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Biskup M, Macek P, Terek-Derszniak M, Zak M, Krol H, Falana K, Gozdz S. Agreement between Accelerometer-Assessed and Self-Reported Physical Activity and Sedentary Behavior in Female Breast Cancer Survivors. Diagnostics (Basel) 2023; 13:3447. [PMID: 37998583 PMCID: PMC10670656 DOI: 10.3390/diagnostics13223447] [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: 09/06/2023] [Revised: 10/25/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
An accurate quantitative assessment of physical activity and sedentary lifestyles enables a better understanding of their relationship with the health records of cancer survivors. The objective of this study was to compare the subjective and objective methods of physical activity measurement in female breast cancer survivors. Materials and methods: In total, 135 female breast cancer survivors at the Holycross Cancer Center, Kielce, Poland, were included in this study. A shortened version of the International Physical Activity Questionnaire (IPAQ) was used to subjectively assess the participants' physical activity (PA), and an ActiGraph GT3X-BT accelerometer was used for an objective assessment. In total, 75% of the studied women did not report any vigorous PA, irrespective of the measurement method. The average values of moderate PA and moderate-to-vigorous PA (MVPA) measured with IPAQ compared with the accelerometer were sevenfold and tenfold higher, respectively. Conversely, the sedentary behavior values measured with the accelerometer were almost three times higher than those measured with IPAQ. The PA and sedentary behavior measurements were significantly different. Irrespective of PA intensity, the accelerometer-based measurements produced significantly lower results than IPAQ, while higher results were observed for sedentary behavior. The measurement differences between these two methods increased as the average differences grew. Regardless of the measurement method, a negative association was observed between moderate PA with general adiposity and adipose tissue distribution, whereas sedentary behavior demonstrated an opposite trend. This indicates the detrimental role of obesity in limiting PA.
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Affiliation(s)
- Malgorzata Biskup
- Collegium Medicum, Jan Kochanowski University, Avenue IX Centuries Kielc 19A, 25-516 Kielce, Poland; (P.M.); (M.Z.); (H.K.); (S.G.)
- Department of Rehabilitation, Holycross Cancer Center, Artwinskiego 3 Street, 25-734 Kielce, Poland;
| | - Pawel Macek
- Collegium Medicum, Jan Kochanowski University, Avenue IX Centuries Kielc 19A, 25-516 Kielce, Poland; (P.M.); (M.Z.); (H.K.); (S.G.)
- Department of Epidemiology and Cancer Control, Holycross Cancer Center, Artwinskiego 3 Street, 25-734 Kielce, Poland
| | | | - Marek Zak
- Collegium Medicum, Jan Kochanowski University, Avenue IX Centuries Kielc 19A, 25-516 Kielce, Poland; (P.M.); (M.Z.); (H.K.); (S.G.)
| | - Halina Krol
- Collegium Medicum, Jan Kochanowski University, Avenue IX Centuries Kielc 19A, 25-516 Kielce, Poland; (P.M.); (M.Z.); (H.K.); (S.G.)
- Department of Research and Education, Holycross Cancer Center, Artwinskiego 3 Street, 25-734 Kielce, Poland
| | - Krzysztof Falana
- Faculty of Law and Social Sciences, Jan Kochanowski University, Uniwersytecka Street 15, 25-406 Kielce, Poland;
| | - Stanislaw Gozdz
- Collegium Medicum, Jan Kochanowski University, Avenue IX Centuries Kielc 19A, 25-516 Kielce, Poland; (P.M.); (M.Z.); (H.K.); (S.G.)
- Department of Clinical Oncology, Holycross Cancer Center, Artwinskiego 3 Street, 25-734 Kielce, Poland
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Juhel BC, Brunelle CL, Bernstein MC, Smith LH, Jung AW, Ababneh HS, Hausman EK, Bucci LK, Bernstein T, Naoum GE, Taghian AG. Side effects of COVID-19 vaccinations in patients treated for breast cancer. Clin Exp Med 2023; 23:3671-3680. [PMID: 37031282 PMCID: PMC10098240 DOI: 10.1007/s10238-023-01050-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/17/2023] [Indexed: 04/10/2023]
Abstract
Lymph node swelling is a side effect of the mRNA COVID-19 vaccines, a distressing side effect for women treated for breast cancer. The purpose of this study is to present side effects reported by a cohort of patients treated for breast cancer. A survey link was sent to 4945 women who received breast cancer treatment and were prospectively screened for breast cancer-related lymphedema. In total, 621 patients who received an mRNA vaccine and responded to the survey were included in analysis. We assessed the frequency and predictors of side effects. The most frequent side effects reported were injection site soreness, fatigue, generalized muscle soreness, headache, and chills, with median duration ≤ 48 h. Lymph node swelling occurred most often in the axilla ipsilateral to the vaccine. The median duration was 1 week or less after all doses. These data will inform patient education regarding future vaccine doses, including reassurances about which side effects to expect, particularly lymph node swelling which may impact mammograms after vaccination. Type and duration of side effects were similar to that reported by the general population in Phase 3 testing trials of the mRNA vaccines. Clinical Trial Registration NCT04872738 posted May 4, 2021.
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Affiliation(s)
- Brooke C Juhel
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cheryl L Brunelle
- Department of Physical and Occupational Therapy, Massachusetts General Hospital, Boston, MA, USA
| | - Madison C Bernstein
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Louisa H Smith
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
- Roux Institute, Northeastern University, Portland, ME, USA
| | - Amanda W Jung
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hazim S Ababneh
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Elizabeth K Hausman
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Loryn K Bucci
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tess Bernstein
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - George E Naoum
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiation Oncology, Northwestern University Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Il, USA
| | - Alphonse G Taghian
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Hayes SC, Dunn M, Plinsinga ML, Reul-Hirche H, Ren Y, Laakso EL, Troester MA. Do Patient-Reported Upper-Body Symptoms Predict Breast Cancer-Related Lymphoedema: Results from a Population-Based, Longitudinal Breast Cancer Cohort Study. Cancers (Basel) 2022; 14:cancers14235998. [PMID: 36497482 PMCID: PMC9740941 DOI: 10.3390/cancers14235998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
The objectives of this work were to (i) describe upper-body symptoms post-breast cancer; (ii) explore the relationship between symptoms and upper-body function, breast cancer-related lymphoedema (BCRL), physical activity levels, and quality of life; and (iii) determine whether the presence of upper-body symptoms predicts BCRL. Nine symptoms, upper-body function, lymphoedema, physical activity, and quality of life were assessed in women with invasive breast cancer at baseline (2- to 9-months post-diagnosis; n = 2442), and at 2- and 7-years post-diagnosis. Mann−Whitney tests, unpaired t-tests, and chi-squared analyses were used to assess cross-sectional relationships, while regression analyses were used to assess the predictive relationships between symptoms at baseline, and BCRL at 2- and 7-years post-diagnosis. Symptoms are common post-breast cancer and persist at 2- and 7-years post-diagnosis. Approximately two in three women, and one in three women, reported >2 symptoms of at least mild severity, and of at least moderate severity, respectively. The presence of symptoms is associated with poorer upper-body function, and lower physical activity levels and quality of life. One or more symptoms of at least moderate severity increases the odds of developing BCRL by 2- and 7-years post-diagnosis (p < 0.05). Consequently, improved monitoring and management of symptoms following breast cancer have the potential to improve health outcomes.
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Affiliation(s)
- Sandra C. Hayes
- Menzies Health Institute Queensland, Griffith University, Brisbane 4111, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane 4111, Australia
| | - Matthew Dunn
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Melanie L. Plinsinga
- Menzies Health Institute Queensland, Griffith University, Brisbane 4111, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane 4111, Australia
- Correspondence:
| | - Hildegard Reul-Hirche
- Menzies Health Institute Queensland, Griffith University, Brisbane 4111, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane 4111, Australia
- Royal Brisbane and Women’s Hospital, Physiotherapy Department, Brisbane 4029, Australia
| | - Yumeng Ren
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - E-Liisa Laakso
- Menzies Health Institute Queensland, Griffith University, Brisbane 4111, Australia
- Mater Research, South Brisbane 4101, Australia
| | - Melissa A. Troester
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
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4
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Uhlmann RA, Mott SL, Curry M, Phadke S, Sugg SL, Erdahl LM, Weigel RJ, Lizarraga IM. Analysis of the Understanding and Worry about Lymphedema of Patients with Breast Cancer. Ann Surg Oncol 2022; 29:6428-6437. [PMID: 35913669 DOI: 10.1245/s10434-022-12189-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/28/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Lymphedema is a potential lifelong sequela of breast cancer treatment. We sought to: (1) evaluate the worry and knowledge of patients about lymphedema, (2) quantify patients reporting lymphedema education and screening, and (3) determine willingness to participate in lymphedema screening and prevention programs. PATIENTS AND METHODS A survey evaluating lymphedema-related knowledge and worry was sent to patients treated for stage 0-III breast cancer. Exclusion criteria included > 10 years since diagnosis, missing clinical staging, and those without axillary surgery. Responses were linked with clinicopathologic information. RESULTS Of 141 patients meeting inclusion criteria, 89% of those without lymphedema were not at all or slightly worried about lymphedema. Higher levels of worry were associated with clinical stage II-III disease [odds ratio (OR) 2.63, p = 0.03], a history of axillary lymph node dissection (ALND) (OR 4.58, p < 0.01), and employment (OR 2.21, p = 0.05). A total of 102 (72%) patients recalled receiving lymphedema education. Lymphedema knowledge was limited, with < 25% of respondents answering > 50% of the risk factor questions correctly. Worry and knowledge were not significantly associated. Of patients without lymphedema, 36% were interested in learning more about lymphedema and 64% were willing to participate in or learn more about a screening program. Most (66%) felt that lymphedema information should be provided before and after cancer treatment. DISCUSSION A majority of our breast cancer survivors had limited knowledge about lymphedema risk factors. While most patients were not worried about developing lymphedema, higher worry was seen in patients with a higher clinical stage at diagnosis, ALND, and employment. Our findings suggest potential targets and timing for patient-centered educational interventions.
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Affiliation(s)
- Rebecca A Uhlmann
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Sarah L Mott
- Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Melissa Curry
- Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Sneha Phadke
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Sonia L Sugg
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Lillian M Erdahl
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Ronald J Weigel
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Ingrid M Lizarraga
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA. .,Department of Surgery, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA.
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5
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Anderson EA, Armer JM. Factors Impacting Management of Breast Cancer-Related Lymphedema (BCRL) in Hispanic/Latina Breast Cancer Survivors: A Literature Review. HISPANIC HEALTH CARE INTERNATIONAL 2021; 19:190-202. [PMID: 33550878 PMCID: PMC8353654 DOI: 10.1177/1540415321990621] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Breast cancer-related lymphedema (BCRL) is a treatment sequela with negative physical and psychological implications. BCRL is a lifetime concern for survivors and is currently incurable. With the increase in the Latino population in the United States, it is critical for the cancer care community to address factors that increase BCRL risk and negatively impact long-term quality of life. This literature review undertook to identify successful intervention strategies for BCRL among Latina survivors. METHODS Multiple databases were searched for published articles from 2006 to 2020. PRISMA guidelines were utilized. Data were extracted related to physical activity, diet, and psychosocial stress concerns of Latinas at risk for or living with BCRL. RESULTS Eleven interventions combined education and skill-building techniques to address physical activity, diet, and stress management for BCRL. Family involvement, peer-mentoring, culturally tailored education, and self-care skill development were identified as important for Latina survivors. CONCLUSION Latina survivors may benefit from culturally tailored BCRL education programs and self-management interventions. Health care professionals and researchers should consider cultural influences when developing clinical intervention strategies to enhance outcomes for Latinas at risk for living with BCRL. In addition, including family members and/or peers in such strategies may be helpful to Latina survivors.
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Affiliation(s)
| | - Jane M. Armer
- S312 Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
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Shah C, Zambelli-Weiner A, Delgado N, Sier A, Bauserman R, Nelms J. The impact of monitoring techniques on progression to chronic breast cancer-related lymphedema: a meta-analysis comparing bioimpedance spectroscopy versus circumferential measurements. Breast Cancer Res Treat 2020; 185:709-740. [PMID: 33245458 PMCID: PMC7921068 DOI: 10.1007/s10549-020-05988-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 10/20/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Chronic breast cancer-related lymphedema (BCRL) is a potentially serious complication following treatment. Monitoring for progression to BCRL may allow for earlier detection and intervention, reducing the rate of progression to chronic BCRL. Therefore, the purpose of this meta-analysis is to evaluate the impact of monitoring techniques on the incidence of chronic BCRL among patients monitored by bioimpedance spectroscopy (BIS) and circumference as compared to background rates. METHODS Eligible peer-reviewed studies from PubMed, CINHAL, or Google Scholar that were published in English from 2013 onward and conducted in North America, Europe, or Oceania. Incidence rates abstracted from studies were classified by BCRL monitoring method: background (no standardized BIS or circumference assessments), BIS or circumference. A random-effects model was used to calculate a pooled annualized estimate of BCRL incidence while accounting for clinical and methodological heterogeneity. Subgroup analyses examined differences in duration of follow-up as well as breast and axillary surgery. RESULTS 50 studies were included, representing over 67,000 women. The annualized incidence of BCRL was 4.9% (95% CI: 4.3-5.5) for background studies (n = 35), 1.5% (95% CI: 0.6-2.4) for BIS-monitored studies (n = 7), and 7.7% (95% CI: 5.6-9.8) for circumference-monitored studies (n = 11). The cumulative BCRL incidence rate in BIS-monitored patients was 3.1% as compared to 12.9% with background monitoring (69% reduction) and 17.0% with circumference-monitored patients (81% reduction). CONCLUSIONS Evidence suggests that monitoring with BIS allowing for early intervention significantly reduces the relative risk of chronic BCRL with a 69% and 81% reduction compared to background and circumference, respectively. Circumference monitoring did not appear to provide a benefit with respect to chronic BCRL incidence. Based on these results, BIS should be considered for BCRL screening in order to detect subclinical BCRL and reduce rates of chronic BCRL, particularly in high-risk patients.
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Affiliation(s)
- Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
| | | | | | - Ashley Sier
- TTi Health Research and Economics, Westminster, MD, USA
| | | | - Jerrod Nelms
- TTi Health Research and Economics, Westminster, MD, USA
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Ammitzbøll G, Dalton SO. Mounting evidence supports the safety of weight lifting after breast cancer. Acta Oncol 2019; 58:1665-1666. [PMID: 31556747 DOI: 10.1080/0284186x.2019.1670357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Gunn Ammitzbøll
- Social Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- COMPAS Danish Research Center for Equality in Cancer, Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Susanne Oksbjerg Dalton
- Social Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- COMPAS Danish Research Center for Equality in Cancer, Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
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8
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Ammitzbøll G, Johansen C, Lanng C, Andersen EW, Kroman N, Zerahn B, Hyldegaard O, Wittenkamp MC, Dalton SO. Progressive resistance training to prevent arm lymphedema in the first year after breast cancer surgery: Results of a randomized controlled trial. Cancer 2019; 125:1683-1692. [PMID: 30633334 DOI: 10.1002/cncr.31962] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/16/2018] [Accepted: 12/06/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Existing research suggests that progressive resistance training (PRT) after breast cancer (BC) surgery is safe, but the preventive effect on arm lymphedema has yet to be determined. METHODS Women aged 18 to 75 years who were undergoing BC surgery with axillary lymph node dissection were eligible for the study. Recruited on the day of surgery, participants were allocated to intervention or usual care by computer randomization. The intervention consisted of PRT 3 times per week: in the first 20 weeks as a supervised group exercise and in the last 30 weeks as a self-administered exercise. The primary outcome was arm lymphedema, which was defined as a >3% increase in the interlimb volume difference by water displacement. Measurements were made at the baseline and at a 12-month follow-up by physiotherapists blinded to group allocation. Analyses of effects included t tests and regression models; missing data were addressed by multiple imputation. RESULTS Among the 158 randomized women, no mean group difference was found in arm volume (0.3%; 95% confidence interval, -1.7% to 2.3%) or lymphedema incidence (adjusted odds ratio, 1.2; 95% confidence interval, 0.5-2.8). None of the participants exited the program because of adverse events. CONCLUSIONS This study provides no evidence that PRT can prevent arm lymphedema in the first year after BC, but the results corroborate the importance and safety of resistance training for patients, including women at high risk for lymphedema.
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Affiliation(s)
- Gunn Ammitzbøll
- Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christoffer Johansen
- Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark.,CASTLE Late Effects Unit, Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Charlotte Lanng
- Department of Breast Surgery, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | | | - Niels Kroman
- Department of Breast Surgery, Copenhagen University Hospital Herlev, Copenhagen, Denmark.,Danish Cancer Society, Copenhagen, Denmark
| | - Bo Zerahn
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Ole Hyldegaard
- Section for Hyperbaric Oxygen Treatment, Department for Anesthetics and Operations, Center for Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Merete Celano Wittenkamp
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
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Sun F, Hall A, Tighe MP, Brunelle CL, Sayegh HE, Gillespie TC, Daniell KM, Taghian AG. Perometry versus simulated circumferential tape measurement for the detection of breast cancer-related lymphedema. Breast Cancer Res Treat 2018; 172:83-91. [PMID: 30062571 DOI: 10.1007/s10549-018-4902-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Despite increasing emphasis on screening and early intervention for breast cancer-related lymphedema (BCRL), there is marked heterogeneity in diagnostic methodology, including for volumetric measures. This retrospective study compared two volumetric modalities, perometry and simulated circumferential tape measurement (anatomic- and interval-based), for BCRL detection. METHODS Between 2005 and 2017, 287 female patients with unilateral breast cancer were prospectively screened for BCRL by perometry and the relative volume change (RVC) formula. Circumferential measurement was performed by sampling at five anatomic landmark-based points or 4-cm intervals from pairs of perometer arm diameter measurements. Volumetric conversion was by a frustum model. The Bland-Altman method was used to compare segmental volume differences. Confusion matrix analysis was performed for each circumferential measurement technique against perometry. RESULTS Median follow-up was 34.7 months over 4 postoperative visits. There was no difference in total arm volume comparing any of the circumferential measurement techniques to perometry. Landmark-based methods significantly underestimated upper arm volume (mean difference - 207 mL [- 336, - 78 mL]) and overestimated forearm volume (mean difference + 170 mL [+ 105, + 237 mL]). Landmark-based methods had greater sensitivity and specificity compared to 4-cm interval methods for detection of both RVC ≥ 10 and 5-10%. Landmark-based methods were comparable to perometry for detection of RVC ≥ 10%, but sensitivity was only 63.2-66.7% for RVC 5-10%. CONCLUSIONS This hypothesis-generating study suggested the superiority of anatomic landmark-based circumferential tape measurement compared to interval-based methods, while generating questions about the underestimation of upper arm volume and overestimation of forearm volume of circumferential tape measurement compared to perometry.
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Affiliation(s)
- Fangdi Sun
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street, Boston, MA, 02114, USA.
| | - Alexander Hall
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street, Boston, MA, 02114, USA
| | - Megan P Tighe
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street, Boston, MA, 02114, USA
| | - Cheryl L Brunelle
- Department of Physical and Occupational Therapy, Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street, Boston, MA, 02114, USA
| | - Hoda E Sayegh
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street, Boston, MA, 02114, USA
| | - Tessa C Gillespie
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street, Boston, MA, 02114, USA
| | - Kayla M Daniell
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street, Boston, MA, 02114, USA
| | - Alphonse G Taghian
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street, Boston, MA, 02114, USA
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10
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Brunelle CL, Swaroop MN, Skolny MN, Asdourian MS, Sayegh HE, Taghian AG. Hand Edema in Patients at Risk of Breast Cancer-Related Lymphedema: Health Professionals Should Take Notice. Phys Ther 2018; 98:510-517. [PMID: 29361079 PMCID: PMC6692642 DOI: 10.1093/ptj/pzy007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 01/17/2018] [Indexed: 11/14/2022]
Abstract
BACKGROUND There is little research on hand edema in the population at risk for breast cancer-related lymphedema (BCRL). OBJECTIVES Study aims included reporting potential importance of hand edema (HE) as a risk factor for progression of edema in patients treated for breast cancer at risk for BCRL, reporting risk factors for BCRL, and reporting treatment of HE. DESIGN/METHODS This was a retrospective analysis of 9 patients treated for breast cancer in Massachusetts General Hospital's lymphedema screening program who presented with isolated HE. Limb volumes via perometry, BCRL risk factors, and HE treatment are reported. RESULTS Edema was mostly isolated to the hand. Three patients had arm edema >5% on perometry; and 2 of these had edema outside the hand on clinical examination. Patients were at high risk of BCRL with an average of 2.9/5 known risk factors. Arm edema progressed to >10% in 2 high-risk patients. Treatment resulted in an average hand volume reduction of 10.2% via perometry and improvement upon clinical examination. LIMITATIONS The small sample size and lack of validated measures of subjective data were limitations. CONCLUSIONS In this cohort, patients with HE carried significant risk factors for BCRL. Two out of 9 (22%), both carrying ≥4/5 risk factors, progressed to edema >10%. Isolated HE may be a prognostic factor for edema progression in patients treated for breast cancer at risk for BCRL. Further research is warranted.
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Affiliation(s)
- Cheryl L Brunelle
- Department of Physical and Occupational Therapy, Massachusetts General Hospital, Boston, Massachusetts
| | - Meyha N Swaroop
- Department of Radiation Oncology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Melissa N Skolny
- Department of Radiation Oncology, Massachusetts General Hospital, and Harvard Medical School
| | - Maria S Asdourian
- Department of Radiation Oncology, Massachusetts General Hospital, and Harvard Medical School
| | - Hoda E Sayegh
- Department of Radiation Oncology, Massachusetts General Hospital, and Harvard Medical School
| | - Alphonse G Taghian
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 (USA),Address all correspondence to Dr Taghian at:
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11
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Asdourian MS, Swaroop MN, Sayegh HE, Brunelle CL, Mina AI, Zheng H, Skolny MN, Taghian AG. Association Between Precautionary Behaviors and Breast Cancer-Related Lymphedema in Patients Undergoing Bilateral Surgery. J Clin Oncol 2017; 35:3934-3941. [PMID: 28976793 PMCID: PMC5721227 DOI: 10.1200/jco.2017.73.7494] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Purpose This study examined the lifestyle and clinical risk factors for lymphedema in a cohort of patients who underwent bilateral breast cancer surgery. Patients and Methods Between 2013 and 2016, 327 patients who underwent bilateral breast cancer surgery were prospectively screened for arm lymphedema as quantified by the weight-adjusted volume change (WAC) formula. Arm perometry and subjective data were collected preoperatively and at regular intervals postoperatively. At the time of each measurement, patients completed a risk assessment survey that reported the number of blood draws, injections, blood pressure readings, trauma to the at-risk arm, and number of flights since the previous measurement. Generalized estimating equations were applied to ascertain the association among arm volume changes, clinical factors, and risk exposures. Results The cohort comprised 327 patients and 654 at-risk arms, with a median postoperative follow-up that ranged from 6.1 to 68.2 months. Of the 654 arms, 83 developed lymphedema, defined as a WAC ≥ 10% relative to baseline. On multivariable analysis, none of the lifestyle risk factors examined through the risk assessment survey were significantly associated with increased WAC. Multivariable analysis demonstrated that having a body mass index ≥ 25 kg/m2 at the time of breast cancer diagnosis ( P = .0404), having undergone axillary lymph node dissection ( P = .0464), and receipt of adjuvant chemotherapy ( P = .0161) were significantly associated with increased arm volume. Conclusion Blood pressure readings, blood draws, injections, and number or duration of flights were not significantly associated with increases in arm volume in this cohort. These findings may help to guide patient education about lymphedema risk reduction strategies for those who undergo bilateral breast cancer surgery.
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Affiliation(s)
| | | | | | | | - Amir I. Mina
- All authors: Massachusetts General Hospital, Boston, MA
| | - Hui Zheng
- All authors: Massachusetts General Hospital, Boston, MA
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Diagnostic Methods, Risk Factors, Prevention, and Management of Breast Cancer-Related Lymphedema: Past, Present, and Future Directions. CURRENT BREAST CANCER REPORTS 2017; 9:111-121. [PMID: 28894513 DOI: 10.1007/s12609-017-0237-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Breast cancer-related lymphedema (BCRL) is a chronic, adverse, and much feared complication of breast cancer treatment, which affects approximately 20% of patients following breast cancer treatment. BCRL has a tremendous impact on breast cancer survivors, including physical impairments and significant psychological consequences. The intent of this review is to discuss recent studies and analyses regarding the risk factors, diagnosis, prevention through early screening and intervention, and management of BCRL. RECENT FINDINGS Highly-evidenced risk factors for BCRL include axillary lymph node dissection, lack of reconstruction, radiation to the lymph nodes, high BMI at diagnosis, weight fluctuations during and after treatment, subclinical edema within and beyond 3 months after surgery, and cellulitis in the at-risk arm. Avoidance of potential risk factors can serve as a method of prevention. Through establishing a screening program by which breast cancer patients are measured pre-operatively and at follow-ups, are objectively assessed through a weight-adjusted analysis, and are clinically assessed for signs and symptoms, BCRL can be tracked accurately and treated effectively. Management of BCRL is done by a trained professional, with research mounting towards the use of compression bandaging as a first line intervention against BCRL. Finally, exercise is safe for breast cancer patients with and without BCRL and does not incite or exacerbate symptoms of BCRL. SUMMARY Recent research has shed light on BCRL risk factors, diagnosis, prevention, and management. We hope that education on these aspects of BCRL will promote an informed, consistent approach and encourage additional research in this field to improve patient outcomes and quality of life in breast cancer survivors.
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Sun F, Skolny MN, Swaroop MN, Rawal B, Catalano PJ, Brunelle CL, Miller CL, Taghian AG. The need for preoperative baseline arm measurement to accurately quantify breast cancer-related lymphedema. Breast Cancer Res Treat 2016; 157:229-240. [PMID: 27154787 DOI: 10.1007/s10549-016-3821-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 05/02/2016] [Indexed: 11/30/2022]
Abstract
Breast cancer-related lymphedema (BCRL) is a feared outcome of breast cancer treatment, yet the push for early screening is hampered by a lack of standardized quantification. We sought to determine the necessity of preoperative baseline in accounting for temporal changes of upper extremity volume. 1028 women with unilateral breast cancer were prospectively screened for lymphedema by perometry. Thresholds were defined: relative volume change (RVC) ≥10 % for clinically significant lymphedema and ≥5 % including subclinical lymphedema. The first postoperative measurement (pseudo-baseline) simulated the case of no baseline. McNemar's test and binomial logistic regression models were used to analyze BCRL misdiagnoses. Preoperatively, 28.3 and 2.9 % of patients had arm asymmetry of ≥5 and 10 %, respectively. Without baseline, 41.6 % of patients were underdiagnosed and 40.1 % overdiagnosed at RVC ≥ 5 %, increasing to 50.0 and 54.8 % at RVC ≥ 10 %. Increased pseudo-baseline asymmetry, increased weight change between baselines, hormonal therapy, dominant use of contralateral arm, and not receiving axillary lymph node dissection (ALND) were associated with increased risk of underdiagnosis at RVC ≥ 5 %; not receiving regional lymph node radiation was significant at RVC ≥ 10 %. Increased pseudo-baseline asymmetry, not receiving ALND, and dominant use of ipsilateral arm were associated with overdiagnosis at RVC ≥ 5 %; increased pseudo-baseline asymmetry and not receiving ALND were significant at RVC ≥ 10 %. The use of a postoperative proxy even early after treatment results in poor sensitivity for identifying BCRL. Providers with access to patients before surgery should consider the consequent need for proper baseline, with specific strategy tailored by institution.
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Affiliation(s)
- Fangdi Sun
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street, Boston, MA, 02114, USA
| | - Melissa N Skolny
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street, Boston, MA, 02114, USA
| | - Meyha N Swaroop
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street, Boston, MA, 02114, USA
| | - Bhupendra Rawal
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02115, USA
| | - Paul J Catalano
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02115, USA
| | - Cheryl L Brunelle
- Department of Physical and Occupational Therapy, Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street, Boston, MA, 02114, USA
| | - Cynthia L Miller
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street, Boston, MA, 02114, USA
| | - Alphonse G Taghian
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street, Boston, MA, 02114, USA.
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Establishing and sustaining a prospective screening program for breast cancer-related lymphedema at the massachusetts general hospital: lessons learned. J Pers Med 2015; 5:153-64. [PMID: 26011383 PMCID: PMC4493493 DOI: 10.3390/jpm5020153] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 05/04/2015] [Accepted: 05/11/2015] [Indexed: 01/24/2023] Open
Abstract
There has been an increasing call to prospectively screen patients with breast cancer for the development of breast cancer-related lymphedema (BCRL) following their breast cancer treatment. While the components of a prospective screening program have been published, some centers struggle with how to initiate, establish, and sustain a screening program of their own. The intent of this manuscript is to share our experience and struggles in establishing a prospective surveillance program within the infrastructure of our institution. It is our hope that by sharing our history other centers can learn from our mistakes and successes to better design their own prospective screening program to best serve their patient population.
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Impact of adjuvant taxane-based chemotherapy on development of breast cancer-related lymphedema: results from a large prospective cohort. Breast Cancer Res Treat 2015; 151:393-403. [PMID: 25940996 PMCID: PMC4432026 DOI: 10.1007/s10549-015-3408-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 04/24/2015] [Indexed: 10/30/2022]
Abstract
Taxane-based chemotherapy for the treatment of breast cancer is associated with fluid retention in the extremities; however, its association with development of breast cancer-related lymphedema is unclear. We sought to determine if adjuvant taxane-based chemotherapy increased risk of lymphedema or mild swelling of the upper extremity. 1121 patients with unilateral breast cancer were prospectively screened for lymphedema with perometer measurements. Lymphedema was defined as a relative volume change (RVC) of ≥10 % from preoperative baseline. Mild swelling was defined as RVC 5- <10 %. Clinicopathologic characteristics were obtained via medical record review. Kaplan-Meier and Cox proportional hazard analyses were performed to determine lymphedema rates and risk factors. 29 % (324/1121) of patients were treated with adjuvant taxane-based chemotherapy. The 2-year cumulative incidence of lymphedema in the overall cohort was 5.27 %. By multivariate analysis, axillary lymph node dissection (ALND) (p < 0.0001), higher body mass index (p = 0.0007), and older age at surgery (p = 0.04) were significantly associated with increased risk of lymphedema; however, taxane chemotherapy was not significant when compared to no chemotherapy and non-taxane chemotherapy (HR 1.14, p = 0.62; HR 1.56, p = 0.40, respectively). Chemotherapy with docetaxel was significantly associated with mild swelling on multivariate analysis in comparison to both no chemotherapy and non-taxane chemotherapy groups (HR 1.63, p = 0.0098; HR 2.15, p = 0.02, respectively). Patients who receive taxane-based chemotherapy are not at an increased risk of lymphedema compared to patients receiving no chemotherapy or non-taxane adjuvant chemotherapy. Those treated with docetaxel may experience mild swelling, but this does not translate into subsequent lymphedema.
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