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Huang J, Li J, Li Y, Huang L, Li B, Huang F, Lv C, Fang F. Bibliometric analysis of breast cancer-related lymphedema research trends over the last 2 decades. Front Oncol 2024; 14:1360899. [PMID: 38444687 PMCID: PMC10912165 DOI: 10.3389/fonc.2024.1360899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/05/2024] [Indexed: 03/07/2024] Open
Abstract
Objective As breast cancer cases rise globally, post-mastectomy lymphedema garners increasing scholarly attention. This study aims to conduct a comprehensive bibliometric analysis of Breast Cancer-Related Lymphedema (BCRL) research from 2003 to 2022, identifying trends and providing global research insights for future studies. Method The literature for this analysis was extracted from the Web of Science (WoS) Core Collection, encompassing 1199 publications, including 702 articles and 101 reviews, totaling 803. Using advanced bibliometric tools such as VOSviewer and CiteSpace, quantitative and visual analyses were performed to map collaboration networks, research clusters, and emerging trends. The search strategy included specific terms related to lymphedema, breast cancer, and BCRL, ensuring a comprehensive representation of the research landscape. Results The bibliometric analysis revealed a steady increase in BCRL publications over the studied period, reaching a peak in 2018. The United States emerged as the leading contributor to BCRL literature, with China also demonstrating a significant presence. Collaboration networks were visualized, showcasing the interconnectedness of institutions and researchers globally. Key research hotspots identified include preventive strategies, complex decongestive therapy, and reconstructive interventions. Conclusion In conclusion, this pioneering bibliometric analysis provides a comprehensive overview of BCRL research trends and collaborations globally. The findings contribute valuable insights into the evolution of the field, highlighting areas of focus and emerging research themes. This study serves as a foundational resource for researchers, clinicians, and policymakers, fostering evidence-based practices and interventions for BCRL in the future.
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Affiliation(s)
- Jinghui Huang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, China
| | - Jiamin Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, China
| | - Ying Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, China
| | - Lele Huang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Bai Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, China
| | - Feng Huang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, China
| | - Can Lv
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, China
| | - Fanfu Fang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, China
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Li X, Wang J, Zhang J, Zhang N, Wu C, Geng Z, Zhou J, Dong L. The Effect of Exercise on Weight and Body Composition of Breast Cancer Patients Undergoing Chemotherapy: A Systematic Review. Cancer Nurs 2023; Publish Ahead of Print:00002820-990000000-00093. [PMID: 36728172 DOI: 10.1097/ncc.0000000000001196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Chemotherapy is a primary adjuvant treatment strategy for breast cancer patients, accompanied by weight gain and negative changes in body composition. However, it is unknown whether exercise is effective in preventing said weight gain and mitigating body composition changes of breast cancer patients undergoing treatment. OBJECTIVES The current study used meta-analysis with trial sequential analysis to determine exercise effect on weight and body composition of breast cancer patients undergoing chemotherapy. METHODS Cochrane Library, PubMed, EMBASE, EBSCO, Scopus, and SinoMed were searched (from the database start date up to August 16, 2021) for randomized controlled studies evaluating the effect of exercise on weight or body composition among breast cancer patients during chemotherapy. RevMan software and TSA Software were used to assess the risk of bias and analyze study results. RESULTS In total, 13 studies comprising 1828 participants were included. Meta-analysis showed that exercise could lead to lower weight, body mass index (BMI), and percentage of body fat during chemotherapy for breast cancer patients, and muscular strength showed significant improvement. Trial sequential analysis showed that evidence of muscular strength was sufficient, but BMI evidence requires further confirmation. CONCLUSION This meta-analysis found significant differences in body weight, BMI, percentage of body fat, and muscular strength between exercise intervention groups and control groups. IMPLICATIONS FOR PRACTICE Exercise during chemotherapy is beneficial in preventing weight gain and negative changes in body composition. Medical practitioners should encourage patients to start exercising during chemotherapy. However, further studies are required because insufficient sample sizes meant that outcomes of body composition remain unconfirmed.
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Affiliation(s)
- Xinyu Li
- Author Affiliations: School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China (Ms Li, Mr Wang, and Drs Zhang, Wu, Geng, Zhou, and Dong); and Department of Breast Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Ms N Zhang)
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Dylke ES, Ward LC. Three Decades of Bioelectrical Impedance Spectroscopy in Lymphedema Assessment: An Historical Perspective. Lymphat Res Biol 2020; 19:206-214. [PMID: 33232645 DOI: 10.1089/lrb.2020.0085] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Bioelectrical impedance spectroscopy (BIS) is a technology that is widely used for the assessment of body composition. The method is based on the measurement of the electrical resistance of the body or a body region that can be quantitatively related to the amount of water in the tissues. Lymphedema is characterized, at least in its early stages, as an accumulation of lymph, an extracellular fluid. In the late 1980s, it was recognized that it might be possible to adapt BIS protocols to measure this increase in lymph volume. Subsequently, the use of BIS for the early detection of breast cancer-related lymphedema was demonstrated in the early 1990s, with BIS reference values indicative of lymphedema published in 2001. The subsequent two decades have seen BIS become a widely accepted method for lymphedema assessment. This review traces the evolution of the BIS technique since its inception and presents the current state of the art, with particular emphasis on utility in clinical practice.
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Affiliation(s)
- Elizabeth S Dylke
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
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Volumetric Differences in the Suprafascial and Subfascial Compartments of Patients with Secondary Unilateral Lower Limb Lymphedema. Plast Reconstr Surg 2020; 145:1528-1537. [PMID: 32459781 DOI: 10.1097/prs.0000000000006844] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The subfascial compartment (deep to the deep fascia) in extremity lymphedema has not been evaluated. This study investigated the volumetric differences between the suprafascial and subfascial compartments of patients with unilateral lower extremity lymphedema. METHODS Thirty-two female patients with unilateral lower extremity lymphedema were enrolled, with eight patients in each of Cheng lymphedema grades I to IV. The volumes of the suprafascial and subfascial compartments were calculated after manually drawing the region of interest on computed tomographic images. The volumetric differences and their ratios in the suprafascial and subfascial compartments between each patient's bilateral limbs were compared. RESULTS The volume of the lymphedematous limbs (9647 ml) was significantly greater than the volume of unaffected limbs (6906 ml), with a median volumetric difference of 2097 ml (30.6 percent) (p < 0.01). The median suprafascial compartment volumetric difference was 1887 ml (56.6 percent) and the subfascial compartment volumetric difference was 208 ml (4.7 percent) (p < 0.01). The median volumetric difference ratio of the thigh and lower leg was 24.6 percent and 40.6 percent, respectively. The median volumetric differences in Cheng lymphedema grades I to IV were 1012, 1787, 2434, and 4107 ml, respectively, which were statistically significant among the four Cheng lymphedema grades using the Kruskal-Wallis test (p < 0.01). CONCLUSIONS The volumetric differences in the lymphedematous limb were statistically significantly greater than in the unaffected limb, including both suprafascial and subfascial compartments. The volumetric differences are consistent with the Cheng lymphedema grading system as a reliable indicator of unilateral extremity lymphedema. CLINICAL QUESTION/LEVEL OF EVIDENCE Diagnostic, IV.
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Bloomquist K, Adamsen L, Hayes SC, Lillelund C, Andersen C, Christensen KB, Oturai P, Ejlertsen B, Tuxen MK, Møller T. Heavy-load resistance exercise during chemotherapy in physically inactive breast cancer survivors at risk for lymphedema: a randomized trial. Acta Oncol 2019; 58:1667-1675. [PMID: 31354000 DOI: 10.1080/0284186x.2019.1643916] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Due to long-standing concerns that heavy-load lifting could increase the risk of developing lymphedema, breast cancer survivors have been advised to refrain from resistance exercise with heavy loads. This study prospectively evaluated the effect of heavy-load resistance exercise on lymphedema development in women receiving chemotherapy for breast cancer.Material and Methods: Physically inactive women receiving adjuvant chemotherapy for breast cancer (n = 153) were randomized to a HIGH (supervised, multimodal exercise including heavy-load resistance exercise: 85-90% 1 repetition maximum [RM], three sets of 5-8 repetitions) versus LOW (pedometer and one-on-one consultations) 12-week intervention. Outcomes (baseline, 12 and 39 weeks) included lymphedema status (extracellular fluid [bioimpedance spectroscopy] and inter-arm volume % difference [dual-energy X-ray absorptiometry], lymphedema symptoms [numeric rating scale 0-10]), upper-extremity strength (1 RM), and quality of life domains (EORTC- BR23). Linear mixed models were used to evaluate equivalence between groups for lymphedema outcomes (equivalence margins for L-Dex, % difference and symptoms scale: ±5, ±3% and ±1, respectively). Superiority analysis was conducted for muscle strength and quality of life domains.Results: Postintervention equivalence between groups was found for extracellular fluid (0.4; 90% CI -2.5 to 3.2) and symptoms of heaviness (-0.2; -0.6 to 0.2), tightness (-0.1; -0.8 to 0.6) and swelling (0.2; -0.4 to 0.8). Nonequivalence was found for inter-arm volume % difference (-3.5%; -17.3 to 10.3) and pain (-0.7; -1.3 to 0), favoring HIGH. Strength gains were superior in the HIGH versus LOW group (3 kg; 1 to 5, p < .05). Further, clinically relevant reductions in breast (-11; -15 to -7) and arm (-6; -10 to -1) symptoms were found in the HIGH group.Conclusion: Findings suggest that physically inactive breast cancer survivors can benefit from supervised heavy-load resistance exercise during chemotherapy without increasing lymphedema risk. Trial registration: ISRCTN13816000.
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Affiliation(s)
- Kira Bloomquist
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
| | - Lis Adamsen
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
| | - Sandra C. Hayes
- Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Australia
| | - Christian Lillelund
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
| | - Christina Andersen
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
| | - Karl Bang Christensen
- Department of Public Health; Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Peter Oturai
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Copenhagen, Denmark
| | - Bent Ejlertsen
- DBCG, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Tom Møller
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
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Effectiveness of Vascularized Lymph Node Transfer for Extremity Lymphedema Using Volumetric and Circumferential Differences. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2003. [PMID: 30881819 PMCID: PMC6416128 DOI: 10.1097/gox.0000000000002003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 09/14/2018] [Indexed: 01/01/2023]
Abstract
Background Circumferential difference of lymphedematous limbs at designated anatomic distances has been the primary mode for measuring lymphedematous extremities. Computed tomography (CT) imaging produces accurate, consistent, hygienic volume measurements and a direct limb representation. This study compares these 2 main modalities and assesses their correlation. Methods CT and circumferential difference measurements, costs, and correlation of patient limbs that received vascularized lymph node transfer were compared. Results Mean circumferential difference by tape measurement pre- and postoperatively was 31.4% ± 19.1% and 17.4% ± 8.8% for upper limbs and 43.2% ± 16.1% and 22.4% ± 12% for the lower limbs, respectively. Mean CT volumetric difference pre- and postoperatively were 36.1 ± 4.1% and 27.2 ± 2.8% for the upper limb and 46.2 ± 3.2% and 33.2 ± 2.1% for the lower limbs, respectively. CT volume measurements significantly correlated with their respective circumferential difference with Pearson correlation coefficient of r = +0.7, which was statistically significant (P = 0.03), indicating a strong positive correlation between circumferential difference and actual limb volume changes as determined by CT imaging. Circumferential differences are more cost effective than CT volume assessments in the domains of measurement frequency (P = 0.03), fee (P < 0.01), time (P = 0.03), total cost per year (P < 0.01), and cost/minute (P = 0.03). Conclusions Standardized circumferential differences that are currently used are comparable to unbiased CT volumetric measurements and can be used as a reliable, reproducible, minimally invasive, low cost, and accurate method of measuring the lymphedematous limbs.
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Bloomquist K, Oturai P, Steele ML, Adamsen L, Møller T, Christensen KB, Ejlertsen B, Hayes SC. Heavy-Load Lifting: Acute Response in Breast Cancer Survivors at Risk for Lymphedema. Med Sci Sports Exerc 2018; 50:187-195. [PMID: 28991039 PMCID: PMC5770105 DOI: 10.1249/mss.0000000000001443] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Purpose Despite a paucity of evidence, prevention guidelines typically advise avoidance of heavy lifting in an effort to protect against breast cancer–related lymphedema. This study compared acute responses in arm swelling and related symptoms after low- and heavy-load resistance exercise among women at risk for lymphedema while receiving adjuvant taxane-based chemotherapy. Methods This is a randomized, crossover equivalence trial. Women receiving adjuvant taxane-based chemotherapy for breast cancer who had undergone axillary lymph node dissection (n = 21) participated in low-load (60%–65% 1-repetition maximum, two sets of 15–20 repetitions) and heavy-load (85%–90% 1-repetition maximum, three sets of 5–8 repetitions) upper-extremity resistance exercise separated by a 1-wk wash-out period. Swelling was determined by bioimpedance spectroscopy and dual-energy x-ray absorptiometry, with breast cancer–related lymphedema symptoms (heaviness, swelling, pain, tightness) reported using a numeric rating scale (0–10). Order of low- versus heavy-load was randomized. All outcomes were assessed before, immediately after, and 24 and 72 h after exercise. Generalized estimating equations were used to evaluate changes over time between groups, with equivalence between resistance exercise loads determined using the principle of confidence interval inclusion. Results The acute response to resistance exercise was equivalent for all outcomes at all time points irrespective of loads lifted, with the exception of extracellular fluid at 72 h after exercise with less swelling after heavy loads (estimated mean difference, −1.00; 95% confidence interval, −3.17 to 1.17). Conclusions Low- and heavy-load resistance exercise elicited similar acute responses in arm swelling and breast cancer–related lymphedema symptoms in women at risk for lymphedema receiving adjuvant taxane-based chemotherapy. These represent important preliminary findings, which can be used to inform future prospective evaluation of the long-term effects of repeated exposure to heavy-load resistance exercise.
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Affiliation(s)
- Kira Bloomquist
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, DENMARK
| | - Peter Oturai
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, DENMARK
| | - Megan L Steele
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, DENMARK
| | - Lis Adamsen
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, DENMARK
| | - Tom Møller
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, DENMARK
| | - Karl Bang Christensen
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, DENMARK
| | - Bent Ejlertsen
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, DENMARK
| | - Sandra C Hayes
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, DENMARK
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Ochalek K, Partsch H, Gradalski T, Szygula Z. Do Compression Sleeves Reduce the Incidence of Arm Lymphedema and Improve Quality of Life? Two-Year Results from a Prospective Randomized Trial in Breast Cancer Survivors. Lymphat Res Biol 2018; 17:70-77. [PMID: 30339481 DOI: 10.1089/lrb.2018.0006] [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: 12/16/2022] Open
Abstract
BACKGROUND In a previous randomized controlled trial it has been demonstrated that arm compression sleeves worn immediately after breast cancer surgery, including axillary lymph node removal in addition to physical therapy are able to reduce the occurrence of early postoperative swelling and of arm lymphedema up to 1 year and to improve quality of life. The aim of the present investigation was to check the further development of the arm swelling in patients using compression sleeves or not, and to compare the quality of life in women treated due to breast cancer 2 years after surgery. MATERIALS AND METHODS Twenty from originally 23 patients who still wore their compression sleeves (15 mmHg) and 21 from 22 patients who had been randomized into the control group without compression could be seen after one more year. Arm volume measurements were performed and quality of life (QLQ-C30 and QLQ-BR23 questionnaires) was assessed. RESULTS Three from 20 patients in the compression group (CG) and 6 from 21 without compression showed arm lymphedema, defined by an increase of the arm volume exceeding 10% compared with the preoperative values. Significant improvement of several quality of life parameters were found in the CG. CONCLUSION Light compression sleeves worn for 2 years are not only able to reduce the incidence of early postoperative edema and of lymphedema, but also lead to a significant improvement of important quality-of-life parameters like physical functioning, fatigue, pain, arm and breast symptoms, and future perspectives.
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Affiliation(s)
- Katarzyna Ochalek
- 1 Department of Clinical Rehabilitation, Faculty of Motor Rehabilitation, University of Physical Education, Krakow, Poland.,2 Lymphoedema Clinic, St. Lazarus Hospice, Krakow, Poland
| | - Hugo Partsch
- 3 Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Zbigniew Szygula
- 4 Department of Physiotherapy, State University of Applied Sciences in Nowy Sacz, Nowy Sacz, Poland
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