patients with Head and Neck or Truncal Lymphedema and Normal Controls. Lymphat Res Biol 2019; 17:661-670. [PMID: 31381475 DOI: 10.1089/lrb.2019.0034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Symptoms associated with midline lymphedema are not fully understood and it is unclear if symptoms associated with swelling in the head and neck are similar to those associated with swelling in the truncal region of the body. Objectives: Describe symptoms experienced by those with head and neck and truncal lymphedema. Compare symptom presence, intensity, and distress among those two groups and participants with no lymphedema. Methods: Cross-sectional descriptive study administered by online survey. Results: Nonlymphedema participants were younger than the lymphedema groups. Those with truncal lymphedema took more diuretic medications than the other groups. Participants with truncal lymphedema experienced a greater number of symptoms than the other groups (p < 0.001). These symptoms were also more severe and intense (p < 0.001). Fourteen symptoms distinguished the truncal group from the other two groups (p < 0.001). Nine symptoms differentiated the head and neck group from the other groups (p < 0.001). Conclusion: These preliminary findings support that symptom profiles differ among those with lymphedema and those without lymphedema. The number, type, severity, and intensity of symptoms vary based upon the location of lymphedema. The need to use two lymphedema anatomical classifications (head and neck and truncal) instead of one classification (midline) when assessing lymphedema-related symptoms is also supported.
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Affiliation(s)
| | - Mary S Dietrich
- Vanderbilt University School of Nursing, Nashville, Tennessee.,Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Melissa A Adair
- Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Bethany Rhoten
- Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Jie Deng
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Sheila H Ridner
- Vanderbilt University School of Nursing, Nashville, Tennessee
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