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Young S, Geary A, Zhao X, Kenzik K, Cassidy M, Newman R, Merrill AL. Assessing breast cancer-related lymphedema screening and treatment gaps in a safety-net hospital. J Surg Oncol 2024; 130:204-209. [PMID: 38873777 DOI: 10.1002/jso.27735] [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: 12/29/2023] [Revised: 05/16/2024] [Accepted: 06/06/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND AND OBJECTIVES We evaluated the unmet breast cancer-related lymphedema (BCRL) treatment and education needs at New England's largest safety-net hospital serving a diverse population by assessing prevalence, risk factors, and treatment. METHODS This was a retrospective cohort study examining breast cancer surgery patients from September 2016 to September 2021. The primary outcome was BCRL diagnosis. Secondary outcomes included BCRL risk factors, and physical and occupational therapy (PT/OT) referral frequency and completion. RESULTS Of 639 patients, 17% of patients had documented BCRL, which was significantly associated with axillary lymph node dissection (ALND). There were no racial, insurance, breast radiation, or BMI category differences between patients with and without a BCRL diagnosis. Of those with BCRL, 58% received a PT/OT referral, and 56% completed their referral. There were no racial, insurance, or BMI category differences between those who received a PT/OT referral and those who did not. CONCLUSION In our high-risk population, rates of documented BCRL were higher than expected, approaching rates of ALND, despite the majority undergoing sentinel lymph node biopsy (SLNB). PT/OT referral and completion rates were low, concerning for an unmet BCRL treatment and education need. No disparities in care delivery were seen, but a program that addresses treatment gaps and ensures accessible and patient-centered BCRL care is urgently needed.
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Affiliation(s)
- Sara Young
- Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Alaina Geary
- Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Xuewei Zhao
- Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Kelly Kenzik
- Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Michael Cassidy
- Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Robin Newman
- Department of Occupational Therapy, Boston University Sargent College, Boston, Massachusetts, USA
| | - Andrea L Merrill
- Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA
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Mirhosseini SM, Soltanipur M, Yarmohammadi H, Rezaei M, Sheikhi Z. Lymphedema after saphenous harvesting for coronary artery bypass surgery: case report and literature review. BMC Cardiovasc Disord 2024; 24:41. [PMID: 38212705 PMCID: PMC10785345 DOI: 10.1186/s12872-024-03712-6] [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: 10/20/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024] Open
Abstract
Different causes have been described for secondary lymphedema as reported in this article. A 75-year-old man was diagnosed with lymphedema about one decade after saphenous harvesting for coronary artery bypass surgery. It took two years for him to find out his diagnosis and receive the proper treatment. After standard complete decongestive therapy, his volume and pain decreased and his quality of life was improved, especially its physical aspect. It is important to recognize the possibility of lymphedema development after saphenous harvesting among patients undergoing coronary artery bypass surgery to prevent significant disturbance of quality of life with timely management.
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Affiliation(s)
| | - Masood Soltanipur
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Medical Students Research Committee, Shahed University, Tehran, Iran
- Quality of Life Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Hossein Yarmohammadi
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Medical Students Research Committee, Shahed University, Tehran, Iran
- Quality of Life Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Mahdi Rezaei
- Medical Students Research Committee, Shahed University, Tehran, Iran
| | - Zahra Sheikhi
- Quality of Life Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran.
- Integrative Oncology Research Group, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, No.146, South Gandi Ave, Vanak Sq, Tehran, 1517964311, Iran.
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Li H, Li WB, Sun ZX, Yu J, Lv PY, Li CX, Liang X, Yu Y, Zhao ZB. Analysis of the Risk Factors of Breast Cancer-Related Lymphedema and Construction and Evaluation of a Prediction Model. Lymphat Res Biol 2023; 21:565-573. [PMID: 37768813 DOI: 10.1089/lrb.2022.0058] [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] [Indexed: 09/30/2023] Open
Abstract
Objective: The occurrence of breast cancer-related lymphedema (BCRL) in postoperative breast cancer survivors is described and the independent risk factors of BCRL are analyzed. A BCRL nomogram prediction model is constructed, and its effectiveness is evaluated to screen out high-risk patients with BCRL. Methods: A univariate analysis was carried out to determine the risk factors possibly related to BCRL, and a logistic regression analysis was utilized to determine the independent risk factors related to BCRL. A BCRL nomogram prediction model was built, and a nomogram was drawn by R software v4.1.0. The area under the curve (AUC) of the receiver operating characteristic (ROC) and the Hosmer-Lemeshow test were used to evaluate the efficacy of the constructed model to assess its clinical application value. Results: The risk factors independently associated with BCRL were body mass index (BMI), handedness on the operation side, no BCRL-related rehabilitation plan, axillary lymph node dissection (ALND), taxane-based chemotherapy, and radiotherapy (all p < 0.05). The BCRL nomogram prediction model was built on this basis, and the results of the efficacy evaluation showed a good fit: AUC = 0.952 (95% confidence interval: 0.930-0.973) for the ROC and χ2 = 6.963, p = 0.540 for the Hosmer-Lemeshow test. Conclusions: The risk factors for BCRL included higher BMI, handedness on the operation side, no BCRL-related rehabilitation plan, ALND, taxane-based chemotherapy, and radiotherapy. In addition, the BCRL nomogram prediction model accurately calculated the risk of possible BCRL among breast cancer survivors and effectively screened for high-risk patients with BCRL. Therefore, this prediction model can provide a basis for rehabilitation physicians and therapists to formulate early and individualized prevention and treatment programs.
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Affiliation(s)
- Hui Li
- Department of Rehabilitation, Hebei Medical University, Heibei, China
| | - Wei-Bo Li
- Department of Gastrointestinal Surgery, The Second Hospital of Hebei Medical University, Heibei, China
| | - Zeng-Xin Sun
- Department of Rehabilitation, Heibei General Hospital, Heibei, China
| | - Jing Yu
- Department of Rehabilitation, Hebei Medical University, Heibei, China
| | - Pei-Yuan Lv
- Department of Internal Medicine-Neurology, Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Heibei, China
| | - Chun-Xiao Li
- Department of Rehabilitation, Hebei Medical University, Heibei, China
| | - Xiao Liang
- Department of Rehabilitation, Hebei Medical University, Heibei, China
| | - Yin Yu
- Department of Rehabilitation, Hebei Medical University, Heibei, China
- Department of Rehabilitation, Heibei General Hospital, Heibei, China
| | - Zhen-Biao Zhao
- Department of Rehabilitation, Hebei Medical University, Heibei, China
- Department of Rehabilitation, Heibei General Hospital, Heibei, China
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Shen A, Wu P, Qiang W, Zhu F, Zhang Z, Wang Y, Lu Q. Breast cancer survivors' experiences of barriers and facilitators to lymphedema self-management behaviors: a theory-based qualitative study. J Cancer Surviv 2023:10.1007/s11764-023-01497-9. [PMID: 37971555 DOI: 10.1007/s11764-023-01497-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Lifelong self-management plays a critical role in the prevention and management of lymphedema among breast cancer survivors. However, adherence to lymphedema self-management behaviors has remained suboptimal. Hence, we adopted a theory-informed method to elucidate the facilitators and barriers of lymphedema self-management for breast cancer survivors. METHODS In-depth semi-structured interviews were conducted between August and October 2022 in the lymphedema nursing clinic of a tertiary cancer hospital. The maximum variation sampling technique was used to ensure a diverse sample. The ITHBC (Integrated Theory of Health Behavior Change) framework was used to inform the interview outline and data analysis. Interview transcripts were coded line-by-line and mapped to domains in accordance with the ITHBC, using both deductive and inductive content analysis. RESULTS A total of 16 participants were interviewed (aged 35 to 67). Twenty-three themes (12 facilitators and 11 barriers) were mapped onto the three domains (knowledge and belief, social facilitation, and self-regulation skill and ability) of ITHBC as facilitators and barriers to lymphedema self-management. Three additional themes including limited treatment resources for lymphedema, inconvenience of lymphedema management, boredom and tedium of lymphedema self-management were categorized under the domain of other barriers. CONCLUSIONS Incorporating these findings into the ITHBC framework allows for a more systematic selection of theory-based strategies that may improve the design of effective lymphedema self-management interventions for breast cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Elucidating impact factors, especially facilitators and barriers, for lymphedema self-management adherence is essential for developing effective intervention programs to enhance breast cancer survivors' lymphedema self-management behaviors.
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Affiliation(s)
- Aomei Shen
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, Huanhuxi Road, Hexi District, Tianjin, China
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, China
| | - Peipei Wu
- Lymphedema Clinic, Tianjin Medical University Cancer Institute & Hospital, Huanhuxi Road, Hexi District, Tianjin, China
| | - Wanmin Qiang
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, Huanhuxi Road, Hexi District, Tianjin, China
| | - Fei Zhu
- School of Nursing, Hebei University, No. 342 Yuhua East Road, Lianchi District, Baoding, China
| | - Zijuan Zhang
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, China
| | - Ying Wang
- Department of Breast Cancer, Tianjin Medical University Cancer Institute & Hospital, Huanhuxi Road, Hexi District, Tianjin, China
| | - Qian Lu
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, China.
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Kruger N, Plinsinga ML, Noble-Jones R, Piller N, Keeley V, Hayes SC. The Lymphatic System, Lymphoedema, and Medical Curricula-Survey of Australian Medical Graduates. Cancers (Basel) 2022; 14:cancers14246219. [PMID: 36551705 PMCID: PMC9777454 DOI: 10.3390/cancers14246219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022] Open
Abstract
The aim of this study was to survey the perceptions of recent (i.e., within the past 12 months) Australian medical graduates regarding (i) their understanding of the lymphatic system and lymphoedema, and (ii) the extent to which the lymphatic system and lymphoedema were covered as part of their medical degree. Medical graduates were invited to participate in a 17-item online survey that asked respondents to rate their level of agreement (using a 5-point Likert scale; higher scores = higher agreement) to statements that explored their understanding and comprehensiveness of their medical degree. Responses to each item were described using n (%). Subscale scores for understanding and medical degree were computed by summing scores of individual items, described using means (SD) and compared by participant characteristics. Medical graduates (n = 230) perceived their understanding of the lymphatic system and lymphoedema to be low, and comprehensiveness of medical curricula specific to the lymphatic system and lymphoedema to be lacking. Subscale scores did not differ by participant characteristics. Improvement of medical graduates understanding of lymphoedema may facilitate greater awareness of lymphoedema, thus optimizing the timeliness of diagnosis and access to treatment.
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Affiliation(s)
- Natalie Kruger
- Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, QLD 4111, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, QLD 4111, Australia
- Physiotherapy Department, Royal Brisbane and Women’s Hospital, Nathan, Brisbane, QLD 4006, Australia
- Correspondence:
| | - Melanie L. Plinsinga
- Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, QLD 4111, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, QLD 4111, Australia
| | - Rhian Noble-Jones
- Lymphoedema Clinical Network Wales, Swansea University, Swansea SA2 8PP, UK
| | - Neil Piller
- School of Medicine, Flinders University, Adelaide, SA 5042, Australia
| | - Vaughan Keeley
- Lymphoedema Department, University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 3NE, UK
| | - Sandra C. Hayes
- Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, QLD 4111, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, QLD 4111, Australia
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Piller N. Recognition of those at risk of lymphedema, benefits of subclinical detection, and the importance of targeted treatment and management. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.4103/ijves.ijves_33_22] [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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