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Doubblestein D, Koehler L, Anderson E, Scheiman N, Stewart P, Schaverien M, Armer J. Development of a core outcome set for breast cancer-related lymphedema: a Delphi study. Breast Cancer Res Treat 2024; 205:359-370. [PMID: 38424364 PMCID: PMC11101528 DOI: 10.1007/s10549-024-07262-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/18/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE For breast cancer survivors (BCS) living with breast cancer-related lymphedema (BCRL), what outcome domains (OD) should be measured to assess the burden of the disease and efficacy of interventions? A Core Outcome Set (COS) that promotes standardized measurement of outcomes within the constraints of time influenced by work environments is essential for patients and the multidisciplinary professionals that manage and research BCRL. METHODS Using Delphi methodology, a multidisciplinary group of BCRL experts (physical and occupational therapists, physicians, researchers, physical therapist assistants, nurses, and massage therapist) completed two waves of online surveys. BCRL expert respondents that completed the first survey (n = 78) had an average of 26.5 years in practice, whereas, respondents who completed the second survey (n = 33) had an average of 24.9 years. ODs were included in the COS when consensus thresholds, ranging from 70% to 80%, were met. RESULTS A total of 12 ODs made up the COS. Reaching a minimum consensus of 70%; volume, tissue consistency, pain, patient-reported upper quadrant function, patient-reported health-related quality of life, and upper extremity activity and motor control were recommended at different phases of the BCRL continuum in a time-constrained environment. Joint function, flexibility, strength, sensation, mobility and balance, and fatigue met an 80% consensus to be added when time and resources were not constrained. CONCLUSION The COS developed in this study thoroughly captures the burden of BCRL. Using this COS may reduce selective reporting, inconsistency in clinical use, and variability of reporting across interdisciplinary healthcare fields, which manage or research BCRL.
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Affiliation(s)
| | - Linda Koehler
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | | | - Nicole Scheiman
- Occupational Therapy Assistant Program, Huntington University, Huntington, IN, USA
| | - Paula Stewart
- Parkridge Medical Center - Wound Care/Lymphedema Clinic, Parkridge Medical Center, Chattanooga, TN, USA
| | - Mark Schaverien
- Department of Plastic Surgery, Division of Surgery, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Jane Armer
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
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Doubblestein D, Koehler L, Anderson E, Scheiman N, Stewart P, Schaverien M, Armer J. Development of a core set of outcome measures to be applied toward breast cancer-related lymphedema core outcome domains. Breast Cancer Res Treat 2024; 205:439-449. [PMID: 38517603 PMCID: PMC11101581 DOI: 10.1007/s10549-024-07298-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/14/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE For breast cancer survivors (BCS) living with breast cancer-related lymphedema (BCRL), what outcome measures (OMs) are recommended to be used to measure standardized outcome domains to fully assess the burden of the disease and efficacy of interventions? An integral component of a standardized core outcome set (COS) are the OMs used to measure the COS. METHODS A supplemental online survey was linked to a Delphi study investigating a COS for BCRL. OMs were limited to a maximum of 10 options for each outcome domain (OD). There were 14 ODs corresponding to the International Classification of Functioning, Disability, and Health (ICF) framework and respondents rated the OMs with a Likert level of recommendation. The feasibility of the listed OMs was also investigated for most outpatient, inpatient, and research settings. RESULTS This study identified 27 standardized OMs with a few ODs having 2-3 highly recommended OMs for proper measurement. A few of the recommended OMs have limitations with reliability due to being semi-quantitative measures requiring the interpretation of the rater. CONCLUSION Narrowing the choices of OMs to 27 highly recommended by BCRL experts may reduce selective reporting, inconsistency in clinical use, and variability of reporting across interdisciplinary healthcare fields which manage or research BCRL. There is a need for valid, reliable, and feasible OMs that measure tissue consistency. Measures of upper extremity activity and motor control need further research in the BCS with BCRL population.
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Affiliation(s)
| | - Linda Koehler
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | | | - Nicole Scheiman
- Occupational Therapy Assistant Program, Huntington University, Huntington, IN, USA
| | - Paula Stewart
- Parkridge Medical Center - Wound Care/Lymphedema Clinic, Parkridge Medical Center, Chattanooga, TN, USA
| | - Mark Schaverien
- Division of Surgery, Department of Plastic Surgery, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Jane Armer
- Professor Emerita, Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
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Maingi S, O'Malley EM. Impact of text reminders on pneumatic compression device (PCD) compliance in patients with breast cancer-related lymphedema. Support Care Cancer 2023; 32:33. [PMID: 38102530 PMCID: PMC10724087 DOI: 10.1007/s00520-023-08246-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE Do cell phone text reminders impact the rate of compliance with pneumatic compression device (PCD) therapy among women with breast cancer-related lymphedema (BCRL)? METHODS A prospective, randomized, 2-group feasibility study conducted at 2 centers. Participants were adult females (≥18 years old) with unilateral BCRL who had the capability of receiving reminder text messages. All participants underwent PCD therapy. Participants were randomized 1:1 to control (no text messages) or test group (received text message reminders if the PCD had not been used for 2 consecutive days). The rate of compliance between treatment groups was the main outcome measure. Secondary outcome measures were changes in arm girth, quality of life (QOL), and symptom severity. RESULTS Twenty-nine participants were enrolled and randomized, 25 were available for follow-up at 60 days (14 test, 11 control). Overall, 52.2% (12/23) of all participants were completely compliant, an additional 43.5% (10/23) were partially compliant, and 1 patient (4.3%) was noncompliant. The test and control groups did not differ in device compliance. In the pooled population, weight, BMI, and arm girth were improved. Overall disease-specific QOL and symptom severity were improved. Regression analysis showed benefits were greater among participants with higher rates of compliance. CONCLUSIONS Automated text reminders did not improve compliance in patients with BCRL as compliance rates were already high in this patient population. Improvements in weight, BMI, arm girth, disease-specific quality of life, and symptom severity measures were observed regardless of the treatment assignment. Full compliance resulted in greater functional and QOL benefits. TRIAL REGISTRATION The study was registered at www. CLINICALTRIALS gov (NCT04432727) on June 16, 2020.
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Affiliation(s)
- Shail Maingi
- St Peter's Health Partners, Albany, NY, 12208, USA.
- Dana-Farber Cancer Institute, 101 Columbian St., South Weymouth, MA, 02190, USA.
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Use of Outcome Measures by Certified Lymphedema Therapists With Survivors of Breast Cancer With Breast Cancer–Related Lymphedema. REHABILITATION ONCOLOGY 2022. [DOI: 10.1097/01.reo.0000000000000310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tzelves L, Manolitsis I, Varkarakis I, Ivanovic M, Kokkonidis M, Useros CS, Kosmidis T, Muñoz M, Grau I, Athanatos M, Vizitiu A, Lampropoulos K, Koutsouri T, Stefanatou D, Perrakis K, Stratigaki C, Autexier S, Kosmidis P, Valachis A. Artificial intelligence supporting cancer patients across Europe—The ASCAPE project. PLoS One 2022; 17:e0265127. [PMID: 35446854 PMCID: PMC9022843 DOI: 10.1371/journal.pone.0265127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/11/2022] [Indexed: 02/07/2023] Open
Abstract
Introduction Breast and prostate cancer survivors can experience impaired quality of life (QoL) in several QoL domains. The current strategy to support cancer survivors with impaired QoL is suboptimal, leading to unmet patient needs. ASCAPE aims to provide personalized- and artificial intelligence (AI)-based predictions for QoL issues in breast- and prostate cancer patients as well as to suggest potential interventions to their physicians to offer a more modern and holistic approach on cancer rehabilitation. Methods and analyses An AI-based platform aiming to predict QoL issues and suggest appropriate interventions to clinicians will be built based on patient data gathered through medical records, questionnaires, apps, and wearables. This platform will be prospectively evaluated through a longitudinal study where breast and prostate cancer survivors from four different study sites across the Europe will be enrolled. The evaluation of the AI-based follow-up strategy through the ASCAPE platform will be based on patients’ experience, engagement, and potential improvement in QoL during the study as well as on clinicians’ view on how ASCAPE platform impacts their clinical practice and doctor-patient relationship, and their experience in using the platform. Ethics and dissemination ASCAPE is the first research project that will prospectively investigate an AI-based approach for an individualized follow-up strategy for patients with breast- or prostate cancer focusing on patients’ QoL issues. ASCAPE represents a paradigm shift both in terms of a more individualized approach for follow-up based on QoL issues, which is an unmet need for cancer survivors, and in terms of how to use Big Data in cancer care through democratizing the knowledge and the access to AI and Big Data related innovations. Trial registration Trial Registration on clinicaltrials.gov: NCT04879563.
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Affiliation(s)
- Lazaros Tzelves
- National and Kapodistrian University of Athens Faculty of Medicine Marousi, 2nd Department of Urology, Athens, Greece
| | - Ioannis Manolitsis
- National and Kapodistrian University of Athens Faculty of Medicine Marousi, 2nd Department of Urology, Athens, Greece
| | - Ioannis Varkarakis
- National and Kapodistrian University of Athens Faculty of Medicine Marousi, 2nd Department of Urology, Athens, Greece
| | | | | | | | | | - Montserrat Muñoz
- Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Imma Grau
- Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Manos Athanatos
- Foundation for Research and Technology-Hellas (FORTH), Heraklion, Crete, Greece
| | | | | | | | | | | | | | - Serge Autexier
- German Research Center for Artificial Intelligence (DFKI), Bremen, Germany
| | - Paris Kosmidis
- CareAcross Ltd, London, United Kingdom
- Second Medical Oncology Department, Hygeia Hospital, Athens, Greece
| | - Antonis Valachis
- Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- * E-mail:
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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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Prospective surveillance model in the home for breast cancer-related lymphoedema: a feasibility study. Breast Cancer Res Treat 2020; 185:401-412. [PMID: 33006001 PMCID: PMC7529356 DOI: 10.1007/s10549-020-05953-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/23/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of this study was to assess the feasibility of delivering a prospective surveillance model in the home over 6 months for women at high risk of developing lymphoedema. METHODS A single-group, intervention study recruited 20 women who had surgical and medical treatment for confirmed node-positive invasive breast cancer and therefore at high risk of developing arm lymphoedema. Participants received a package including Bioimpedance Spectroscopy (BIS) monitoring, lymphoedema education and support to promote self-management and physical activity. RESULTS Participants adhered to BIS monitoring 74% of the time, and felt extremely confident in using the device. By 6 months, mean BIS L-Dex scores had increased from 3.5 (SD 5.6) to 8.4 (SD 11.1); five women (25%) who experienced > + 6.5 increase in L-Dex score were fitted with a compression garment. Self-reported symptoms and distress decreased by 0.4 out of 10 (95% CI 0.1 to 0.7); number of self-management strategies used increased by 0.6 (95% CI 0.1 to 1.2); and planned exercise increased by 2.8 h/week (95% CI 0.4 to 5.2). CONCLUSIONS These findings indicate a prospective surveillance model of care in the home with BIS is feasible and associated with increased self-management. A Phase II randomised trial is warranted as well as research exploring the costs associated with implementing this model of care for high-risk individuals.
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Koehler LA, Mayrovitz HN. Tissue Dielectric Constant Measures in Women With and Without Clinical Trunk Lymphedema Following Breast Cancer Surgery: A 78-Week Longitudinal Study. Phys Ther 2020; 100:1384-1392. [PMID: 32379872 PMCID: PMC7439223 DOI: 10.1093/ptj/pzaa080] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 01/11/2019] [Accepted: 02/11/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Following breast cancer surgery with lymph node removal, women are at risk of developing lymphedema in the upper extremity or trunk. Currently, trunk lymphedema diagnosis relies on a clinical assessment because no quantifiable standard method exists. Tissue dielectric constant (TDC) values are quantifiable measures of localized skin tissue water and may be able to detect trunk lymphedema. The goal of this study was to (1) compare parameters derived from TDC measurements with those derived from clinically accepted criteria for trunk lymphedema in women following breast cancer surgery and (2) explore the potential utility of TDC to detect trunk lymphedema early in its progression. METHODS This prospective longitudinal study, a secondary analysis from a larger study, observed women with and without clinically determined truncal lymphedema following breast cancer surgery. TDC was measured on the lateral trunk wall at post-surgery weeks 2, 4, 12, and 78 in women who had surgical breast cancer treatment with lymph node removal. Clinical assessment for trunk lymphedema was determined at 78 weeks by a lymphedema expert. Comparison of TDC measurements in women with and without clinical trunk lymphedema was analyzed. RESULTS Clinical assessment identified trunk lymphedema in 15 out of 32 women at 78 weeks. These women had TDC ratios statistically higher than women without truncal lymphedema. CONCLUSION The overall findings indicate that TDC has the ability to quantify trunk lymphedema and might be valuable in early detection. IMPACT TDC may be a beneficial tool in the early detection of breast cancer-related trunk lymphedema, which could trigger intervention. LAY SUMMARY A new device may help recognize trunk lymphedema in patients with breast cancer so they could receive appropriate treatment.
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Affiliation(s)
- Linda A Koehler
- Department of Rehabilitation Medicine, Division of Physical Therapy, Division of Rehabilitation Science, University of Minnesota, Mayo Mail Code 388, 420 Delaware St, SE, Minneapolis, MN 55455 (USA); and Masonic Cancer Center, University of Minnesota,Address all correspondence to Dr Koehler at:
| | - Harvey N Mayrovitz
- College of Medical Sciences, Nova Southeastern University, Ft Lauderdale, Florida
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Koehler LA, Mayrovitz HN. Spatial and Temporal Variability of Upper Extremity Edema Measures After Breast Cancer Surgery. Lymphat Res Biol 2018; 17:308-315. [PMID: 30427746 DOI: 10.1089/lrb.2018.0022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Tissue dielectric constant (TDC), as an index of local tissue water, and girth measurements are quantitative methods to measure and characterize lymphedema. Objective: To describe the spatial and temporal variability in arm girth and TDC values in women surgically treated for breast cancer and to describe the relationship between these measures. Methods and Results: This was a prospective longitudinal study that observed 36 women for 78 weeks after breast cancer surgery with lymph node removal. Arm circumferences and TDC values, as indices of local tissue water, were measured on both arms at multiple sites at postsurgery weeks 2, 4, 12, and 78 in women undergoing surgical breast cancer treatment with one or more axillary lymph nodes removed. TDC and girth values remained relatively uniform from visit-to-visit for both at-risk and contralateral control arms with no overall statistically significant difference in values (p > 0.05). There was a strong inverse correlation between arm girth and the TDC value in both the at-risk and control arms (p < 0.001). Overall, there was no statistically significant difference in TDC interarm ratios among visits or anatomical sites. TDC values for at-risk and control arms tended to significantly decrease with increasing distance from the wrist (p < 0.001). Conclusion: TDC arm values and girth measures remained relatively uniform in women after breast cancer surgery. The fact that TDC values are higher distally than proximally provides new information from which TDC measurements may be interpreted and also provides a better understanding of arm spatial variability in relation to girth measures.
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Affiliation(s)
- Linda A Koehler
- 1 Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, University of Minnesota, Minneapolis, Minnesota.,2 Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Harvey N Mayrovitz
- 3 College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, Florida.,4 Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Ft. Lauderdale, Florida
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Spinelli B, Kallan MJ, Zhang X, Cheville A, Troxel A, Cohn J, Dean L, Sturgeon K, Evangelista M, Zhang Z, Ebaugh D, Schmitz KH. Intra- and Interrater Reliability and Concurrent Validity of a New Tool for Assessment of Breast Cancer-Related Lymphedema of the Upper Extremity. Arch Phys Med Rehabil 2018; 100:315-326. [PMID: 30291828 DOI: 10.1016/j.apmr.2018.08.185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/27/2018] [Accepted: 08/23/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The goal of this study was to develop and assess intra- and interrater reliability and validity of a clinical evaluation tool for breast cancer-related lymphedema, for use in the context of outcome evaluation in clinical trials. DESIGN Blinded repeated measures observational study. SETTING Outpatient research laboratory. PARTICIPANTS Breast cancer survivors with and without lymphedema (N=71). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The assessment of intraclass correlation coefficients (ICCs) for the Breast Cancer-Related Lymphedema of the Upper Extremity (CLUE) standardized clinical evaluation tool. RESULTS Intrarater reliability for the CLUE tool was ICC: 0.88 (95% confidence interval [95% CI], 0.71-0.96). Interrater reliability for the CLUE tool was ICC: 0.90 (95% CI, 0.79-0.95). Concurrent validity of the CLUE score (Pearson r) was 0.79 with perometric interlimb difference and 0.53 with the Norman lymphedema overall score. CONCLUSIONS The CLUE tool shows excellent inter- and intrarater reliability. The overall CLUE score for the upper extremity also shows moderately strong concurrent validity with objective and subjective measures. This newly developed clinical, physical assessment of upper extremity lymphedema provides standardization and a single score that accounts for multiple constructs. Next steps include evaluation of sensitivity to change, which would establish usefulness to evaluate intervention efficacy.
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Affiliation(s)
- Bryan Spinelli
- Department of Physical Therapy, Thomas Jefferson University, Philadelphia, PA
| | - Michael J Kallan
- Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Xiaochen Zhang
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Andrea Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Andrea Troxel
- Department of Biostatistics, New York University, New York, NY
| | - Joy Cohn
- Good Shepherd Penn Partners, Philadelphia, PA
| | - Lorraine Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Kathleen Sturgeon
- Department of Public Health Sciences, Penn State Cancer Institute, Penn State College of Medicine, Hershey, PA
| | - Margaret Evangelista
- Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Zi Zhang
- Department of Radiology, Harlem Hospital Center, Columbia University, New York, NY
| | - David Ebaugh
- Department of Physical Therapy, Drexel University, Philadelphia, PA
| | - Kathryn H Schmitz
- Department of Public Health Sciences, Penn State Cancer Institute, Penn State College of Medicine, Hershey, PA.
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Clinical Implementation of the Clinical Practice Guidelines for Diagnosing Upper-Quadrant Lymphedema Secondary to Cancer. REHABILITATION ONCOLOGY 2018. [DOI: 10.1097/01.reo.0000000000000115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Jeffs E, Ream E, Taylor C, Bick D. Clinical effectiveness of decongestive treatments on excess arm volume and patient-centered outcomes in women with early breast cancer-related arm lymphedema: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2018; 16:453-506. [PMID: 29419623 PMCID: PMC5828398 DOI: 10.11124/jbisrir-2016-003185] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To identify the effect of decongestive lymphedema treatment on excess arm volume or patient-centered outcomes in women presenting within either 12 months or a mean nine months of developing arm lymphedema following breast cancer treatment. INTRODUCTION Lymphedema is a common consequence of breast cancer treatment requiring life-long treatment to reduce symptoms and prevent complications. Currently, evidence to inform the optimal decongestive lymphedema treatment package is lacking. INCLUSION CRITERIA The review included studies on women who received lymphedema treatment within either 12 months or a mean of nine months of developing unilateral breast cancer-related arm lymphedema. The intervention was any decongestive lymphedema treatment delivered with the purpose of reducing arm lymphedema, compared to another form of lymphedema treatment (whether self or practitioner-administered), placebo or no treatment. The clinical outcome was excess arm volume; patient-centered outcomes were health-related quality of life, arm heaviness, arm function, patient-perceived benefit and satisfaction with treatment. Experimental study designs were eligible, including randomized and non-randomized controlled trials, quasi-experimental, prospective and retrospective before and after studies were considered. METHODS A three-step search strategy was utilized to find published and unpublished studies. The search identified studies published from the inception of each database to July 6, 2016. Reference lists were scanned to identify further eligible studies. Studies were critically appraised using appropriate standardized critical appraisal instruments from the Joanna Briggs Institute. Details describing each study and treatment results regarding outcomes of interest were extracted from papers included in the review using appropriate standardized data extraction tools from the Joanna Briggs Institute. Due to heterogeneity in included studies, results for similar outcome measures were not pooled in statistical meta-analysis. A narrative and tabular format was used to synthesize results from identified and included studies. RESULTS Seven studies reporting results for outcomes of interest were critically appraised and included in the review: five randomized controlled trials and two descriptive (uncontrolled) studies. Reported outcomes included excess arm volume (five studies), health-related quality of life (three studies), arm heaviness (one study), arm function (two studies) and patient-perceived benefit (two studies). There was some evidence that decongestive treatments were effective for women presenting within either 12 months or a mean of nine months of developing breast cancer-related arm lymphedema, but the wide range of data prevented comparison of treatment findings which limited our ability to answer the review questions. CONCLUSIONS Weak evidence (grade B) for the impact of decongestive lymphedema treatment on women with early lymphedema (i.e. less than 12 months duration of BCRL symptoms) did not allow any conclusions to be drawn about the most effective treatment to be offered when these women first present for treatment. Findings provided no justification to support change to current practice.Future primary research needs to focus on the most effective treatment for women when they first present with lymphedema symptoms, e.g. treatment provided within 12 months of developing symptoms. Studies should be adequately powered and recruit women exclusively with less than 12 months duration of breast cancer-related lymphedema symptoms, provide longer follow-up to monitor treatment effect over time, with comparable treatment protocols, outcome measures and reporting methods.
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Affiliation(s)
- Eunice Jeffs
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, United Kingdom
- The Nottingham Centre for Evidence Based Healthcare: a Joanna Briggs Institute Centre of Excellence
| | - Emma Ream
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Cath Taylor
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, United Kingdom
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Debra Bick
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
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13
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Iuchi T, Kobayashi M, Tsuchiya S, Ohno N, Dai M, Matsumoto M, Ogai K, Sato A, Sawazaki T, Miyati T, Tanaka S, Sugama J. Objective assessment of leg edema using ultrasonography with a gel pad. PLoS One 2017; 12:e0182042. [PMID: 28792959 PMCID: PMC5549959 DOI: 10.1371/journal.pone.0182042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 07/11/2017] [Indexed: 11/18/2022] Open
Abstract
Ultrasonography (US) is useful for visual detection of edematous tissues to assess subcutaneous echogenicity. However, visualization of subcutaneous echogenicity is interpreted differently among operators because the evaluation is subjective and individual operators have unique knowledge. This study objectively assessed leg edema using US with a gel pad including fat for normalization of echogenicity in subcutaneous tissue. Five younger adults and four elderly people with leg edema were recruited. We compared assessments of US and limb circumference before and after the intervention of vibration to decrease edema in younger adults, and edema prior to going to sleep and reduced edema in the early morning in elderly people. These assessments were performed twice in elderly people by three operators and reliability, interrater differences, and bias were assessed. For US assessment, echogenicity in subcutaneous tissue was normalized to that of the gel pad by dividing the mean echogenicity of subcutaneous tissue by the mean echogenicity of the gel pad. In younger adults, the normalized subcutaneous echogenicity before the intervention was significantly higher than that after the intervention. In elderly people, echogenicity indicating edema was significantly higher than that after edema reduction. Edema was detected with accuracy rates of 76.9% in younger adults and 75.0% in elderly people. Meanwhile, limb circumference could be used to detect edema in 50.0% of healthy adults and 87.8% of elderly people. The intra-reliability was excellent (intraclass correlation coefficient > 0.9, p < 0.01), and the inter-reliability was good (intraclass correlation coefficient > 0.7, p < 0.01) for normalized subcutaneous echogenicity. Bland-Altman plots revealed that inter-rater differences and systematic bias were small. Normalized subcutaneous echogenicity with the pad can sensitively and objectively assess leg edema with high reliability. Therefore, this method has the potential to become a new gold standard for objective assessment of leg edema in clinical practice.
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Affiliation(s)
- Terumi Iuchi
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
- Wellness Promotion Science Center, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Masato Kobayashi
- Wellness Promotion Science Center, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
- * E-mail:
| | - Sayumi Tsuchiya
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Naoki Ohno
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
- Wellness Promotion Science Center, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Misako Dai
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Masaru Matsumoto
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
- Wellness Promotion Science Center, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Kazuhiro Ogai
- Wellness Promotion Science Center, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Aya Sato
- Faculty of Nursing & Social Welfare Sciences, Fukui Prefecture University, Fukui, Japan
| | - Takuto Sawazaki
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Tosiaki Miyati
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
- Wellness Promotion Science Center, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Shinobu Tanaka
- Faculty of Mechanical Engineering, Institute of Science and Engineering, Kanazawa University, Kanazawa, Japan
| | - Junko Sugama
- Wellness Promotion Science Center, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
- Institute for Frontier Science Initiative, Kanazawa University, Kanazawa, Japan
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14
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McLaughlin SA, Staley AC, Vicini F, Thiruchelvam P, Hutchison NA, Mendez J, MacNeill F, Rockson SG, DeSnyder SM, Klimberg S, Alatriste M, Boccardo F, Smith ML, Feldman SM. Considerations for Clinicians in the Diagnosis, Prevention, and Treatment of Breast Cancer-Related Lymphedema: Recommendations from a Multidisciplinary Expert ASBrS Panel : Part 1: Definitions, Assessments, Education, and Future Directions. Ann Surg Oncol 2017; 24:2818-2826. [PMID: 28766232 DOI: 10.1245/s10434-017-5982-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Indexed: 12/21/2022]
Affiliation(s)
| | | | - Frank Vicini
- Radiation Oncology, UCLA School of Medicine, Los Angeles, USA
| | | | - Nancy A Hutchison
- Courage Kenny Rehabilitation Institute of AllinaHealth, Minneapolis, MN, USA
| | | | - Fiona MacNeill
- Association of Breast Surgery Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - Stanley G Rockson
- Center for Lymphatic and Venous Disorders, Stanford University School of Medicine, Stanford, CA, USA
| | - Sarah M DeSnyder
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Francesco Boccardo
- Department of Surgery, Unit of Lymphatic Surgery - S. Martino University Hospital, University of Genoa, Genoa, Italy
| | - Mark L Smith
- Hofstra Northwell School of Medicine, Northwell Health Cancer Institute, Lake Success, NY, USA
| | - Sheldon M Feldman
- Division of Breast Surgery and Breast Surgical Oncology, Department of Surgery, Montefiore Medical Center, The University Hospital for the Albert Einstein College of Medicine, New York, NY, USA
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15
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Effect of Arm Position on Circumference Measurement of Upper Arms in Healthy and in Women With Breast Cancer–Related Lymphedema. REHABILITATION ONCOLOGY 2017. [DOI: 10.1097/01.reo.0000000000000054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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16
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17
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Oncology EDGE Task Force on Prostate Cancer Outcomes: A Systematic Review of Outcome Measures for Functional Mobility. REHABILITATION ONCOLOGY 2016. [DOI: 10.1097/01.reo.0000000000000029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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18
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Jeffs E, Purushotham A. The prevalence of lymphoedema in women who attended an information and exercise class to reduce the risk of breast cancer-related upper limb lymphoedema. SPRINGERPLUS 2016; 5:21. [PMID: 26759760 PMCID: PMC4703592 DOI: 10.1186/s40064-015-1629-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 12/17/2015] [Indexed: 11/22/2022]
Abstract
Breast cancer-related upper limb lymphoedema (BCRL) affects approximately 20 % of women undergoing axillary intervention. Women who attended a “reducing your risk of lymphoedema” class, including exercise instruction, anecdotally reported positive BCRL outcomes. The aim of this study was to examine BCRL outcomes and perceived benefit for attendees at a “reducing your risk of lymphoedema” class between 2000 and 2005. A cross-sectional study was conducted in two parts: (1) self-report questionnaire regarding lymphoedema status and benefit received from class and exercise programme; (2) clinical evaluation and objective measurement to confirm BCRL. 46 women completed questionnaires; 40 continued to clinical evaluation and objective measurement. BCRL prevalence defined as ≥10 % excess limb volume was only 5 %, although clinician judgement identified 23 % with arm lymphoedema and 8 % with lymphoedema limited to the hand. Clinician judgement correlated highly with patient self-report (Kappa = 0.833, p = 0.000). All women found the class beneficial, reporting increased confidence to return to normal life and a wide range of activities/exercise. We conclude that prevalence of BCRL should be determined by both clinical judgement and objective measurement to avoid underestimation. The benefit of group education with a lymphoedema expert and of exercise instruction should be further explored, and the potential for exercise to reduce BCRL prevalence should be examined.
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Affiliation(s)
- E Jeffs
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, Waterloo Campus, 57 Waterloo Road, London, SE1 8WA UK
| | - A Purushotham
- Guy's and St Thomas NHS Foundation Trust, Guy's Hospital, 3rd Floor Bermondsey Wing, Great Maze Pond, London, SE1 9RT UK
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19
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20
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Breast Cancer Rehabilitation. TOPICS IN GERIATRIC REHABILITATION 2015. [DOI: 10.1097/tgr.0000000000000082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Successful Management of Severe Unilateral Lower Extremity Lymphedema in an Outpatient Setting. Phys Ther 2015; 95:1295-306. [PMID: 25882483 DOI: 10.2522/ptj.20140358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 04/02/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Non-cancer-related lymphedema is frequently unrecognized until it has advanced and, therefore, presents substantial management challenges. Treatment for lymphedema reflects cancer research and not the distinct complexities of non-cancer-related lymphedema. This case report describes an outpatient intervention for a patient with non-cancer-related unilateral lower extremity lymphedema. CASE DESCRIPTION The patient was a 42-year-old woman who was morbidly obese and had left lower extremity chronic stage III lymphedema. Massive disfiguring lymphedema of her lower leg caused chronic wounds, pain, difficulty ambulating, and the inability to lift her leg in transfers. The patient received complete decongestive therapy (CDT) in an outpatient setting. OUTCOMES The volume of the patient's leg decreased more than 66%, so that her massive lower leg was transformed to nearly the same size as her unaffected limb. Proper compression management restored independent transfers and pain-free ambulation. DISCUSSION Delayed diagnosis and treatment of non-cancer-related lymphedema result in increased severity and impaired mobility, making this a unique, complex condition requiring modifications to CDT in the outpatient setting. This case report demonstrates successful outpatient treatment of a patient with severe unilateral lower extremity lymphedema associated with large wounds and impaired mobility using CDT that was modified to accommodate her complex medical status, transportation barriers, and health insurance availability. Following 23 weeks of physical therapist interventions, the patient's affected lower extremity was the same size as the unaffected lower extremity, and she was independent in ambulation and stair climbing.
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Jeffs E, Ream E, Shewbridge A, Cowan-Dickie S, Crawshaw D, Huit M, Wiseman T. Exploring patient perception of success and benefit in self-management of breast cancer-related arm lymphoedema. Eur J Oncol Nurs 2015; 20:173-83. [PMID: 26338435 DOI: 10.1016/j.ejon.2015.08.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 08/03/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to identify factors influencing patient perception of success and benefit with self-management of breast cancer-related lymphoedema (BCRL) and explore how patients decide whether their swollen limb has improved or deteriorated. METHODS This qualitative study used a Grounded Theory approach. Twenty-one women in the BCRL self-management phase participated in one in-depth interview exploring their experience and perspective on self-managing their BCRL. FINDINGS Seven enablers and blocks to self-management were identified: routine, recognising benefit of self-management and consequences of non-treatment, owning treatment, knowledge and understanding, problem-solving, time required for treatment and aesthetics of hosiery. Women determined treatment outcome by monitoring size, appearance, texture and internal sensations within the affected arm. CONCLUSIONS Women who participated in this study showed varying degrees of acceptance and adjustment to life with lymphoedema. This appears to directly impact their ability to self-manage lymphoedema. Lymphoedema practitioners and oncology nurses have a valuable role providing knowledge and support to patients transitioning to independent self-care. A better understanding of factors facilitating patients to become experts in their condition may improve longer term outcomes and reduce cost pressures on lymphoedema services.
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Affiliation(s)
- Eunice Jeffs
- Guy's & St Thomas's NHS Foundation Trust, London, UK; King's College London, UK.
| | | | | | | | | | - Martine Huit
- Guy's & St Thomas's NHS Foundation Trust, London, UK
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23
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Breast Cancer EDGE Task Force Outcomes: Clinical Measures of Health Related Quality of Life. REHABILITATION ONCOLOGY 2015. [DOI: 10.1097/01893697-201533010-00003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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24
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Oncology Section Task Force on Breast Cancer Outcomes: Clinical Measures of Balance A Systematic Review. REHABILITATION ONCOLOGY 2015. [DOI: 10.1097/01893697-201533010-00004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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