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Nascimben M, Lippi L, de Sire A, Invernizzi M, Rimondini L. Algorithm-Based Risk Identification in Patients with Breast Cancer-Related Lymphedema: A Cross-Sectional Study. Cancers (Basel) 2023; 15:cancers15020336. [PMID: 36672283 PMCID: PMC9856619 DOI: 10.3390/cancers15020336] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 12/27/2022] [Indexed: 01/06/2023] Open
Abstract
Background: Breast cancer-related lymphedema (BCRL) could be one consequence of breast cancer (BC). Although several risk factors have been identified, a predictive algorithm still needs to be made available to determine the patient's risk from an ensemble of clinical variables. Therefore, this study aimed to characterize the risk of BCRL by investigating the characteristics of autogenerated clusters of patients. Methods: The dataset under analysis was a multi-centric data collection of twenty-three clinical features from patients undergoing axillary dissection for BC and presenting BCRL or not. The patients' variables were initially analyzed separately in two low-dimensional embeddings. Afterward, the two models were merged in a bi-dimensional prognostic map, with patients categorized into three clusters using a Gaussian mixture model. Results: The prognostic map represented the medical records of 294 women (mean age: 59.823±12.879 years) grouped into three clusters with a different proportion of subjects affected by BCRL (probability that a patient with BCRL belonged to Cluster A: 5.71%; Cluster B: 71.42%; Cluster C: 22.86%). The investigation evaluated intra- and inter-cluster factors and identified a subset of clinical variables meaningful in determining cluster membership and significantly associated with BCRL biological hazard. Conclusions: The results of this study provide potential insight for precise risk assessment of patients affected by BCRL, with implications in prevention strategies, for instance, focusing the resources on identifying patients at higher risk.
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Affiliation(s)
- Mauro Nascimben
- Center for Translational Research on Autoimmune and Allergic Diseases-CAAD, Department of Health Sciences, Università del Piemonte Orientale “A. Avogadro”, 28100 Novara, Italy
- Enginsoft SpA, 35129 Padua, Italy
- Correspondence:
| | - Lorenzo Lippi
- Physical and Rehabilitative Medicine, Department of Health Sciences, Università del Piemonte Orientale “A. Avogadro”, 28100 Novara, Italy
- Infrastruttura Ricerca Formazione Innovazione (IRFI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Alessandro de Sire
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Græcia”, 88100 Catanzaro, Italy
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, Università del Piemonte Orientale “A. Avogadro”, 28100 Novara, Italy
- Infrastruttura Ricerca Formazione Innovazione (IRFI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Lia Rimondini
- Center for Translational Research on Autoimmune and Allergic Diseases-CAAD, Department of Health Sciences, Università del Piemonte Orientale “A. Avogadro”, 28100 Novara, Italy
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Long-Term Effects of Extracorporeal Shock Wave Therapy on Breast Cancer-Related Lymphedema. J Clin Med 2022; 11:jcm11226747. [PMID: 36431224 PMCID: PMC9699053 DOI: 10.3390/jcm11226747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/12/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022] Open
Abstract
Extracorporeal shock wave therapy (ESWT) can reduce breast cancer-related lymphedema (BCRL). However, evidence of the long-term effectiveness of ESWT on BCRL is sparse. The aim of the study was to investigate whether ESWT has long-term effects on BCRL. We enrolled patients with stage 2 lymphedema. The 28 female patients were randomly divided into the ESWT group (n = 14) and the control group (n = 14). ESWT was applied thrice a week for a total of 3 weeks with an intensity of 0.056 to 0.068 mJ/mm2 and a frequency of 4 Hz. Complex decongestive therapy (CDT) was applied in both groups. The arm circumference, fluid volume, ratio of water content, and skin thickness were measured. Patients were evaluated at before treatment, 3 weeks after ESWT completion, and 3 months post-ESWT completion. The ESWT group, the circumference of the whole arm, volume, ratio of water content, QuickDASH score, and skin thickness showed statistically significant improvement at 3 weeks and 3 months post-treatment. When comparing the changes in measurement between the two groups at 3 weeks and 3 months post-treatment, ESWT group showed statistically significant improvement in circumference (cm) below the elbow, ratio of water content and skin thickness at 3 weeks and 3 months post treatment. Overall, ESWT improved lymphedema in patients with stage 2 BCRL, and the effects persisted for at least 3 months. Therefore, ESWT may be an additional treatment method for patients with lymphedema.
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Şahinoğlu E, Ergin G, Karadibak D. The efficacy of change in limb volume on functional mobility, health-related quality of life, social appearance anxiety, and depression in patients with lower extremity lymphedema. Phlebology 2022; 37:200-205. [DOI: 10.1177/02683555211061011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives This study aims to investigate the impact of change in limb volume on the levels of functional mobility, health-related quality of life, social appearance anxiety, and depression before and after complex decongestive physiotherapy in patients with lower extremity lymphedema. Method Twenty-seven patients with unilateral lower extremity lymphedema were included. The treatment period was 20 sessions. The outcome measures were the limb volume, the Timed Up and Go test, the Short Form-36, the Social Appearance Anxiety Scale, and the Beck Depression Inventory. Results A statistically significant decrease in the limb volume ( p < 0.001) and statistically significant improvements in the Timed Up and Go test performance ( p < 0.001), the Short Form-36 Physical Component Summary score ( p < 0.01), the Social Appearance Anxiety Scale score ( p < 0.001), and the Beck Depression Inventory score ( p < 0.001) were found. No statistically significant difference was found on the Short Form-36 Mental Component Summary score ( p > 0.05). Conclusion The decrease in the limb volume improves the functional mobility, physical health-related quality of life, social appearance anxiety, and depression in patients with lower extremity lymphedema, but not the mental health-related quality of life.
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Affiliation(s)
- Ertan Şahinoğlu
- Dr İsmail Atabek Physical Therapy and Rehabilitation Center, İzmir, Turkey
| | - Gülbin Ergin
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, İzmir Bakircay University, İzmir, Turkey
| | - Didem Karadibak
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, İzmir, Turkey
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Kim Y, Kim S, Lim JY, Hwang CM, Ko MH, Hwang JH. Home-Based Intermittent Pneumatic Compression Therapy: The Impact in Chronic Leg Lymphedema in Patients Treated for Gynecologic Cancer. Healthcare (Basel) 2022; 10:healthcare10040638. [PMID: 35455817 PMCID: PMC9032801 DOI: 10.3390/healthcare10040638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 02/04/2023] Open
Abstract
We conducted a prospective study of cancer patients to investigate the efficacy, quality of life, satisfaction, and safety of a home-based intermittent pneumatic compression (IPC) device during the maintenance phase of lower extremity lymphedema. This device has a unique mode designed to mimic the manual lymphatic drainage (MLD) technique and thereby gently facilitate lymphatic draining of proximal extremities. Thirty patients with stage 3 chronic secondary unilateral leg lymphedema in the maintenance phase underwent IPC and conventional compression therapy for 4 weeks at home. The participants were guided to use 1 h course (30 min of MLD-mimicking mode and 30 min of conventional mode) of IPC device twice a day for 4 weeks. We assessed the patients’ limb-volume measurement, quality of life (QOL), and satisfaction four times. There were no significant time-dependent interactions in the inter-limb volume difference ratio (Vratio). In a subgroup analysis, participants who used the home-based IPC device and maintained their routine self-maintenance program of short-stretch bandages (group B, n = 21) showed a more significant decline in Vratio than those who did not maintained their routine care (group A, n = 9). All scores of QOL decreased significantly after the intervention without subgroup difference. All participants were satisfied with the 4-week intervention. This study demonstrated that a home-based IPC device with an MLD-mimicking program is a useful option for maintaining the volume of limbs and improving the QOL of patients with stage 3 chronic leg lymphedema during the maintenance phase.
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Affiliation(s)
- Yoon Kim
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea;
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul 01022, Korea
| | - Seonghee Kim
- Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Korea; (S.K.); (C.M.H.)
| | - Ji Young Lim
- Department of Physical Therapy, Graduate School of Medical Sciences, Konyang University, Daejeon 35365, Korea;
| | - Chea Min Hwang
- Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Korea; (S.K.); (C.M.H.)
| | - Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju 54907, Korea;
| | - Ji Hye Hwang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea;
- Correspondence: ; Tel.: +82-2-3410-2816; Fax: +82-2-3410-2820
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Zhang Y, Li N, Chen J, Luo X, Li M, Yan J. Breast Cancer-Related Lymphedema Risk-Management Behaviors Among Chinese Breast Cancer Survivors and Relationships with Socio-Demographic and Clinical Characteristics: A Longitudinal Study. Patient Prefer Adherence 2022; 16:797-808. [PMID: 35370404 PMCID: PMC8965334 DOI: 10.2147/ppa.s356750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/14/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We sought to determine changes in breast cancer-related lymphedema (BCRL) risk-management behaviors in the six-month period after surgery among Chinese breast cancer survivors and to explore the relationship between their socio-demographic and clinical characteristics and these behaviors. PATIENTS AND METHODS A longitudinal study design was adopted. Females aged ≥18 years with a first breast cancer diagnosis and who had undergone modified radical mastectomy were recruited from a cancer hospital in China. Respondents with a history of other malignant tumors, mental illness, or cognitive impairment were excluded from the study. Socio-demographic and clinical factors were assessed at baseline. BCRL risk-management behaviors were assessed with the Lymphedema Risk-Management Behavior Questionnaire (LRMBQ) and Functional Exercise Adherence Scale (FEAS) in the first, third, and sixth months after surgery. Repeated-measures analysis of variance was used to examine changes in BCRL risk-management behaviors over the three study time periods, and a generalized linear mixed model was used to determine socio-demographic and clinical factors associated with BCRL risk-management behaviors. RESULTS A total of 166 participants completed all three assessments. The scores of the total LRMBQ and its "Skin care" and "Lifestyle" subscales did not change significantly, but those of the "Avoidance of limb compression and injury" and "Other matters requiring attention" subscales changed over the three study time periods. Additionally, scores of the total FEAS and most of its subscales changed over the three study time periods. Furthermore, BCRL risk-management behaviors were significantly related to patients' geographic residence, education level, and tumor stage. CONCLUSION Some dimensions of BCRL risk-management behaviors changed over time, and several socio-demographic and clinical factors are related to BCRL risk-management behaviors. It is recommended that health care professionals consider the dynamic nature of BCRL risk-management behaviors and related factors when planning health education and promotion interventions.
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Affiliation(s)
- Yue Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Na Li
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province, People’s Republic of China
| | - Jing Chen
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Xia Luo
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Mingfang Li
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Jun Yan
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
- Correspondence: Jun Yan, School of Nursing, Sun Yat-sen University, No. 74, Zhongshan II Road, Guangzhou, Guangdong Province, People’s Republic of China, Tel +86-13416347847, Email
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Extracorporeal Shock Wave Therapy Combined with Complex Decongestive Therapy in Patients with Breast Cancer-Related Lymphedema: A Systemic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10245970. [PMID: 34945266 PMCID: PMC8705697 DOI: 10.3390/jcm10245970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 12/13/2022] Open
Abstract
Breast cancer-related lymphedema (BCRL) is one of the most significant complications seen after surgery. Several studies demonstrated that extracorporeal shock wave therapy (ESWT), in addition to conventional complex decongestive therapy (CDT), had a positive effect on BCRL in various aspects. The systematic review and meta-analysis aim to explore the effectiveness of ESWT with or without CDT on BRCL patients. We searched PubMed, Embase, PEDro, Cochrane Library Databases, and Google Scholar for eligible articles and used PRISMA2020 for paper selection. Included studies were assessed by the PEDro score, Modified Jadad scale, STROBE assessment, and GRADE framework for the risk of bias evaluation. The primary outcomes were the volume of lymphedema and arm circumference. Secondary outcome measures were skin thickness, shoulder joint range of motion (ROM), and an impact on quality-of-life questionnaire. Studies were meta-analyzed with the mean difference (MD). Eight studies were included in the systemic review and four in the meta-analysis. In summary, we found that adjunctive ESWT may significantly improve the volume of lymphedema (MD = -76.44; 95% CI: -93.21, -59.68; p < 0.00001), skin thickness (MD = -1.65; 95% CI: -3.27, -0.02; p = 0.05), and shoulder ROM (MD = 7.03; 95% CI: 4.42, 9.64; p < 0.00001). The evidence level was very low upon GRADE appraisal. ESWT combined with CDT could significantly improve the volume of lymphedema, skin thickness, and shoulder ROM in patients with BCRL. There is not enough evidence to support the use of ESWT as a replacement for CDT. This study was registered with PROSPERO: CRD42021277110.
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McNeely ML, Dolgoy ND, Rafn BS, Ghosh S, Ospina PA, Al Onazi MM, Radke L, Shular M, Kuusk U, Webster M, Campbell KL, Mackey JR. Nighttime compression supports improved self-management of breast cancer-related lymphedema: A multicenter randomized controlled trial. Cancer 2021; 128:587-596. [PMID: 34614195 DOI: 10.1002/cncr.33943] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/11/2021] [Accepted: 06/28/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lymphedema is a prevalent long-term effect of breast cancer treatment associated with reduced quality of life. This study examined the efficacy of nighttime compression as a self-management strategy for women with chronic breast cancer-related lymphedema. METHODS Th authors conducted a parallel 3-arm, multicenter, randomized trial. Women were recruited from 3 centers in Canada and randomized to group 1 (daytime compression garment alone [standard care]), group 2 (daytime compression garment plus nighttime compression bandaging), or group 3 (daytime compression garment plus the use of a nighttime compression system garment). The primary outcome was the change in excess arm volume from the baseline to 12 weeks. Participants from all groups used a nighttime compression system garment from weeks 13 to 24. RESULTS One hundred twenty women were enrolled, 118 completed the randomized trial, and 114 completed the 24-week follow-up. The rates of adherence to nighttime compression were 95% ± 15% and 96% ± 11% in the compression bandaging and nighttime compression system groups, respectively. After the intervention, the addition of nighttime compression was found to be superior to standard care for both absolute milliliter reductions (P = .006) and percentage reductions (P = .002) in excess arm lymphedema volume. Significant within-group changes were seen for quality of life across all groups; however, no between-group differences were found (P > .05). CONCLUSIONS The trial demonstrated a significant improvement in arm lymphedema volume from the addition of nighttime compression whether through the application of compression bandaging or through the use of a nighttime compression system garment. LAY SUMMARY Lymphedema is swelling that occurs in the arm on the side of the surgery for breast cancer. Lymphedema occurs in approximately 21% of women. Lymphedema tends to worsen over time and can result in recurrent infections in the arm, functional impairment, and pain. Currently, treatment consists of intensive treatments to reduce the swelling followed by regular use of a compression sleeve during the day. This study examined and found a benefit from the addition of nighttime compression (whether through self-applied compression bandaging or through the use of a nighttime compression system garment) to the use of a daytime compression sleeve.
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Affiliation(s)
- Margaret L McNeely
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada.,Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - Naomi D Dolgoy
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Bolette Skjodt Rafn
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sunita Ghosh
- Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - Paula A Ospina
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Mona M Al Onazi
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Lori Radke
- Tom Baker Cancer Centre, Alberta Health Service, Calgary, Alberta, Canada
| | - Mara Shular
- Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - Urve Kuusk
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marc Webster
- Tom Baker Cancer Centre, Alberta Health Service, Calgary, Alberta, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - John R Mackey
- Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
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Lee KW, Kim SB, Lee JH, Kim YS. Effects of Extracorporeal Shockwave Therapy on Improvements in Lymphedema, Quality of Life, and Fibrous Tissue in Breast Cancer-Related Lymphedema. Ann Rehabil Med 2020; 44:386-392. [PMID: 32986941 PMCID: PMC7655225 DOI: 10.5535/arm.19213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/04/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the effects of extracorporeal shockwave therapy (ESWT) on improving lymphedema, quality of life, and fibrous tissue in patients with stage 2 lymphedema. METHODS Breast cancer-related lymphedema patients referred to the rehabilitation center were recruited. We enrolled stage 2 lymphedema patients who had firmness of the skin at their forearm, a circumference difference of more than 2 cm between each arm, or a volume difference between upper extremities greater than 200 mL, confirmed by lymphoscintigraphy. The patients were randomly divided into the ESWT group and the control group. ESWT was performed for 3 weeks (two sessions per week); both groups received complex decongestive physical therapy. All patients were evaluated at baseline and at 3 weeks after treatment. The measurements performed included visual analog scale score, volume, circumference, QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand) score, bioelectrical impedance, and skin thickness. RESULTS The patients in both groups (n=15 in each group) completed the 3-week therapy experiment. No significant differences were observed in demographic characteristics between groups. After the 3-week treatment period, improvement was noted in the circumference difference below the elbow, volume, ratio of extracellular water to total body water, and skin thickness in the ESWT group. A significant difference was found in all the above-mentioned areas except in circumference below the elbow in the ESWT group. CONCLUSION ESWT reduced edema and skin fibrosis without significant complications. Therefore, ESWT can be used together with complex decongestive physical therapy for treating lymphedema.
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Affiliation(s)
- Kyeong Woo Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Korea
| | - Sang Beom Kim
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Korea
| | - Jong Hwa Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Korea
| | - Young Sam Kim
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Korea
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Keskin D, Dalyan M, Ünsal-Delialioğlu S, Düzlü-Öztürk Ü. The results of the intensive phase of complete decongestive therapy and the determination of predictive factors for response to treatment in patients with breast cancer related-lymphedema. Cancer Rep (Hoboken) 2020; 3:e1225. [PMID: 32672004 DOI: 10.1002/cnr2.1225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/25/2019] [Accepted: 10/03/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Lymphedema is a common complication of breast cancer or its treatment. The gold standard treatment for lymphedema is complete decongestive therapy. There are few studies about the predictive factors for the effectiveness of complete decongestive therapy. AIM To evaluate the results of the intensive phase of complete decongestive therapy, and to determine the predictive factors for the response to treatment in patients with breast cancer-related lymphedema. METHODS AND RESULTS Fifty-seven patients with breast cancer-related lymphedema (mean age: 56.2 ± 11.2 years) who underwent complete decongestive therapy between 2014 and 2016 were evaluated retrospectively. Extremity volume was calculated using circumferential measurements and the truncated cone formula technique. Response to treatment was evaluated using the percentage reduction of excess volume formula, which was obtained by calculating the extremity volume before and after treatment. The median percentage reduction of excess volume was 27.7% (IQR,13.6-50.3). The history of skin infection was related to lower percentage reduction of excess volume (P = 0.001). Although percentage reduction of excess volume was positively correlated with education level (r = 0.286, P = 0.031), percentage reduction of excess volume was negatively correlated with lymphedema duration (r = -0.361, P = 0.006), postoperative duration (r = -0.314, P = 0.018), percentage of excess volume (r = -0.398, P = 0.002), and number of complete decongestive therapy sessions (r = -0.436, P = 0.001). Univariate and multivariate analyses showed that the independent variables for percentage reduction of excess volume were percentage of excess volume (P = 0.009) and education level (P = 0.021). CONCLUSION Complete decongestive therapy is an effective method in patients with breast cancer related-lymphedema. The most important predictive factors for the efficacy of treatment were found as percentage of excess volume and education level. Patients with breast cancer should be followed up regularly and receive complete decongestive therapy in the early stage of lymphedema.
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Affiliation(s)
- Dilek Keskin
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Meltem Dalyan
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Sibel Ünsal-Delialioğlu
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Ülkü Düzlü-Öztürk
- Physiotherapy and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
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Fish ML, Grover R, Schwarz GS. Quality-of-Life Outcomes in Surgical vs Nonsurgical Treatment of Breast Cancer–Related Lymphedema. JAMA Surg 2020; 155:513-519. [DOI: 10.1001/jamasurg.2020.0230] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Morgan L. Fish
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Ritwik Grover
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
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11
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Tastaban E, Soyder A, Aydin E, Sendur OF, Turan Y, Ture M, Bilgen M. Role of intermittent pneumatic compression in the treatment of breast cancer-related lymphoedema: a randomized controlled trial. Clin Rehabil 2020; 34:220-228. [PMID: 31795748 DOI: 10.1177/0269215519888792] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
OBJECTIVE To evaluate the role of intermittent pneumatic compression in the treatment of breast cancer-related lymphoedema. DESIGN Randomized controlled trial. SETTING Physical medicine and rehabilitation clinic at a university hospital. SUBJECTS Seventy-six patients with lymphoedema. INTERVENTIONS Patients were allocated into Group 1 (complex decongestive treatment, n = 38) and Group 2 (complex decongestive treatment + intermittent pneumatic compression, n = 38). The complex decongestive treatment involved skin care, manual lymphatic drainage, compression bandaging, and exercise for 20 sessions. Group 2 additionally received intermittent pneumatic compression. MAIN MEASURES Quantitative outcomes consisted of volumetric measures prior to and after the treatment. Clinical assessments included severity of pain, heaviness and tightness, disability, grip strength, and depression. RESULTS Lymphoedema was similar at baseline, but treatments significantly reduced the excess volume (from 373 mL to 203 mL in Group 1 and 379.5 mL to 189.5 mL in Group 2). Percentage excess volumes (PEVs) decreased in both groups. The percentage reduction of excess volume was better in Group 2 than Group 1, but the intergroup difference was not significant. The clinical scores reflected improvements, but the heaviness and tightness read significantly lower in Group 2 than Group 1. CONCLUSION Intermittent pneumatic compression seems to add no benefit when combined with complex decongestive treatment of lymphoedema, but, may be functional in reducing the sensations of heaviness and tightness for the patients with pitting oedema.
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Affiliation(s)
- Engin Tastaban
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Aykut Soyder
- Department of General Surgery, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Elif Aydin
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Omer Faruk Sendur
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Yasemin Turan
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Mevlut Ture
- Department of Biostatistics, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Mehmet Bilgen
- Department of Biophysics, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
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Ergin G, Şahinoğlu E, Karadibak D, Yavuzşen T. Effectiveness of Kinesio Taping on Anastomotic Regions in Patients with Breast Cancer-Related Lymphedema: A Randomized Controlled Pilot Study. Lymphat Res Biol 2019; 17:655-660. [PMID: 31329507 DOI: 10.1089/lrb.2019.0003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: The purpose of the study was to investigate the effect of using Kinesio Taping® (KT) on anastomotic regions along with complex decongestive physiotherapy (CDP) in patients with breast cancer-related lymphedema (BCRL). Methods and Results: Patients with unilateral BCRL were divided into two groups in this randomized controlled study: Group 1 (CDP, n = 14) and Group 2 (CDP+ KT, n = 18). Assessment of limb size was quantified by using circumferential limb measurements and then calculated for each segment by using the frustum formula. CDP included manual lymphatic drainage, compression bandages, exercises, and skin care. KT was applied to lymphatic anastomosis. All patients received treatment for 1 hour per day, 5 days per week for 4 weeks. The outcome measure was difference in the reduction of limb volumes between the groups. There was a significant difference in both groups before and after treatment (p < 0.05), but there was no significant difference between the two groups regarding changes in limb volume (p > 0.05). Conclusion: The results suggest that applying KT to lymphatic anastomotic regions is not effective in reducing limb volume in the management of BCRL.
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Affiliation(s)
- Gülbin Ergin
- Department of Physiotherapy and Rehabilitation, Health Science Faculty, European University of Lefke, Lefke, North Cyprus
| | - Ertan Şahinoğlu
- Dr. İsmail Atabek Physical Therapy and Rehabilitation Center, İzmir, Turkey
| | - Didem Karadibak
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, İzmir, Turkey
| | - Tuğba Yavuzşen
- Institute for Oncology, Dokuz Eylul University, İzmir, Turkey
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13
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Crevenna R. Physical medicine in cancer rehabilitation: A narrative review. HAMDAN MEDICAL JOURNAL 2019. [DOI: 10.4103/hmj.hmj_38_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Ergin G, Şahinoğlu E, Karadibak D, Yavuzşen T. Effect of Bandage Compliance on Upper Extremity Volume in Patients with Breast Cancer-Related Lymphedema. Lymphat Res Biol 2018; 16:553-558. [PMID: 30339488 DOI: 10.1089/lrb.2017.0060] [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] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Complex decongestive physiotherapy (CDP) is an effective treatment for patients with breast cancer-related lymphedema (BCRL). Bandaging is an important component of CDP. Although the literature suggests that bandages must be kept on for about 24 hours, some patients cannot tolerate keeping them on for this length of time. Also, it has been observed that limb volume decreased in patients who did not keep bandages on for 24 hours in clinical trials. But there is no evidence that this reduction in time is statistically significant. Our purpose was to compare the effectiveness of bandage compliance for a longer or a shorter period on limb volume in patients with BCRL. METHODS AND RESULTS We retroprospectively reviewed the medical records of 39 patients who received CDP. Twenty-eight eligible patients were divided into two groups, group 1 (n = 18) and group 2 (n = 10), according to the average number of hours of bandage compliance, which was 13-24 and 7-12 hours, respectively. The primary outcome was the change in limb volume between groups. The values for the limb volumes showed a statistically significant decrease in both groups. There was no significant difference in volume reduction between the groups. CONCLUSION This study shows that keeping bandages on for between about 12 and 24 hours has the same effect on patients with BCRL as receiving CDP.
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Affiliation(s)
- Gülbin Ergin
- 1 Department of Physical Therapy and Rehabilitation, Health Science Faculty, European University of Lefke , Lefke, Turkey
| | - Ertan Şahinoğlu
- 2 Dr. İsmail Atabek Physical Therapy and Rehabilitation Center , İzmir, Turkey
| | - Didem Karadibak
- 3 School of Physical Therapy and Rehabilitation, Dokuz Eylul University , İzmir, Turkey
| | - Tuğba Yavuzşen
- 4 Institute for Oncology, Dokuz Eylul University , İzmir, Turkey
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15
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Crevenna R, Kainberger F, Wiltschke C, Marosi C, Wolzt M, Cenik F, Keilani M. Cancer rehabilitation: current trends and practices within an Austrian University Hospital Center. Disabil Rehabil 2018; 42:2-7. [PMID: 30328719 DOI: 10.1080/09638288.2018.1514665] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Cancer rehabilitation has the goal to improve functional status, quality of life, participation, and can improve quality of patient-centered programs and health care efficiencies. In Austria, inpatient cancer rehabilitation is well established but outpatient rehabilitation has not yet established well.Methods: The present article is describing current rehabilitation in practice and focuses on cancer rehabilitation in Austria, namely bringing together a descriptive account of current trends and practices within an Austrian University Hospital Center (General Hospital of Vienna linked to the Medical University of Vienna) and the Comprehensive Cancer Centre (CCC) Vienna, Austria.Results: Cancer Rehabilitation in the described Austrian University Hospital Center is well developed due to the help of all different clinics dealing with cancer patients and of the opinion leaders of the CCC Vienna. The Department of Physical Medicine, Rehabilitation, and Occupational Medicine of the Medical University of Vienna as a part of the CCC Vienna with his "Pioneer-Status" and the described milestones has been integrated in the national cancer rehabilitation concept of our country from the beginning.Conclusions: Also in Austria, Physical Medicine and Rehabilitation with competencies in diagnostic and therapy as well as of coordination of the multiprofessional and interdisciplinary rehabilitation teams is an important part of cancer rehabilitation.Implications for rehabilitationCancer rehabilitation is an important part in the treatment and care of cancer patients with the goal to improve functional status, quality of life, and participationCancer rehabilitation helps cancer survivors to be integrated in their normal live, namely to increase social participation and/or workabilityThe field of Physical Medicine and Rehabilitation with competencies in diagnostic and therapy as well as of coordination of the multi-professional and interdisciplinary rehabilitation teams is an important part of cancer rehabilitationInterventions and treatment approaches from the field of Physical Medicine and rehabilitation include the application of Physical Modalities like electrotherapy, thermotherapy, balneology and climatic therapy, phototherapy, and mechanotherapy Cancer rehabilitation has to be early integrated into the cancer care continuum.
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Affiliation(s)
- Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Franz Kainberger
- Department of Biomedical Imaging and Image-guided Therapy, Division of Neuro- and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Christoph Wiltschke
- Department of Internal Medicine I/Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Department of Internal Medicine I/Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Fadime Cenik
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Mohammad Keilani
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
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16
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Schouten B, Bergs J, Vankrunkelsven P, Hellings J. Healthcare professionals’ perspectives on the prevalence, barriers and management of psychosocial issues in cancer care: A mixed methods study. Eur J Cancer Care (Engl) 2018; 28:e12936. [DOI: 10.1111/ecc.12936] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 07/02/2018] [Accepted: 09/02/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Bojoura Schouten
- Faculty of Medicine and Life Sciences; Hasselt University; Hasselt Belgium
| | - Jochen Bergs
- Faculty of Medicine and Life Sciences; Hasselt University; Hasselt Belgium
| | - Patrick Vankrunkelsven
- Department of Public Health and Primary Care, Faculty of Medicine; Katholieke Universiteit Leuven; Leuven Belgium
- Belgian Center for Evidence-Based Medicine (CEBAM); Leuven Belgium
| | - Johan Hellings
- Faculty of Medicine and Life Sciences; Hasselt University; Hasselt Belgium
- AZ Delta Hospital; Roeselare Belgium
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17
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Meshram GG, Kaur N, Hura KS. Unilateral Primary Congenital Lymphedema of the Upper Limb in an 11-Month-Old Infant: A Clinical and Pharmacological Perspective. Open Access Maced J Med Sci 2018; 6:1682-1684. [PMID: 30337988 PMCID: PMC6182543 DOI: 10.3889/oamjms.2018.261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 08/21/2018] [Accepted: 08/30/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND: Lymphedema is the accumulation of a protein-rich fluid in the interstitial space due to reduced lymph transport capacity. Congenital primary lymphedema affecting only one of the upper limbs is a rarity. CASE REPORT: We present a case of an 11-month-old infant presenting with swelling of the right upper limb, which had gradually progressed over the past five months. Lymphoscintigraphy was suggestive of lymphatic blockade in the right upper limb. All other investigations were within normal limits. A diagnosis of primary congenital lymphedema affecting the right upper limb was made. The patient was managed conservatively with complex decongestive therapy and was requested regular follow-up. The lymphedema did not increase within four months of follow-up. CONCLUSIONS: Complex decongestive therapy is the cornerstone of the management of primary congenital lymphedema. New investigational therapies such as leukotriene B4 antagonists hold a promise for patients with lymphedema.
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Affiliation(s)
- Girish Gulab Meshram
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Neeraj Kaur
- Department of Radiology, The University of Texas Health Science Centre, San Antonio, Texas, USA
| | - Kanwaljeet Singh Hura
- Department of Paediatrics, Richmond University Medical Centre, Staten Island, New York, USA
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18
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Zocca J, Valimahomed A, Yu J, Gulati A. A review of recent advances in the management of breast cancer related pain. BREAST CANCER MANAGEMENT 2018. [DOI: 10.2217/bmt-2018-0003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The incidence of breast cancer has stabilized over the past 10 years, while death rates have declined. Thus, many women are living with long-term effects of breast cancer, including pain syndromes relating to breast cancer. As our understanding of these types of pain syndromes improves, delivery of care to this population becomes paramount. In this review, we discuss advances in rehabilitation and interventional pain management to improve pain and symptom management. Appropriate use of physical therapy may significantly improve a patient's functional status, while fascial plane blocks can lead to pain relief which may last for months. Targeted therapies for pain relief may result in better quality of life for individuals suffering from breast cancer related pain.
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Affiliation(s)
- Jennifer Zocca
- Department of Pain Management, Maiden Lane Medical, 18 East, 41st Street, LLC, New York, NY, 10017, USA
| | - Ali Valimahomed
- Department of Pain Medicine & Anesthesia, Brigham & Women's Hospital: Boston Hospital & Medical Center, 75 Francis Street, Boston, MA, 02115, USA
| | - James Yu
- Touro College of Osteopathic Medicine, 230 West, 125th Street, New York, NY, 10027, USA
| | - Amitabh Gulati
- Department of Anesthesiology & Critical Care, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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19
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Sherman KA, Kilby CJ, Elder E, Ridner SH. Factors associated with professional healthcare advice seeking in women at risk for developing breast cancer-related lymphedema. PATIENT EDUCATION AND COUNSELING 2018; 101:445-451. [PMID: 29107400 DOI: 10.1016/j.pec.2017.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/27/2017] [Accepted: 10/17/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Approximately 6-20% of breast cancer patients undergoing lymph node surgery will develop lymphedema. At-risk individuals are encouraged to seek professional healthcare advice if symptoms arise. This study aimed to identify cognitive and affective factors associated with professional healthcare advice (PHCA) seeking behavior in women with heightened lymphedema risk. METHODS Women with increased lymphedema risk (N=462) completed an online survey measuring cognitive and affective responses to lymphedema risk, including the Illness Perception Questionnaire (Revised), and adherence to seeking PHCA. RESULTS Overall, 62% of women reported seeking professional healthcare advice if symptoms arose. Logistic regression analysis indicated that adherence to seeking PHCA if lymphedema symptoms arise was associated with greater illness coherence, belief in the efficacy of seeking PHCA, and lymphedema risk-related emotional distress. CONCLUSION Women were more likely to seek PHCA if symptoms arose if they held a coherent understanding of lymphedema and believed in the usefulness of seeking PHCA. For these women, psychological distress associated with lymphedema risk was associated with enhanced adherence to seeking PHCA. PRACTICE IMPLICATIONS Health professionals should target lymphedema education to ensure at-risk women have a coherent understanding of lymphedema and that they believe in the effectiveness of seeking PHCA to help manage lymphedema symptoms.
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Affiliation(s)
- Kerry A Sherman
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Australia; Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
| | - Christopher J Kilby
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Australia; Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Elisabeth Elder
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Australia
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20
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Investigating the Lymphatic System by Dual-Color Elemental Mass Spectrometry Imaging. CONTRAST MEDIA & MOLECULAR IMAGING 2017; 2017:4035721. [PMID: 29097921 PMCID: PMC5612703 DOI: 10.1155/2017/4035721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/24/2016] [Accepted: 12/19/2016] [Indexed: 12/02/2022]
Abstract
Secondary lymphedema accompanied with strong restrictions in quality of life is still major side effects in cancer therapy. Therefore, dedicated diagnostic tools and further investigation of the lymphatic system are crucial to improve lymphedema therapy. In this pilot study, a method for quantitative analysis of the lymphatic system in a rat model by laser ablation (LA) with inductively coupled plasma mass spectrometry imaging (ICP-MSI) is presented. As a possible lymph marker, thulium(III)(1R,4R,7R,10R)-α,α′,α′′,α′′′-tetramethyl-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetate (Tm-DOTMA) is introduced and compared to the clinically used magnetic resonance imaging contrast agent gadolinium(III)2,2′,2′′-(10-((2R,3S)-1,3,4-trihydroxybutan-2-yl)-1,4,7,10-tetraazacyclododecane-1,4,7-triyl)triacetate (Gd-DO3A-butrol). Gadobutrol functioned as standard contrast media in MRI lymphangiography to detect lymphatic flow qualitatively. Thus, Tm-DOTMA was investigated as lymphatic marker to detect lymphatic flow quantitatively. Both contrast agents were successfully used to visualize the lymphatic flow in successive lymph nodes in LA-ICP-MS due to lower limits of detection compared to MRI. Furthermore, the distribution of contrast agents by multicolored imaging showed accumulation in specific areas (sectors) of the lymph nodes after application of contrast agents in different areas.
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21
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Postoperative Orthognathic Surgery Edema Assessment With and Without Manual Lymphatic Drainage. J Craniofac Surg 2017; 28:1816-1820. [DOI: 10.1097/scs.0000000000003850] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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22
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Do J, Jeon J, Kim W. The effects of bandaging with an additional pad and taping on secondary arm lymphedema in a patient after mastectomy. J Phys Ther Sci 2017; 29:1272-1275. [PMID: 28744063 PMCID: PMC5509607 DOI: 10.1589/jpts.29.1272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 04/30/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this case study was to determine the effectiveness of bandaging the arm of a patient with secondary lymphedema on the patient's quality of life, arm volume and arm function using an additional pad and taping along with some other standard therapy modalities for lymphedema. [Subjects and Methods] I used a bandage with an additional pad and taping, along with MLD, exercise, and skin care to treat a patient with unilateral breast-cancer-related arm lymphedema who had fibrotic tissue on her lower arm and hand. I made a pad called a "muff" and applied it under tape while using Vodder's technique. Treatment was performed during 5 therapy sessions a week for 2 weeks. [Results] After the physiotherapy sessions, the excess edema volume decreased to 608 ml, and the percentage of excess volume (PEV) was 9.6%. The therapeutic efficacy, measured as percentage reduction of excess volume (PREV), was -79.5%, meaning that the edema volume was reduced 79.5%. The use of an additional pad and taping on a large edematous site with fibrotic changes can produce more efficacious lymphedema care. [Conclusion] The use of an additional pad and taping on a large edematous site with fibrotic changes has demonstrated a positive result in lymphedema management for a post mastectomy patient and, therefore, further studies on this method are suggested with a larger sample size.
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Affiliation(s)
- Junghwa Do
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
| | - JaeYong Jeon
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
| | - Won Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
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23
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The effects of complex exercise on shoulder range of motion and pain for women with breast cancer-related lymphedema: a single-blind, randomized controlled trial. Breast Cancer 2016; 24:608-614. [PMID: 28008557 DOI: 10.1007/s12282-016-0747-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND This study was to investigate the effects of complex exercise on shoulder range of motion and pain for women with breast cancer-related lymphedema. METHODS 69 women participated in this study and then they were randomly allocated to complex exercise group (n = 35) or the conventional decongestive therapy group (n = 34). All subjects received 8 sessions for 4 weeks. To identify the effects on shoulder range of motion and pain, goniometer and visual analog scale were used, respectively. The outcome measurements were performed before and after the 4 week intervention. RESULTS After 4 weeks, complex exercise group had greater improvements in shoulder range of motion and pain compared with the conventional decongestive therapy group (p < 0.05). CONCLUSION These results suggest that complex exercise is beneficial to improve shoulder range of motion as well as pain of the women with breast cancer-related lymphedema. Complex exercise would be useful to improve shoulder range of motion and pain of the women with breast cancer-related lymphedema.
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24
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Mete Civelek G, Aypak C, Turedi O. Knowledge of Primary Care Physicians About Breast-Cancer-Related Lymphedema: Turkish Perspective. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:687-692. [PMID: 26159749 DOI: 10.1007/s13187-015-0880-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Breast-cancer-related lymphedema (BCRL) is a common complication of breast cancer treatment. Informing patients about BCRL can contribute to decrease their risk of developing the condition or prevent it from progressing further. In order to educate patients about BCRL effectively, clinical knowledge of clinicians must be adequate. In study, we aimed to reflect BCRL knowledge and attitude of Turkish primary care physicians (PCPs). This questionnaire-based study was conducted by face-to-face interview method. The participants included actively working PCPs from all parts of Turkey. The questionnaire elicited data on physicians' demographics, the BCRL knowledge, self-reported BCRL knowledge, referral patterns, and education. A total of 314 PCPs with a mean age of 36.9 % ± 8.1 years (mean ± standard deviation) were included in the study. Median BCRL knowledge score of all study group was 15 (11-18) [median (25-75 % range)]. PCPs who received education about BCRL during their medical faculty and/or residency periods had significantly higher knowledge scores (p = 0.005). Of PCPs, 94.9 % indicated to make a BCRL referral for a breast cancer patient. Among them, 55 % preferred to make a referral to a general surgeon, 28.2 % to an oncologist, and 16.8 % to a physical medicine and rehabilitation specialist. Assessment of factors related with BCRL should be part of routine evaluation of patients with breast cancer in primary care. Education of PCPs about BCRL is warranted in order to improve the BCRL care.
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Affiliation(s)
- Gul Mete Civelek
- Department of Physical Medicine and Rehabilitation, Dıskapı Yıldırım Beyazıt Education and Research Hospital, Irfan Bastug Caddesi, Dıskapı, Altındag, Ankara, 06110, Turkey.
| | - Cenk Aypak
- Department of Family Medicine, Dıskapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
| | - Ozlem Turedi
- Department of Family Medicine, Dıskapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
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25
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Pinto e Silva MP, Bassani MA, Miquelutti MA, Marques ADA, do Amaral MTP, de Oliveira MMF, Ferreira NDO. Manual lymphatic drainage and multilayer compression therapy for vulvar edema: a case series. Physiother Theory Pract 2016; 31:527-31. [PMID: 26395830 DOI: 10.3109/09593985.2015.1038375] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND OBJECTIVE Vulvar edema is a condition rarely reported and without defined treatment that may result in functional limitation. The aim of the report is to describe a case series of patients with disabling vulvar edema of different etiologies that were treated with manual lymphatic drainage (MLD) and multilayer compression therapy (MCT). CASE SERIES Four cases of vulvar edema are described: one in a woman with cervical cancer; one in a woman in the postoperative period of bilateral adrenalectomy for pheocromocytoma; and two in pregnant women with preeclampsia. All cases were treated with MLD and MCT during hospitalization. OUTCOMES Total resolution of the edema occurred in 2 to 5 d of treatment. CONCLUSION The present case series is the first to report the use of the MLD and MCT in the successful management of female genital edema. This report suggests that the vulvar edemas for these four patients treated with MLD and MCT seem to resolve faster than expected based on previously reported untreated edemas or edemas treated with different therapeutic approaches.
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Affiliation(s)
| | - Mariana Almada Bassani
- a Center for Assistance to Women's Health, University of Campinas (UNICAMP) , Campinas , SP , Brazil
| | - Maria Amelia Miquelutti
- a Center for Assistance to Women's Health, University of Campinas (UNICAMP) , Campinas , SP , Brazil
| | - Andrea de Andrade Marques
- a Center for Assistance to Women's Health, University of Campinas (UNICAMP) , Campinas , SP , Brazil
| | - Maria Teresa Pace do Amaral
- b Course of Physiotherapy, Management and Health Care Department, Federal University of São Paulo (UNIFESP) , Santos-SP , Brazil , and
| | | | - Néville de Oliveira Ferreira
- c Department of Physiotherapy , Health Science Center, Federal University of Espírito Santo (UFES) , Vitória , ES , Brazil
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26
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Zhang L, Fan A, Yan J, He Y, Zhang H, Zhang H, Zhong Q, Liu F, Luo Q, Zhang L, Tang H, Xin M. Combining Manual Lymph Drainage with Physical Exercise after Modified Radical Mastectomy Effectively Prevents Upper Limb Lymphedema. Lymphat Res Biol 2016; 14:104-8. [DOI: 10.1089/lrb.2015.0036] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Lijuan Zhang
- Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Aiqun Fan
- Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Jun Yan
- School of Nursing, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Yan He
- Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Huiting Zhang
- Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Huizhen Zhang
- Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Qiaoling Zhong
- Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Feng Liu
- Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Qinghua Luo
- Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Liping Zhang
- Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Hailin Tang
- Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Mingzhu Xin
- Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
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27
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Maehr B, Keilani M, Wiltschke C, Hassler M, Licht T, Marosi C, Huetterer E, Cenik F, Crevenna R. Cancer rehabilitation in Austria--aspects of Physical Medicine and Rehabilitation. Wien Med Wochenschr 2016; 166:39-43. [PMID: 26758980 DOI: 10.1007/s10354-015-0414-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 12/07/2015] [Indexed: 11/30/2022]
Abstract
In Austria, cancer rehabilitation is an important issue in the management of cancer patients. Survival rates and survival time of cancer patients are increasing, and cancer rehabilitation is an important part in the treatment and care of cancer patients with the goal to improve functional status, quality of life, and (social) participation. Today, in Austria there are approximately 600 beds for inpatient rehabilitation. The field of outpatient rehabilitation will maybe be expanded after evaluating the existing pilot projects. Beside other specialities, the field of Physical Medicine and Rehabilitation (PM&R) plays an important role in cancer rehabilitation. In cancer rehabilitation, especially activating modalities from PM&R such as exercise are very important and well-accepted parts to improve functional status, quality of life, and participation of patients.
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Affiliation(s)
- Bruno Maehr
- Rosalienhof, Bad Tatzmannsdorf, Burgenland, Austria.,Gesellschaft zur Erforschung onkologischer rehabilitativer Grundlagen (GEORG), Vienna, Austria
| | - Mohammad Keilani
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Gesellschaft zur Erforschung onkologischer rehabilitativer Grundlagen (GEORG), Vienna, Austria
| | - Christoph Wiltschke
- Department of Internal Medicine I/Oncology, Medical University of Vienna, Vienna, Austria.,Gesellschaft zur Erforschung onkologischer rehabilitativer Grundlagen (GEORG), Vienna, Austria
| | - Marco Hassler
- Sonnberghof, Bad Sauerbrunn, Burgenland, Austria.,Gesellschaft zur Erforschung onkologischer rehabilitativer Grundlagen (GEORG), Vienna, Austria
| | - Thomas Licht
- , St. Veit/Pongau, Salzburg, Austria.,Gesellschaft zur Erforschung onkologischer rehabilitativer Grundlagen (GEORG), Vienna, Austria
| | - Christine Marosi
- Department of Internal Medicine I/Oncology, Medical University of Vienna, Vienna, Austria.,Gesellschaft zur Erforschung onkologischer rehabilitativer Grundlagen (GEORG), Vienna, Austria
| | - Elisabeth Huetterer
- Department of Internal Medicine I/Oncology, Medical University of Vienna, Vienna, Austria.,Gesellschaft zur Erforschung onkologischer rehabilitativer Grundlagen (GEORG), Vienna, Austria
| | - Fadime Cenik
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Gesellschaft zur Erforschung onkologischer rehabilitativer Grundlagen (GEORG), Vienna, Austria
| | - Richard Crevenna
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. .,Gesellschaft zur Erforschung onkologischer rehabilitativer Grundlagen (GEORG), Vienna, Austria.
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Kim SY, Bae H, Ji HM. Computed Tomography as an Objective Measurement Tool for Secondary Lymphedema Treated With Extracorporeal Shock Wave Therapy. Ann Rehabil Med 2015; 39:488-93. [PMID: 26161357 PMCID: PMC4496522 DOI: 10.5535/arm.2015.39.3.488] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 08/29/2014] [Indexed: 11/24/2022] Open
Abstract
Two patients with stage three secondary lymphedema of the upper extremities underwent treatment for breast cancer, including surgery, chemotherapy, and radiotherapy. They were examined with computed tomography (CT) before and after extracorporeal shock wave therapy (ESWT). We used a manual tracing method using PiViewSTAR software to calculate the volume of the upper extremities. There was a decrease in the volume of the subcutaneous compartment measured by CT before and after ESWT. CT may be helpful in determining the treatment target area of ESWT and to monitor the effect of treatment by measuring the changes in volume before and after ESWT in patients with lymphedema. Therefore, CT may have good clinical potential for treatment and follow-up in the management of lymphedema.
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Affiliation(s)
- So-Yeon Kim
- Department of Rehabilitation Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hasuk Bae
- Department of Rehabilitation Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hye Min Ji
- Department of Rehabilitation Medicine, Ewha Womans University School of Medicine, Seoul, Korea
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29
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Psychosocial factors associated with adherence for self-management behaviors in women with breast cancer-related lymphedema. Support Care Cancer 2015; 24:139-146. [DOI: 10.1007/s00520-015-2766-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/30/2015] [Indexed: 10/23/2022]
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30
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Atalay OT, Özkir A, Çalik BB, Baskan E, Taşkin H. Effects of phase I complex decongestive physiotherapy on physical functions and depression levels in breast cancer related lymph edema. J Phys Ther Sci 2015; 27:865-70. [PMID: 25931748 PMCID: PMC4395732 DOI: 10.1589/jpts.27.865] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 11/07/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Breast cancer-related upper extremity lymph edema is known to cause physical, functional and psychological impairments in women after modified radical mastectomy. The aim of this study was to investigate the effects of phase I Complex Decongestive Physiotherapy (CDP) on physical functions and depression levels in women with breast cancer-related upper extremity lymph edema. [Subjects and Methods] Fifty-eight subjects with breast cancer-related upper extremity lymph edema were the subjects of this study. The arm circumference, shoulder range of motion (ROM), muscle strength and depression levels of the subjects were assessed before and after phase I CDP treatment. [Results] After phase I CDP, there was a statistically significant reduction in circumference measurements at all levels of the affected arm. There was not any statistically significant difference in muscle strength after CDP. The shoulder ROM improved after treatment. There was a significant reduction in the Beck Depression Inventory score. A significant positive correlation was found between depression levels and circumference measurement. [Conclusion] Based on the results we suggest that by reducing limb volume, beside improving physical functions, phase I CDP can affect psychological status, especially depression which is very common in women with breast cancer-related upper extremity lymph edema.
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Affiliation(s)
- Orçin Telli Atalay
- Department of Physiotherapy and Rehabilitation, School of
Physical Therapy and Rehabilitation, Pamukkale University, Turkey
| | - Anıl Özkir
- Department of Physiotherapy and Rehabilitation, Institute
of Health Sciences, Pamukkale University, Turkey
| | - Bilge Başakçi Çalik
- Department of Orthopedical Rehabilitation, School of
Physical Therapy and Rehabilitation, Pamukkale University, Turkey
| | - Emre Baskan
- Department of Neurological Rehabilitation, School of
Physical Therapy and Rehabilitation, Pamukkale University, Turkey
| | - Harun Taşkin
- Department of Physiotherapy and Rehabilitation, School of
Physical Therapy and Rehabilitation, Pamukkale University, Turkey
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31
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Lower Limb Lymphedema and Neurological Complications After Lymphadenectomy for Gynecological Cancer. Int J Gynecol Cancer 2015; 25:521-5. [DOI: 10.1097/igc.0000000000000341] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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32
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Factors predicting adherence to risk management behaviors of women at increased risk for developing lymphedema. Support Care Cancer 2014; 23:61-9. [PMID: 24970542 DOI: 10.1007/s00520-014-2321-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 06/11/2014] [Indexed: 12/31/2022]
Abstract
PURPOSE Lymphedema affects 20-30% of women following breast cancer treatment. However, even when women are informed, they do not necessarily adhere to recommended lymphedema self-management regimens. Utilizing the Cognitive-Social Health Information Processing framework, we assessed the cognitive and emotional factors influencing adherence to lymphedema risk management. METHODS Women with breast cancer who had undergone breast and lymph node surgery were recruited through the Fox Chase Cancer Center breast clinic. Participants (N = 103) completed measures of lymphedema-related perceived risk, beliefs and expectancies, distress, self-regulatory ability to manage distress, knowledge, and adherence to risk management behaviors. They then received the American Cancer Society publication "Lymphedema: What Every Woman with Breast Cancer Should Know." Cognitive and affective variables were reassessed at 6 and 12 months post-baseline. RESULTS Maximum likelihood multilevel model analyses indicated that overall adherence increased over time, with significant differences between baseline and 6- and 12-month assessments. Adherence to wearing gloves was significantly lower than that for all other behaviors except electric razor use. Distress significantly decreased, and knowledge significantly increased, over time. Greater knowledge, higher self-efficacy to enact behaviors, lower distress, and higher self-regulatory ability to manage distress were associated with increased adherence. CONCLUSIONS Women who understand lymphedema risk management and feel confident in managing this risk are more likely to adhere to recommended strategies. These factors should be rigorously assessed as part of routine care to ensure that women have the self-efficacy to seek treatment and the self-regulatory skills to manage distress, which may undermine attempts to seek medical assistance.
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33
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Are “Smart Pressure Monitored Suits” “Smarter” than Conventional Garments in Clinical Applications?*. Hong Kong J Occup Ther 2013. [DOI: 10.1016/j.hkjot.2013.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective/Background There is still no standardized regime to prescribe pressure garments with quantifiable pressure dosage to patients with different medical conditions. This study aimed to examine the efficacy of a newly developed system [a smart pressure monitored suit (SPMS)] for pressure intervention when compared with the conventional method of pressure garment production (conventional garment or CG). The SPMS is designed with a set of standard methods of measurements and computerized pattern drafting software (YUKA) to adjust the pressure range through computation of the percentage of strain directly on the drafted pattern. The CG was fabricated by occupational therapists in clinical settings. Methods A selected group of patients who required pressure therapy intervention was recruited through convenience sampling. They were provided with both a SPMS and a CG, each to be worn for 1 month. The interface pressure levels of both garments were measured before the implementation. Patients’ feedback was collected using a standardized questionnaire on the comfort of wear, elasticity, and durability of the garments. Results There was a significant difference in the deterioration of pressure between the SPMSs and the CGs (p < .05) before and after 1 month of wear. The satisfaction on overall efficacy of the SPMSs was significantly higher than that of CGs (p < .05). Conclusion This standardized system using a SPMS appeared to provide a more accurate and consistent pressure range and long-lasting effect to the patients. It also appeared to be more efficient and effective in terms of production and fabrication.
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Hwang JM, Hwang JH, Kim TW, Lee SY, Chang HJ, Chu IH. Long-term effects of complex decongestive therapy in breast cancer patients with arm lymphedema after axillary dissection. Ann Rehabil Med 2013; 37:690-7. [PMID: 24236257 PMCID: PMC3825946 DOI: 10.5535/arm.2013.37.5.690] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 07/26/2013] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate the long-term effects of complex decongestive therapy (CDT) on edema reduction in breast cancer-related lymphedema patients after axillary dissection, according to the initial volume of edema. Methods A retrospective review of 57 patients with unilateral arm after an axillary dissection for breast cancer was performed. The patients, treated with two weeks of CDT and self-administered home therapy, were followed for 24 months. Arm volume was serially measured by using an optoelectronic volumeter prior to and immediately after CDT; and there were follow-up visits at 3, 6, 12, and 24 months. Patients were divided into two groups according to the percent excess volume (PEV) prior to CDT: group 1, PEV<20% and group 2, PEV≥20%. Results In group 1, mean PEV before CDT was 11.4±5.0% and 14.1±10.6% at 24 months after CDT with no significant difference. At the end of CDT, PEV was 28.8±15.7% in group 2, which was significantly lower than the baseline (41.9±19.6%). The reduction of PEV was maintained for 24 months in group 2. Conclusion The long-term effects of CDT were well-maintained for 24 months, but there was a difference in progression of PEV between the two groups. The patients with more initial PEV showed significant volume-reducing effects of CDT. In patients with less initial PEV, the severity of lymphedema did not progress to higher grades.
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Affiliation(s)
- Jung Min Hwang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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35
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Brown JC, Cheville AL, Tchou JC, Harris SR, Schmitz KH. Prescription and adherence to lymphedema self-care modalities among women with breast cancer-related lymphedema. Support Care Cancer 2013; 22:135-43. [PMID: 24013569 DOI: 10.1007/s00520-013-1962-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 08/27/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE To profile the prescription for and adherence to breast cancer-related lymphedema (BCRL) self-care modalities among breast cancer (BrCa) survivors with BCRL in a 12-month randomized weightlifting trial. METHODS We developed a questionnaire that assessed prescription for and adherence to 10 BCRL self-care modalities that included physical therapy exercise, pneumatic compression pump, medication, lymphedema bandaging, arm elevation, self-administered lymphatic drainage, therapist-administered lymphatic drainage, compression garments, skin care, and taping. We measured prescription for and adherence to BCRL self-care modalities at baseline, 3, 6, and 12 months. Longitudinal logistic regression was used to estimate the odds ratio (OR) and 95 % confidence interval (95 % CI) associated with prescription for and adherence to BCRL modalities over time. RESULTS This study included 141 BrCa survivors with BCRL. Women were prescribed an average of 3.6 ± 2.1 BCRL self-care modalities during the study. The prescription for therapist-administered lymphatic drainage (OR = 0.92, 95 % CI 0.88-0.96), pneumatic compression pump use (OR = 0.94, 95 % CI 0.89-0.98), and bandaging (OR = 0.96, 95 % CI 0.93-0.99) decreased over 12 months of follow-up. No other prescribed BCRL self-care modalities changed during the study. Over 12 months, the average adherence to all BCRL self-care modalities varied with 13, 24, 32, and 31 % of women reporting <25, 25-49, 50-74, and ≥75 % adherence, respectively. Over 12 months, there was a noticeable change from high to low adherence in self-administered lymphatic drainage, such that there was a 15 % increased likelihood of adherence <25 % compared to ≥75 % (OR = 1.15 (95 % CI 1.05-1.26); p = 0.002). The adherence patterns of all other modalities did not change over follow-up. CONCLUSIONS Our findings suggest the prescription for BCRL self-care modalities is variable. The average adherence to BCRL self-care was non-optimal. Future research is necessary to prepare BrCa survivors with the knowledge, skills, abilities, and resources necessary to care for this lifelong condition.
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Affiliation(s)
- Justin C Brown
- University of Pennsylvania School of Medicine, 423 Guardian Drive, 8th Floor, Blockley Hall, Philadelphia, PA, 19104, USA
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36
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Fialka-Moser V, Korpan M, Varela E, Ward A, Gutenbrunner C, Casillas J, Delarque A, Berteanu M, Christodoulou N. The role of physical and rehabilitation medicine specialist in lymphoedema. Ann Phys Rehabil Med 2013; 56:396-410. [DOI: 10.1016/j.rehab.2013.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 02/27/2013] [Indexed: 11/30/2022]
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Lee BK, Lee JS, Kim TS. The Influence of 4 wks Complex Therapeutic Exercises on Visual Analog Scale of Pain and Range of Motion for Middle-Aged Women with Breast Cancer-Related Lymphedema. ACTA ACUST UNITED AC 2013. [DOI: 10.13066/kspm.2013.8.2.153] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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38
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Bae H, Kim HJ. Clinical outcomes of extracorporeal shock wave therapy in patients with secondary lymphedema: a pilot study. Ann Rehabil Med 2013; 37:229-34. [PMID: 23705118 PMCID: PMC3660484 DOI: 10.5535/arm.2013.37.2.229] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 09/24/2012] [Indexed: 11/15/2022] Open
Abstract
Objective To investigate the clinical effect of extracorporeal shock wave therapy (ESWT) in patients with secondary lymphedema after breast cancer treatment. Methods In a prospective clinical trial, ESWT was performed consecutively 4 times over two weeks in 7 patients who were diagnosed with stage 3 secondary lymphedema after breast cancer treatment. Each patient was treated with four sessions of ESWT (0.056-0.068 mJ/mm2, 2,000 impulses). The parameters were the circumference of the arm, thickness of the skin and volume of the arm. We measured these parameters with baseline values before ESWT and repeated the evaluation after each ESWT treatment. Subjective data on skin thickness, edema and sensory impairment were obtained using a visual analogue scale (VAS). Results The mean volume of the affected arm after four consecutive ESWT was significantly reduced from 2,332 to 2,144 mL (p<0.05). The circumference and thickness of the skin fold of the affected arm were significantly decreased after the fourth ESWT (p<0.05). The three VAS scores were significantly improved after the fourth ESWT. Almost all patients were satisfied with this treatment and felt softer texture in their affected arm after treatment. Conclusion ESWT is an effective modality in the treatment of stage 3 lymphedema after breast cancer treatment. ESWT reduced the circumference and the thickness of arms with lymphedema and satisfied almost all patients with lymphedema. Therefore, this treatment provides clinically favorable outcome to patients with breast cancer-related lymphedema.
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Affiliation(s)
- Hasuk Bae
- Department of Rehabilitation Medicine, Ewha Womans University School of Medicine, Seoul, Korea
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