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Fujimoto Y, Yuri Y, Fujii M, Tamiya H. Factors Predicting Treatment Adherence in Outpatients with Cancer-Related Edema: Decision Tree Analysis. Cancer Manag Res 2024; 16:1215-1220. [PMID: 39282607 PMCID: PMC11401516 DOI: 10.2147/cmar.s476588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 08/14/2024] [Indexed: 09/19/2024] Open
Abstract
Purpose This study aimed to determine the combination of factors associated with continuity of care in outpatients with cancer-related edema six months after the initial visit. Patients and Methods A total of 101 outpatients were divided into two groups: continuation (n=65) and non-continuation (n=36) groups. Details regarding age, body mass index, sex, affected extremities (upper or lower), site of edema (unilateral or bilateral), International Society of Lymphology (ISL) classification, presence of distant metastasis, and overall score on the lymphedema quality of life questionnaire (LYMQOL) were obtained before initial lymphedema care. In this study, we performed a decision tree analysis using a classification and regression tree (CART) to detect the combination of factors associated with the continuity of edema care for cancer-related edema. Results Significant differences were observed in the site of edema (unilateral or bilateral) and distant metastasis between the two groups. In the decision tree using CART analysis, the factors selected to influence the possibility of continuation were the side of edema as the first layer, and body mass index of 23.0 and distant metastasis (with/without) as the second layer. Outpatients with unilateral edema and a body mass index higher than 23.0 were most likely to be able to continue care. In contrast, outpatients with bilateral edema and distant metastasis had greater difficulty in continuing care. Conclusion In this study, factors that were suggested to influence the continuity of cancer-related edema care were the side with edema, body mass index higher than 23.0, and distant metastasis. This information may be helpful for developing care strategies and improving patient adherence.
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Affiliation(s)
- Yudai Fujimoto
- Department of Rehabilitation, Osaka International Cancer Institute, Osaka, Japan
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Yoshimi Yuri
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Miki Fujii
- Department of Rehabilitation, Osaka International Cancer Institute, Osaka, Japan
| | - Hironari Tamiya
- Department of Rehabilitation, Osaka International Cancer Institute, Osaka, Japan
- Department of Orthopaedic Surgery (Musculoskeletal Oncology Service), Osaka International Cancer Institute, Osaka, Japan
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2
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Pandurangi R, Sekar T, Paulmurugan R. Restoration of the Lost Human Beta Defensin-1 Protein in Cancer as a Strategy to Improve the Efficacy of Chemotherapy. J Med Chem 2024; 67:14200-14209. [PMID: 39137365 DOI: 10.1021/acs.jmedchem.4c01040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Both innate and adaptive immunity are important components of the human defense system against various diseases including cancer. Human beta defensin-1 (hBD-1) is one such immunomodulatory peptide which is lost in malignant cancers, while high levels of expression are maintained in benign cells, making it a potential biomarker for the onset and metastasis of the disease. Triple-negative breast cancer (TNBC) is an aggressive form of breast cancer for which no targeted therapy has been approved so far. That makes chemotherapy a first line of treatment despite high side effects. A priori Activation of Apoptosis Pathways of Tumor often referred to as AAAPT technology is a novel targeted tumor sensitizing technology that sensitizes low responsive and resistant tumor cells to evoke a better response from the current treatments for TNBC. Here, we show that hBD-1 is a targeted tumor sensitizer.
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Affiliation(s)
- Raghu Pandurangi
- President, CSO, Sci-Engi-Medco Solutions Inc. (SEMCO), 573, Lexington Landing Pl, St Charles, 2, St Charles, Missouri 63303, United States
| | - Thillai Sekar
- Molecular Imaging Program at Stanford (MIPS), Department of Radiology, Stanford University School of Medicine, 3155 Porter Drive, Room: 2236, Palo Alto, California 94304, United States
| | - Ramasamy Paulmurugan
- Molecular Imaging Program at Stanford (MIPS), Department of Radiology, Stanford University School of Medicine, 3155 Porter Drive, Room: 2236, Palo Alto, California 94304, United States
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3
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Gromek P, Senkowska Z, Płuciennik E, Pasieka Z, Zhao LY, Gielecińska A, Kciuk M, Kłosiński K, Kałuzińska-Kołat Ż, Kołat D. Revisiting the standards of cancer detection and therapy alongside their comparison to modern methods. World J Methodol 2024; 14:92982. [PMID: 38983668 PMCID: PMC11229876 DOI: 10.5662/wjm.v14.i2.92982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/15/2024] [Accepted: 04/28/2024] [Indexed: 06/13/2024] Open
Abstract
In accordance with the World Health Organization data, cancer remains at the forefront of fatal diseases. An upward trend in cancer incidence and mortality has been observed globally, emphasizing that efforts in developing detection and treatment methods should continue. The diagnostic path typically begins with learning the medical history of a patient; this is followed by basic blood tests and imaging tests to indicate where cancer may be located to schedule a needle biopsy. Prompt initiation of diagnosis is crucial since delayed cancer detection entails higher costs of treatment and hospitalization. Thus, there is a need for novel cancer detection methods such as liquid biopsy, elastography, synthetic biosensors, fluorescence imaging, and reflectance confocal microscopy. Conventional therapeutic methods, although still common in clinical practice, pose many limitations and are unsatisfactory. Nowadays, there is a dynamic advancement of clinical research and the development of more precise and effective methods such as oncolytic virotherapy, exosome-based therapy, nanotechnology, dendritic cells, chimeric antigen receptors, immune checkpoint inhibitors, natural product-based therapy, tumor-treating fields, and photodynamic therapy. The present paper compares available data on conventional and modern methods of cancer detection and therapy to facilitate an understanding of this rapidly advancing field and its future directions. As evidenced, modern methods are not without drawbacks; there is still a need to develop new detection strategies and therapeutic approaches to improve sensitivity, specificity, safety, and efficacy. Nevertheless, an appropriate route has been taken, as confirmed by the approval of some modern methods by the Food and Drug Administration.
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Affiliation(s)
- Piotr Gromek
- Department of Functional Genomics, Medical University of Lodz, Lodz 90-752, Lodzkie, Poland
| | - Zuzanna Senkowska
- Department of Functional Genomics, Medical University of Lodz, Lodz 90-752, Lodzkie, Poland
| | - Elżbieta Płuciennik
- Department of Functional Genomics, Medical University of Lodz, Lodz 90-752, Lodzkie, Poland
| | - Zbigniew Pasieka
- Department of Biomedicine and Experimental Surgery, Medical University of Lodz, Lodz 90-136, Lodzkie, Poland
| | - Lin-Yong Zhao
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Adrianna Gielecińska
- Department of Molecular Biotechnology and Genetics, University of Lodz, Lodz 90-237, Lodzkie, Poland
- Doctoral School of Exact and Natural Sciences, University of Lodz, Lodz 90-237, Lodzkie, Poland
| | - Mateusz Kciuk
- Department of Molecular Biotechnology and Genetics, University of Lodz, Lodz 90-237, Lodzkie, Poland
| | - Karol Kłosiński
- Department of Biomedicine and Experimental Surgery, Medical University of Lodz, Lodz 90-136, Lodzkie, Poland
| | - Żaneta Kałuzińska-Kołat
- Department of Functional Genomics, Medical University of Lodz, Lodz 90-752, Lodzkie, Poland
- Department of Biomedicine and Experimental Surgery, Medical University of Lodz, Lodz 90-136, Lodzkie, Poland
| | - Damian Kołat
- Department of Functional Genomics, Medical University of Lodz, Lodz 90-752, Lodzkie, Poland
- Department of Biomedicine and Experimental Surgery, Medical University of Lodz, Lodz 90-136, Lodzkie, Poland
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4
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Kleeven A, Jonis YMJ, Tielemans H, van Kuijk S, Kimman M, van der Hulst R, Vasilic D, Hummelink S, Qiu SS. The N-LVA Study: effectiveness and cost-effectiveness of lymphaticovenous anastomosis (LVA) for patients with cancer who suffer from chronic peripheral lymphoedema - study protocol of a multicentre, randomised sham-controlled trial. BMJ Open 2024; 14:e086226. [PMID: 38626967 PMCID: PMC11029230 DOI: 10.1136/bmjopen-2024-086226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Cancer-related lymphoedema is one of the most debilitating side-effects of cancer treatment with an overall incidence of 15.5%. Patients may suffer from a variety of symptoms, possibly resulting in a diminished health-related quality of life (HRQoL). A microsurgical technique known as lymphaticovenous anastomosis (LVA) might be a promising treatment option. The objective of this study is to evaluate whether LVA is effective and cost-effective compared with sham surgery in improving the HRQoL. METHODS AND ANALYSIS A multicentre, double-blind, randomised sham-controlled trial conducted in three university hospitals in the Netherlands. The study population comprises 110 patients over the age of 18 years with unilateral, peripheral cancer-related lymphoedema, including 70 patients with upper limb lymphoedema and 40 patients with lower limb lymphoedema. A total of 55 patients will undergo the LVA operation, while the remaining 55 will undergo sham surgery. The follow-up will be at least 24 months. Patients are encouraged to complete the follow-up by explaining the importance of the study. Furthermore, patients may benefit from regular monitoring moments for their lymphoedema. The primary outcome is the HRQoL. The secondary outcomes are the limb circumference, excess limb volume, changes in conservative therapy, postoperative complications, patency of the LVA and incremental cost-effectiveness. ETHICS AND DISSEMINATION The study was approved by the Medical Ethical Committee of Maastricht University Medical Center on 20 September 2023 (NL84169.068.23). The results will be presented at scientific conferences and published in peer-reviewed medical journals. TRIAL REGISTRATION NUMBER NCT06082349.
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Affiliation(s)
- Alieske Kleeven
- Department of Plastic and Reconstructive Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Yasmine M J Jonis
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hanneke Tielemans
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sander van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Merel Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - René van der Hulst
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Dalibor Vasilic
- Department of Plastic and Reconstructive Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Stefan Hummelink
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Shan Shan Qiu
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
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El Khoury R, Bush RL. Lymphedema: The understudied vascular condition of an under-represented population. J Vasc Surg Venous Lymphat Disord 2023; 11:1241-1242. [PMID: 37863548 DOI: 10.1016/j.jvsv.2023.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Rym El Khoury
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Ruth L Bush
- Department of Educational Affairs and Department of Surgery, John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX
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Chaput G, Ibrahim M. Cancer-related lymphedema. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2023; 69:691-695. [PMID: 37833081 PMCID: PMC10575652 DOI: 10.46747/cfp.6910691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Affiliation(s)
- Genevieve Chaput
- Casley-Smith certification in lymphedema; is Assistant Professor at McGill University in Montréal, Que; is an attending physician at the McGill University Health Centre (MUHC); and is Medical Chief of supportive and palliative care services at the Lachine Hospital of the MUHC
| | - Marize Ibrahim
- Lymphedema therapist and physical therapist specializing in oncology at the lymphedema clinic of the MUHC
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7
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Chaput G, Ibrahim M. Le lymphœdème lié au cancer. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2023; 69:e206-e210. [PMID: 37833084 PMCID: PMC10575661 DOI: 10.46747/cfp.6910e206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Affiliation(s)
- Genevieve Chaput
- Détient une certification Casley-Smith en lymphœdème; est professeure adjointe à l'Université McGill à Montréal (Québec); est médecin traitante au Centre universitaire de santé McGill (CUSM); et est directrice médicale des services de soins de soutien et palliatifs de l'Hôpital de Lachine du CUSM
| | - Marize Ibrahim
- Thérapeute spécialisée en lymphœdème et physiothérapeute spécialisée en oncologie à la clinique du lymphœdème du CUSM
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8
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Pereira de Godoy HJ, Pereira de Godoy AC, Pereira de Godoy JM, Guerreiro Godoy MDF. Multi-segment bioimpedance in the evaluation of treatment for secondary lower limb lymphedema: Gynecological cancer. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/13148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
<b>Aim</b>: The present aimed study was to report the mobilization of body fluids after five days of intensive treatment for secondary lower limb lymphedema.<br />
<b>Materials and methods</b>: A crossover clinical trial was conducted involving the analysis of changes in intracellular and extracellular fluids in all extremities and the trunk in women with lower limb lymphedema secondary to treatment for gynecological cancer. Evaluations were performed with multi-segment bio impedance analysis before and after intensive treatment using Godoy Method® eight hours per day for five days. Comparisons were made using Wilcoxon signed-ranks test.<br />
<b>Results</b>: Significant changes in intracellular and extracellular fluids were found in all extremities and the trunk (p<0.0001 for all comparisons).<br />
<b>Conclusion</b>: Intensive Godoy Method® leads to important changes in the distribution of body fluids in the treatment of lower limb lymphedema following treatment for gynecological cancer, with a significant increase in fluids in the upper limbs and trunk as well as significant reductions in the lower limb and in intracellular and extracellular water.
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Affiliation(s)
| | | | - Jose Maria Pereira de Godoy
- Medicine School in São José do Rio Preto, São José do Rio Preto, BRAZIL
- National Council for Scientific and Technological Development, Lago Sul, BRAZIL
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Sleep disturbance in cancer survivors with lymphedema: a scoping review. Support Care Cancer 2022; 30:9647-9657. [PMID: 36201052 DOI: 10.1007/s00520-022-07378-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 09/26/2022] [Indexed: 10/10/2022]
Abstract
PURPOSE The purpose of this study is to identify the amount and scope of knowledge on sleep disturbance in cancer survivors who have lymphedema. The research question investigated was "what are the known sleep disturbances in cancer survivors with lymphedema?" METHODS A literature search was performed on February 15 to March 27, 2021, in four databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) and structure recommended by Arksey and O'Malley. An iterative process of study selection was performed by two reviewers for abstract and full-text review. The Joanna Briggs Institute's critical appraisal tools were used to analyze study quality. RESULTS One hundred twenty-one unique references were reviewed, and seven met the inclusion criteria. One article had the primary aim of assessing sleep and noted that the presence of lymphedema did increase the risk for sleep disturbance. Four cross-sectional studies compared sleep quality between cancer survivors with lymphedema and cancer survivors without lymphedema. These studies found that lymphedema is a significant predictor of insomnia and is a risk factor for insomnia. Two randomized control trials compared sleep among breast cancer survivors with lymphedema after an intervention. Sleep improved with a yoga intervention and was unchanged after adding a night-time compression garment. CONCLUSION In this scoping review, breast and gynecological cancer survivors with lymphedema report increased sleep disturbance compared to survivors without lymphedema. Further research is needed to characterize the specific sleep disturbances in cancer survivors with lymphedema for improved screening and treatment.
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McNeely ML, Dolgoy ND, Rafn BS, Ghosh S, Ospina PA, Al Onazi MM, Radke L, Shular M, Kuusk U, Webster M, Campbell KL, Mackey JR. Nighttime compression supports improved self-management of breast cancer-related lymphedema: A multicenter randomized controlled trial. Cancer 2021; 128:587-596. [PMID: 34614195 DOI: 10.1002/cncr.33943] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/11/2021] [Accepted: 06/28/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lymphedema is a prevalent long-term effect of breast cancer treatment associated with reduced quality of life. This study examined the efficacy of nighttime compression as a self-management strategy for women with chronic breast cancer-related lymphedema. METHODS Th authors conducted a parallel 3-arm, multicenter, randomized trial. Women were recruited from 3 centers in Canada and randomized to group 1 (daytime compression garment alone [standard care]), group 2 (daytime compression garment plus nighttime compression bandaging), or group 3 (daytime compression garment plus the use of a nighttime compression system garment). The primary outcome was the change in excess arm volume from the baseline to 12 weeks. Participants from all groups used a nighttime compression system garment from weeks 13 to 24. RESULTS One hundred twenty women were enrolled, 118 completed the randomized trial, and 114 completed the 24-week follow-up. The rates of adherence to nighttime compression were 95% ± 15% and 96% ± 11% in the compression bandaging and nighttime compression system groups, respectively. After the intervention, the addition of nighttime compression was found to be superior to standard care for both absolute milliliter reductions (P = .006) and percentage reductions (P = .002) in excess arm lymphedema volume. Significant within-group changes were seen for quality of life across all groups; however, no between-group differences were found (P > .05). CONCLUSIONS The trial demonstrated a significant improvement in arm lymphedema volume from the addition of nighttime compression whether through the application of compression bandaging or through the use of a nighttime compression system garment. LAY SUMMARY Lymphedema is swelling that occurs in the arm on the side of the surgery for breast cancer. Lymphedema occurs in approximately 21% of women. Lymphedema tends to worsen over time and can result in recurrent infections in the arm, functional impairment, and pain. Currently, treatment consists of intensive treatments to reduce the swelling followed by regular use of a compression sleeve during the day. This study examined and found a benefit from the addition of nighttime compression (whether through self-applied compression bandaging or through the use of a nighttime compression system garment) to the use of a daytime compression sleeve.
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Affiliation(s)
- Margaret L McNeely
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada.,Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - Naomi D Dolgoy
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Bolette Skjodt Rafn
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sunita Ghosh
- Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - Paula A Ospina
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Mona M Al Onazi
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Lori Radke
- Tom Baker Cancer Centre, Alberta Health Service, Calgary, Alberta, Canada
| | - Mara Shular
- Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - Urve Kuusk
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marc Webster
- Tom Baker Cancer Centre, Alberta Health Service, Calgary, Alberta, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - John R Mackey
- Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
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Chaput G, Regnier L. Radiotherapy: Clinical pearls for primary care. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:753-757. [PMID: 34649900 PMCID: PMC8516179 DOI: 10.46747/cfp.6710753] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Genevieve Chaput
- Assistant Professor at McGill University in Montreal, Que, an attending physician in the departments of family medicine and secondary care and oncology at the McGill University Health Centre, and Medical Director of the Vaudreuil-Soulanges Palliative Care Residence
| | - Laura Regnier
- Assistant Professor in the Department of Family Medicine at the University of Ottawa in Ontario, and a general practitioner in oncology in the Radiation Oncology Department at The Ottawa Hospital Cancer Centre
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Herremans KM, Cribbin MP, Riner AN, Neal DW, Hollen TL, Clevenger P, Munoz D, Blewett S, Giap F, Okunieff PG, Mendenhall NP, Bradley JA, Mendenhall WM, Mailhot-Vega RB, Brooks E, Daily KC, Heldermon CD, Marshall JK, Hanna MW, Leyngold MM, Virk SS, Shaw CM, Spiguel LR. Five-Year Breast Surgeon Experience in LYMPHA at Time of ALND for Treatment of Clinical T1-4N1-3M0 Breast Cancer. Ann Surg Oncol 2021; 28:5775-5787. [PMID: 34365563 DOI: 10.1245/s10434-021-10551-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/20/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Breast cancer-related lymphedema (BCRL) is a source of postoperative morbidity for breast cancer survivors. Lymphatic microsurgical preventive healing approach (LYMPHA) is a technique used to prevent BCRL at the time of axillary lymph node dissection (ALND). We report the 5-year experience of a breast surgeon trained in LYMPHA and investigate the outcomes of patients who underwent LYMPHA following ALND for treatment of cT1-4N1-3M0 breast cancer. METHODS A retrospective review of patients with cT1-4N1-3M0 breast cancer was performed in patients who underwent ALND with and without LYMPHA. Diagnosis of BCRL was made by certified lymphedema therapists. Descriptive statistics and lymphedema surveillance data were analyzed using results of Fisher's exact or Wilcoxon rank-sum tests. Logistic regression and propensity matching were performed to assess the reduction of BCRL occurrence following LYMPHA. RESULTS In a 5-year period, 132 patients met inclusion criteria with 76 patients undergoing LYMPHA at the time of ALND and 56 patients undergoing ALND alone. Patients who underwent LYMPHA at the time of ALND were significantly less likely to develop BCRL than those who underwent ALND alone (p = 0.045). Risk factors associated with BCRL development were increased patient age (p = 0.007), body mass index (BMI) (p = 0.003), and, in patients undergoing LYMPHA, number of positive nodes (p = 0.026). CONCLUSIONS LYMPHA may be successfully employed by breast surgeons trained in lymphatic-venous anastomosis at the time of ALND. While research efforts should continue to focus on prevention and surveillance of BCRL, LYMPHA remains an option to reduce BCRL and improve patient quality of life.
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Affiliation(s)
- Kelly M Herremans
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Morgan P Cribbin
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Andrea N Riner
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Dan W Neal
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Tracy L Hollen
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Pamela Clevenger
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Derly Munoz
- Department of Physical Therapy, University of Florida College of Public Health and Health Professions, Gainesville, FL, USA
| | - Shannon Blewett
- Department of Physical Therapy, University of Florida College of Public Health and Health Professions, Gainesville, FL, USA
| | - Fantine Giap
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Paul G Okunieff
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Nancy P Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Julie A Bradley
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Raymond B Mailhot-Vega
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Eric Brooks
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Karen C Daily
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Coy D Heldermon
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Julia K Marshall
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Mariam W Hanna
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Mark M Leyngold
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Sarah S Virk
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Christiana M Shaw
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Lisa R Spiguel
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA.
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13
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Blei F. Update April 2021. Lymphat Res Biol 2021; 19:189-202. [PMID: 33900826 DOI: 10.1089/lrb.2021.29102.fb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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