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Devoogdt N, Thomis S, Belva F, Dickinson-Blok J, Fourgeaud C, Giacalone G, Karlsmark T, Kavola H, Keeley V, Marques ML, Mansour S, Nissen CV, Nørregaard S, Oberlin M, Ručigaj TP, Somalo-Barranco G, Suominen S, Van Duinen K, Vignes S, Damstra R. The VASCERN PPL working group patient pathway for primary and paediatric lymphoedema. Eur J Med Genet 2024; 67:104905. [PMID: 38143023 DOI: 10.1016/j.ejmg.2023.104905] [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: 11/02/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023]
Abstract
Lymphoedema is caused by an imbalance between fluid production and transport by the lymphatic system. This imbalance can be either caused by reduced transport capacity of the lymphatic system or too much fluid production and leads to swelling associated with tissue changes (skin thickening, fat deposition). Its main common complication is the increased risk of developing cellulitis/erysipelas in the affected area, which can worsen the lymphatic function and can be the cause of raised morbidity of the patient if not treated correctly/urgently. The term primary lymphoedema covers a group of rare conditions caused by abnormal functioning and/or development of the lymphatic system. It covers a highly heterogeneous group of conditions. An accurate diagnosis of primary lymphoedema is crucial for the implementation of an optimal treatment plan and management, as well as to reduce the risk of worsening. Patient care is diverse across Europe, and national specialised centres and networks are not available everywhere. The European Reference Network on Rare Multisystemic Vascular Diseases (VASCERN) gathers the best expertise in Europe and provide accessible cross-border healthcare to patients with rare vascular diseases. There are six different working groups in VASCERN, which focus on arterial diseases, hereditary haemorrhagic telangiectasia, neurovascular diseases, lymphoedema and vascular anomalies. The working group Paediatric and Primary Lymphedema (PPL WG) gathers and shares knowledge and expertise in the diagnosis and management of adults and children with primary and paediatric lymphoedema. The members of PPL WG have worked together to produce this opinion statement reflecting strategies on how to approach patients with primary and paediatric lymphoedema. The objective of this patient pathway is to improve patient care by reducing the time to diagnosis, define the best management and follow-up strategies and avoid overuse of resources. Therefore, the patient pathway describes the clinical evaluation and investigations that lead to a clinical diagnosis, the genetic testing, differential diagnosis, the management and treatment options and the patient follow up at expert and local centres. Also, the importance of the patient group participation in the PPL WG is discussed.
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Affiliation(s)
- Nele Devoogdt
- Centre for Lymphedema, Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Sarah Thomis
- Centre for Lymphedema, Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | | | - Janine Dickinson-Blok
- Expert Center for Lymphovascular Medicine, Nij Smellinghe Hospital, Drachten, the Netherlands
| | - Caroline Fourgeaud
- Department of Lymphology and Reference Center for Rare Vascular Diseases, Cognacq-Jay Hospital, 15, Rue Eugène-Millon, 75015, Paris, France
| | | | - Tonny Karlsmark
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Heli Kavola
- Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Vaughan Keeley
- Derby Lymphedema Service, University Hospitals of Derby and Burton NHS Trust, Derby, UK
| | | | - Sahar Mansour
- Department of Lymphovascular Medicine, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Christoffer V Nissen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Susan Nørregaard
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Michael Oberlin
- European Centre for Lymphology, Földi Clinic, Hinterzarten, Germany
| | | | | | - Sinikka Suominen
- Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Kirsten Van Duinen
- Expert Center for Lymphovascular Medicine, Nij Smellinghe Hospital, Drachten, the Netherlands
| | - Stéphane Vignes
- Department of Lymphology and Reference Center for Rare Vascular Diseases, Cognacq-Jay Hospital, 15, Rue Eugène-Millon, 75015, Paris, France
| | - Robert Damstra
- Expert Center for Lymphovascular Medicine, Nij Smellinghe Hospital, Drachten, the Netherlands.
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Cheng MH, Ho OA, Tsai TJ, Lin YL, Kuo CF. Breast cancer-related lymphedema correlated with incidence of cellulitis and mortality. J Surg Oncol 2022; 126:1162-1168. [PMID: 35960614 DOI: 10.1002/jso.27054] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/25/2022] [Accepted: 07/30/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND This study investigated breast cancer-related lymphedema (BCRL) and its correlation with the incidence of cellulitis and mortality in the National Health Insurance (NHI) database in Taiwan. METHODS Between 2004 and 2014, the NHI database of patients with breast cancer who underwent surgical procedures, adjuvant therapies, BCRL, cellulitis, and mortality were retrospectively reviewed. Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for incidence of BCRL and cellulitis in different treatment groups. The associations of BCRL with the incidence of cellulitis and mortality were further analyzed using the Kaplan-Meier curve. RESULTS Among 100 301 patients, 5464 (5.4%) developed BCRL with a median onset of 1.3 years. At a mean follow-up of 4.77 years, the incidence of cellulitis in the BCRL group (12.7%, 694/5464 patients) was significantly higher than in the no-BCRL group (2.73%, 2589/94 837 patients) (HR: 3.74; 95% CI: 3.43-4.08; p < 0.0001). At a mean follow-up of 5.77 years, the mortality rate in the cellulitis group (34.21%, 1123/3283 patients) was significantly greater than in the no-cellulitis group (16.29%, 15 804/97 018 patients) (HR: 1.17; 95% CI: 1.1-1.24; p < 0.0001). CONCLUSIONS BCRL had a significantly higher incidence of cellulitis and mortality.
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Affiliation(s)
- Ming-Huei Cheng
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Section of Plastic Surgery, The University of Michigan, Ann Arbor, Michigan, USA.,Center of Lymphedema Microsurgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Olivia A Ho
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Tai-Jung Tsai
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Ling Lin
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Center for Artificial Intelligence Research in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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3
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Healthcare Practitioners' Knowledge of Lymphedema. Int J Vasc Med 2022; 2021:3806150. [PMID: 35003807 PMCID: PMC8741388 DOI: 10.1155/2021/3806150] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/03/2021] [Accepted: 12/08/2021] [Indexed: 01/26/2023] Open
Abstract
Objectives Lymphedema is neglected in medical education, and a review on healthcare practitioners' (HCPs) knowledge is necessary to shed light on gaps and to provide evidence for establishing educational programs on lymphedema. Methods This systematic review was performed based on the PRISMA guideline in PubMed, Scopus, Web of Science, and Google Scholar databases. There was no limitation on the type of lymphedema or HCPs. The quality assessment was performed based on QATSDD. Data regarding study characteristics, questionnaire context, and findings of the study were summarized from each article. Results After the screening, 16 articles were included that 12 were cross-sectional, two were qualitative, and two were interventional pilot studies. Breast cancer and other cancer-related lymphedema, lymphatic filariasis, and podoconiosis were included, and the majority of articles were focused on primary HCPs. The overall knowledge was low and average in five and 11 articles, respectively, and prior education was a significant factor related to higher knowledge of lymphedema in two studies. Conclusion Structured education of lymphedema is needed to increase the knowledge of HCPs and to enhance their collaboration in multidisciplinary care teams. Improvement of HCPs' knowledge may lead to better outcomes of lymphedema patients' management which are neglected.
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Vignes S, Poizeau F, Dupuy A. Cellulitis risk factors for patients with primary or secondary lymphedema. J Vasc Surg Venous Lymphat Disord 2021; 10:179-185.e1. [PMID: 33957278 DOI: 10.1016/j.jvsv.2021.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 04/01/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Limb lymphedema is a chronic disease with primary and secondary forms, with the latter occurring essentially after cancer treatment. In the present study, we retrospectively analyzed the cellulitis frequency and its associated risk factors for patients with primary or secondary limb lymphedema. METHODS Information from all 1991 patients referred to a specialized lymphedema center from January to June 2018 was collected, including previous cellulitis episodes and the clinical and lymphedema characteristics. RESULTS Of the 1846 patients whose information could be analyzed, 695 (37.6%) had experienced one or more cellulitis episodes, and 23.3% had had recurrent cellulitis. Cellulitis occurred in 39.5%, 30.5%, and 38.6% (P = .02) of the patients with secondary upper limb, secondary lower limb, and primary lower limb lymphedema, respectively. The corresponding duration of lymphedema was 106.5, 97, and 243.1 months. For secondary upper limb lymphedema, a long interval from lymphedema onset to the first consultation at our specialized center, younger age at lymphedema onset, and the use of radiotherapy were independently associated with cellulitis. However, axillary lymph node excision, the use of chemotherapy, and segmentation of the upper limb lymphedema were not associated with cellulitis. A longer interval from lymphedema onset to the first consultation and lymph node excision were associated with cellulitis in those with lower limb secondary lymphedema but higher body mass index and younger age at lymphedema onset were not. For primary lower limb lymphedema, male sex, greater body mass index, and younger age at lymphedema onset were associated with cellulitis. CONCLUSIONS Different risk factors for cellulitis were identified for patients with lymphedema at risk. Awareness of those factors is important for physicians to recognize lymphedema promptly and refer patients to specialized centers to optimize treatment.
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Affiliation(s)
- Stéphane Vignes
- Department of Lymphology, Referral Center for Rare Vascular Diseases, Cognacq-Jay Hospital, Paris, France.
| | - Florence Poizeau
- Department of Dermatology, Centre Hospitalier Universitaire de Rennes, Rennes, France; EA 7449 REPERES (Pharmacoepidemiology and Health Services Research), Rennes 1 University, Rennes, France
| | - Alain Dupuy
- Department of Dermatology, Centre Hospitalier Universitaire de Rennes, Rennes, France; EA 7449 REPERES (Pharmacoepidemiology and Health Services Research), Rennes 1 University, Rennes, France
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Vignes S, Albuisson J, Champion L, Constans J, Tauveron V, Malloizel J, Quéré I, Simon L, Arrault M, Trévidic P, Azria P, Maruani A. Primary lymphedema French National Diagnosis and Care Protocol (PNDS; Protocole National de Diagnostic et de Soins). Orphanet J Rare Dis 2021; 16:18. [PMID: 33407666 PMCID: PMC7789008 DOI: 10.1186/s13023-020-01652-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 12/19/2020] [Indexed: 11/10/2022] Open
Abstract
Primary lymphedema is a rare chronic pathology associated with constitutional abnormalities of the lymphatic system. The objective of this French National Diagnosis and Care Protocol (Protocole National de Diagnostic et de Soins; PNDS), based on a critical literature review and multidisciplinary expert consensus, is to provide health professionals with an explanation of the optimal management and care of patients with primary lymphedema. This PNDS, written by consultants at the French National Referral Center for Primary Lymphedema, was published in 2019 (https://has-sante.fr/upload/docs/application/pdf/2019-02/pnds_lymphoedeme_primaire_final_has.pdf).
Primary lymphedema can be isolated or syndromic (whose manifestations are more complex with a group of symptoms) and mainly affects the lower limbs, or, much more rarely, upper limbs or external genitalia. Women are more frequently affected than men, preferentially young. The diagnosis is clinical, associating mild or non-pitting edema and skin thickening, as confirmed by the Stemmer’s sign (impossibility to pinch the skin on the dorsal side or the base of the second toe), which is pathognomonic of lymphedema. Limb lymphoscintigraphy is useful to confirm the diagnosis. Other causes of swelling or edema of the lower limbs must be ruled out, such as lipedema. The main acute lymphedema complication is cellulitis (erysipelas). Functional and psychological repercussions can be major,
deteriorating the patient’s quality of life. Treatment aims to prevent those complications, reduce the volume with low-stretch bandages, then stabilize it over the long term by exercises and wearing a compression garment. Patient education (or parents of a child) is essential to improve observance.
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Affiliation(s)
- Stéphane Vignes
- Department of Lymphology and Reference Center for Rare Vascular Diseases, Cognacq-Jay Hospital, 15, rue Eugène-Millon, 75015, Paris, France.
| | | | - Laurence Champion
- Department of Nuclear Medicine, René Huguenin-Curie Hospital, 35, rue Dailly, 92210, Saint-Cloud, France
| | - Joël Constans
- Department of Vascular Medicine, Saint-André Hospital, CHU de Bordeaux, 1, rue Jean-Burguet, 33000, Bordeaux, France
| | - Valérie Tauveron
- Department of Dermatology and Reference Center for Rare Diseases and Vascular Malformations (MAGEC), CHRU Tours, 37044, Tours Cedex 9, France
| | - Julie Malloizel
- Department of Vascular Medicine, Rangueil Hospital, 1, avenue du Pr Jean-Poulhès, 31059, Toulouse, France
| | - Isabelle Quéré
- Department of Vascular Medicine and Reference Center for Rare Vascular Diseases, CHU Montpellier, 80, avenue Augustin-Fliche, 34090, Montpellier, France
| | - Laura Simon
- Department of Lymphology and Reference Center for Rare Vascular Diseases, Cognacq-Jay Hospital, 15, rue Eugène-Millon, 75015, Paris, France
| | - Maria Arrault
- Department of Lymphology and Reference Center for Rare Vascular Diseases, Cognacq-Jay Hospital, 15, rue Eugène-Millon, 75015, Paris, France
| | | | - Philippe Azria
- Department of Internal Medicine, Saint-Joseph Hospital, 185, rue Raymond-Losserand, 75014, Paris, France
| | - Annabel Maruani
- Department of Dermatology and Reference Center for Rare Diseases and Vascular Malformations (MAGEC), CHRU Tours, 37044, Tours Cedex 9, France.,INSERM 1246 - SPHERE, Universities of Tours and Nantes, 37000, Tours, France
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6
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Bozon G, Mestre Godin S, Chorron G, Nou Howaldt M, Laroche JP, LeCollen L, Calais C, Quéré I, Galanaud JP. Assessment of primary lymphedema and post-thrombotic lower limb edema patient's pathway. JOURNAL DE MÉDECINE VASCULAIRE 2020; 45:55-61. [PMID: 32265015 DOI: 10.1016/j.jdmv.2020.01.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 12/06/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To assess: (1) lower limb primary lymphedema or post-thrombotic syndrome patient's pathway in terms of health care professional use and (2) if aetiology of edema has an impact on this pathway. METHODS Ancillary survey of the transversal prospective CHROEDEM pilot study. Forty patients with either lower limb primary lymphedema or post-thrombotic syndrome were invited to participate. RESULTS Seventy-five percent of primary lymphedema patients and 50% of post-thrombotic patients benefited from a multidisciplinary management (P=0.10) including the general practitioner, the vascular medicine physician and either a physiotherapist (particularly in case of primary lymphedema), a registered nurse (particularly in case of post-thrombotic syndrome). Main ambulatory health care professionals' correspondent of hospital-based vascular medicine physicians were general practitioners (80%) in post-thrombotic patients, and general practitioners (60%) and physiotherapists (45%) in primary lymphedema patients. Pharmacists were also involved in patient education. CONCLUSION Management of primary lymphedema and post-thrombotic related chronic edema is usually multidisciplinary. General practitioners and vascular medicine physicians are the cornerstones of this management, that also involves the physiotherapist in case of primary lymphedema and in a lesser extent the registered nurse and the pharmacist. This suggests that these five healthcare professional should play a key role in case of development of standardized patient pathways for primary lymphedema and post-thrombotic syndrome.
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Affiliation(s)
- G Bozon
- Department of vascular medicine, CHU Montpellier, Saint-Eloi hospital, 80, avenue Augustin-Fliche, 34090 Montpellier, France.
| | - S Mestre Godin
- Department of vascular medicine, CHU Montpellier, Saint-Eloi hospital, 80, avenue Augustin-Fliche, 34090 Montpellier, France; EA 2992, Montpellier 1 university, 34000 Montpellier, France
| | - G Chorron
- Département de l'information médicale, CHU de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - M Nou Howaldt
- Department of vascular medicine, CHU Montpellier, Saint-Eloi hospital, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - J P Laroche
- Department of vascular medicine, CHU Montpellier, Saint-Eloi hospital, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - L LeCollen
- Department of vascular medicine, CHU Montpellier, Saint-Eloi hospital, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - C Calais
- Department of vascular medicine, CHU Montpellier, Saint-Eloi hospital, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - I Quéré
- Department of vascular medicine, CHU Montpellier, Saint-Eloi hospital, 80, avenue Augustin-Fliche, 34090 Montpellier, France; EA 2992, Montpellier 1 university, 34000 Montpellier, France
| | - J P Galanaud
- Department of vascular medicine, CHU Montpellier, Saint-Eloi hospital, 80, avenue Augustin-Fliche, 34090 Montpellier, France; EA 2992, Montpellier 1 university, 34000 Montpellier, France; Department of medicine, Sunnybrook Health Sciences Centre, université de Toronto, 2075, Bayview avenue, M4N 3M5 Toronto, ON, Canada
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Shallwani SM, Hodgson P, Towers A. Examining Obesity in Lymphedema: A Retrospective Study of 178 New Patients with Suspected Lymphedema at a Canadian Hospital-Based Clinic. Physiother Can 2020; 72:18-25. [PMID: 34385745 PMCID: PMC8330978 DOI: 10.3138/ptc-2018-0076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose: Physiotherapists have an important role to play in the early detection and treatment of lymphedema, a chronic inflammatory condition characterized by excess interstitial protein-rich fluid, which is estimated to affect more than one million Canadians. Obesity has been identified both as an important cause of and as a risk factor for developing lymphedema of various aetiologies. Little is currently known about obesity in Canadians affected by lymphedema. The objective of this study was to report on the prevalence of overweight and obesity in a Canadian lymphedema clinic population and the relationships among BMI; demographic, medical, and lymphedema characteristics; and cellulitis history. Method: We conducted a retrospective electronic record review of the clinical data collected from new patients evaluated for suspected lymphedema at a specialized Canadian hospital-based clinic over a 2-year period. We used descriptive analyses to characterize the sample and one-way analysis of variance and χ2 tests for comparative analyses. Results: Of the 178 patients whose records were reviewed, 36.5% were classified as overweight and 39.3% as obese. Patients with non-cancer diagnoses had a higher mean BMI than those with cancer-related diagnoses (p < 0.001). A higher BMI was associated with a longer time since lymphedema onset (p < 0.001), bilateral lymphedema (p = 0.010), and history of cellulitis (p < 0.001). Conclusions: Obesity is prevalent in the Canadian population with lymphedema and is associated with delayed referral and increased cellulitis rates. Early detection and tailored management strategies are needed to address obesity in patients with lymphedema and the complexities associated with these two related conditions.
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Affiliation(s)
- Shirin M. Shallwani
- Lymphedema Program
- Physiotherapy Department, McGill University Health Centre, Montreal
- School of Rehabilitation Sciences, University of Ottawa, Ottawa
| | | | - Anna Towers
- Lymphedema Program
- Department of Oncology, McGill University, Montreal
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Buso G, Depairon M, Tomson D, Raffoul W, Vettor R, Mazzolai L. Lipedema: A Call to Action! Obesity (Silver Spring) 2019; 27:1567-1576. [PMID: 31544340 PMCID: PMC6790573 DOI: 10.1002/oby.22597] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/30/2019] [Indexed: 01/31/2023]
Abstract
Lipedema is a chronic progressive disease characterized by abnormal fat distribution resulting in disproportionate, painful limbs. It almost exclusively affects women, leading to considerable disability, daily functioning impairment, and psychosocial distress. Literature shows both scarce and conflicting data regarding its prevalence. Lipedema has been considered a rare entity by several authors, though it may be a far more frequent condition than thought. Despite the clinical impact on women's health, lipedema is in fact mostly unknown, underdiagnosed, and too often misdiagnosed with other similarly presenting diseases. Polygenic susceptibility combined with hormonal, microvascular, and lymphatic disorders may be partly responsible for its development. Furthermore, consistent information on lipedema pathophysiology is still lacking, and an etiological treatment is not yet available. Weight loss measures exhibit minimal effect on the abnormal body fat distribution, resulting in eating disorders, increased obesity risk, depression, and other psychological complaints. Surgical techniques, such as liposuction and excisional lipectomy, represent therapeutic options in selected cases. This review aims to outline current evidence regarding lipedema epidemiology, pathophysiology, clinical presentation, differential diagnosis, and management. Increased awareness and a better understanding of its clinical presentation and pathophysiology are warranted to enable clinicians to diagnose and treat affected patients at an earlier stage.
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Affiliation(s)
- Giacomo Buso
- Angiology Division, Heart and Vessel DepartmentLausanne University HospitalLausanneSwitzerland
| | - Michele Depairon
- Angiology Division, Heart and Vessel DepartmentLausanne University HospitalLausanneSwitzerland
| | - Didier Tomson
- Angiology Division, Heart and Vessel DepartmentLausanne University HospitalLausanneSwitzerland
| | - Wassim Raffoul
- Plastic Surgery Division, Locomotor System DepartmentLausanne University HospitalLausanneSwitzerland
| | - Roberto Vettor
- Department of Medicine, Center for the Study and the Integrated Management of Obesity (EASO COM)Padova University HospitalPadovaItaly
| | - Lucia Mazzolai
- Angiology Division, Heart and Vessel DepartmentLausanne University HospitalLausanneSwitzerland
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9
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Simon M, Vignes S. [General practitioner questionnaire concerning upper limb lymphedema after breast cancer]. JOURNAL DE MÉDECINE VASCULAIRE 2019; 44:3-8. [PMID: 30770083 DOI: 10.1016/j.jdmv.2018.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION In France, breast cancer is the most frequent cancer in women. Lymphedema, the main complication, is poorly known. The objective of this study was to assess the state of knowledge of upper limb lymphedema (risk factors, complications, treatment) after treatment of breast cancer among general practitioners from the Haute-Normandie and Île-de-France regions. MATERIALS AND METHODS A cross-sectional study with 23 closed questions was sent by email to 490 practicing doctors. RESULTS One hundred and sixty-two questionnaires (33%) could be analyzed. Among the participating physicians (men: 55%), 46% were aged over 50 and 75% were from the Haute-Normandie region; 86% of them followed at least 5 women who had breast cancer. Risk factors for lymphedema were: axillary dissection (89%), risk reduction with sentinel lymph node (82%), radiotherapy (81%), mastectomy (45%) and overweight/obesity (42%). For 54% of physicians, lymphedema appeared within 6 months after cancer treatment and was diagnosed upon examination (clinical signs, perimeter measurements) in 78%, without the need for radiological examinations (100%). Physicians with more than 10 years of experience searched for more lymphedema (86% vs. 62%, P<0.0001). Prescriptions included: elastic compression during the day (77%), manual lymphatic drainage (74%), overnight compression (36%) and consultation in a specialized lymphology department (8%). Six percent of physicians had never managed lymphedema and 22% sent patients to an oncologist. Advice given was: prevention of infectious risk (80%), weight loss (42%), avoidance of sports involving the affected limb (22%), and regular arm elevation (14%). Physicians recommended avoiding blood sampling (75%), measuring blood pressure (66%) on the limb ipsilateral to cancer, while 20% did not prohibit any action on the limb. CONCLUSION Lymphedema knowledge in general practitioners is generally adequate although the number of women followed by each of them was low. It seems necessary to optimize the training of generalists on lymphedema in order to improve patient management.
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Affiliation(s)
- M Simon
- Unité de Lymphologie, site constitutif du Centre national de référence des maladies vasculaires rares (lymphœdèmes primaires), hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France
| | - S Vignes
- Unité de Lymphologie, site constitutif du Centre national de référence des maladies vasculaires rares (lymphœdèmes primaires), hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France.
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10
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Simon L, Trévidic P, Denis P, Vignes S. Vulvar lymphangioma circumscriptum: comparison of primary and acquired forms in a cohort of 57 patients. J Eur Acad Dermatol Venereol 2017; 32:e56-e58. [PMID: 28758249 DOI: 10.1111/jdv.14497] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 07/13/2017] [Indexed: 11/28/2022]
Affiliation(s)
- L Simon
- Department of Lymphology, Centre National de Référence des Maladies Vasculaires Rares (Lymphoedèmes Primaires), Hôpital Cognacq-Jay, Paris, France
| | | | - P Denis
- Cabinet d'Histopathologie, Paris, France
| | - S Vignes
- Department of Lymphology, Centre National de Référence des Maladies Vasculaires Rares (Lymphoedèmes Primaires), Hôpital Cognacq-Jay, Paris, France
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