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Matsumoto A, Ushio K, Kimura H, Tomioka S, Sasada S, Asaeda M, Nakashima Y, Fukuhara K, Mikami Y. Database study of risk factors for breast cancer-related lymphedema: a statistical analysis of 2359 cases over 10 years. Surg Today 2025; 55:685-692. [PMID: 39562356 PMCID: PMC12011890 DOI: 10.1007/s00595-024-02960-5] [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: 08/25/2024] [Accepted: 10/03/2024] [Indexed: 11/21/2024]
Abstract
PURPOSE Identifying risk factors for breast cancer-related lymphedema (BCRL) is crucial for its prevention, necessitating large-scale epidemiological studies. Despite their suitability for large-scale surveys, to our knowledge, databases have not been the basis of any study done to investigate BCRL risk factors. This study aimed to test the hypothesis that a database-based study would be useful for identifying BCRL risk factors. METHODS Patients with breast cancer diagnosed between April 2009 and March 2020 were identified from the Hiroshima University Hospital's medical database. This retrospective observational study validated the risk factors for BCRL using logistic regression analysis (p < 0.05). RESULTS Among the total 4471 breast cancer patients identified, 2359 met the study criteria, with a BCRL incidence of 4.8%. Identified risk factors included obesity with a BMI of 25-30 (OR = 3.066, 95% CI 1.408-6.677), severe obesity with a BMI > 30 (OR = 5.791, 95% CI 2.239-14.97), surgical axillary lymph node dissection (OR = 3.212, 95% CI 1.918-5.378), chemotherapy with docetaxel (OR = 1.795, 95% CI 1.062-3.032), and conventional radiation to the breast or chest wall including lymph nodes in the irradiated area (OR = 3.299, 95% CI 1.842-5.910). CONCLUSIONS The BCRL risk factors identified by our database analysis were in line with those documented in previous studies, indicating the usefulness of database-based studies. Future studies should include more patients and study items.
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Affiliation(s)
- Akihiro Matsumoto
- Collaborative Research Division of Medical Care Design in Indonesia, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, Japan.
| | - Kai Ushio
- Department of Rehabilitation Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, Japan
| | - Hiroaki Kimura
- Department of Rehabilitation Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, Japan
| | - Shinichi Tomioka
- Department of Public Health and Health Policy, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, Japan
| | - Shinsuke Sasada
- Research Institute for Radiation Biology and Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, Japan
| | - Makoto Asaeda
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, Japan
| | - Yuki Nakashima
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, Japan
| | - Koki Fukuhara
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, Japan
| | - Yukio Mikami
- Collaborative Research Division of Medical Care Design in Indonesia, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, Japan
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Duminuco A, Novello G, Mauro E, Scalisi E, Del Fabro V, Sambataro D, Palumbo G, Di Raimondo F, Romeo D. Chemotherapy extravasation: diagnosis, prevention and management. J Chemother 2025:1-13. [PMID: 40205769 DOI: 10.1080/1120009x.2025.2488599] [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: 01/03/2025] [Revised: 03/11/2025] [Accepted: 03/26/2025] [Indexed: 04/11/2025]
Abstract
Chemotherapy extravasation, the unintended leakage of cytotoxic drugs into surrounding tissues, is a significant complication in oncological treatments, potentially leading to severe tissue damage and long-term consequences. This review explores the factors influencing extravasation risk, including infusion site, patient comorbidities and the physicochemical properties of drugs. Early detection is crucial to prevent irreversible damage. Treatment strategies vary based on the type of drug involved, ranging from topical dimethyl sulfoxide and hyaluronidase to specific antidotes like dexrazoxane for anthracycline extravasations. Preventive measures, including proper catheter placement, drug dilution and patient monitoring, are essential to mitigate risks. Effective management requires a multidisciplinary approach, combining prompt recognition, intervention and ongoing education for healthcare providers to improve patient safety and outcomes in chemotherapy administration. Enhanced training on the early signs of extravasation and advancements in treatment modalities offer critical support in minimizing adverse effects, ensuring timely and appropriate care.
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Affiliation(s)
- Andrea Duminuco
- Hematology with BMT Unit, A.O.U. Policlinico "G.Rodolico-San Marco", Catania, Italy
| | - Giuseppe Novello
- Department of Medical Oncology, A.O.U. Policlinico "G.Rodolico-San Marco", Catania, Italy
| | - Elisa Mauro
- Hematology with BMT Unit, A.O.U. Policlinico "G.Rodolico-San Marco", Catania, Italy
| | - Elvira Scalisi
- Hematology with BMT Unit, A.O.U. Policlinico "G.Rodolico-San Marco", Catania, Italy
| | | | - Daniela Sambataro
- Faculty of Medicine and Surgery, "Kore" University of Enna, Enna, Italy
| | - Giuseppe Palumbo
- Hematology with BMT Unit, A.O.U. Policlinico "G.Rodolico-San Marco", Catania, Italy
| | | | - Demetria Romeo
- Unità Farmaci Antiblastici, Farmacia I, A.O.U. Policlinico "G.Rodolico-San Marco", Catania, Italy
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García-Chico C, López-Ortiz S, Lorenzo-Crespo C, Pinto-Fraga J, Santos-Lozano A, Domínguez-García A. Wrapping up the evidence: bandaging in breast cancer-related lymphedema-a systematic review and meta-analysis. Breast Cancer 2025:10.1007/s12282-025-01693-8. [PMID: 40164942 DOI: 10.1007/s12282-025-01693-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Accepted: 03/16/2025] [Indexed: 04/02/2025]
Abstract
BACKGROUND The standard approach for breast cancer-related lymphedema (BCRL) is Complex Decongestive Therapy. This therapy involves various components, including the use of compression bandages to reduce swelling. Among these, multilayer bandage is the most frequently applied bandage in these patients. Nevertheless, alternative bandaging methods may also be effective. The current systematic review and meta-analysis of randomized-controlled trials (RCTs) aimed to compare the effectiveness of different bandaging techniques in patients with BCRL. METHODS A search was conducted in PubMed, Web of Science, and Scopus to identify RCTs that analyzed different bandaging techniques in patients with BCRL. The methodological quality of the RCTs was assessed using the Physiotherapy Evidence Database (PEDro). The meta-analysis was performed using RevMan 5.4 software, with standardized mean differences (SMDs) calculated by comparing change scores and standard deviations between intervention and control groups. This study was registered in PROSPERO (CRD42024597170). RESULTS A total of 21 RCTs were included in the systematic review (n = 1122) and five could be meta-analyzed (n = 239). The meta-analysis did not reveal significant differences in the reduction of the affected arm volume among different bandaging techniques, including multilayer, kinesio-taping, cohesive, and alginate bandage [SMD = - 0.04, 95% confidence interval - 0.30 to 0.21; p = 0.750; I2 = 0%]. CONCLUSIONS The current scientific evidence does not suggest a clear advantage of one bandaging technique over another, including kinesio-taping and multilayer bandages. Further studies with larger sample sizes are warranted to better understand their potential benefits across the different stages and phases of BCRL management.
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Affiliation(s)
- Celia García-Chico
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University, 47012, Valladolid, Spain
| | - Susana López-Ortiz
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University, 47012, Valladolid, Spain.
| | - Carmen Lorenzo-Crespo
- Department of Health Sciences, Miguel de Cervantes European University, 47012, Valladolid, Spain
| | - José Pinto-Fraga
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University, 47012, Valladolid, Spain
| | - Alejandro Santos-Lozano
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University, 47012, Valladolid, Spain
- Research Institute of the Hospital 12 de Octubre ('Imas12' [PAHERG Group]), 28041, Madrid, Spain
| | - Ana Domínguez-García
- Department of Health Sciences, Miguel de Cervantes European University, 47012, Valladolid, Spain
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Schulz T, Lee Warg M, Kurow O, Langer S, Nuwayhid R. The burden of lymphedema on quality of life. VASA 2025; 54:124-132. [PMID: 39791212 DOI: 10.1024/0301-1526/a001173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2025]
Abstract
Background: Due to a lack of validated methodologies, this study aimed to evaluate the quality of life (QoL) among individuals affected by lymphedema and to compare them with the general population and common diseases. Patients and methods: Patients were recruited from October 2023 till March 2024. The SF-36 and LYMQOL questionnaires were administered. The Robert Koch Institute provided data from the survey for secondary evaluations of the DEGS1 study. Descriptive analysis of the patient's data was conducted, followed by an analysis of risk factors, a comparison with common diseases and a pairs matched analyses with the general population based on the parameters sex, age and Body Mass Index (BMI). A p-value below 0.05 was considered significant. Results: Among the 273 patients, 18 had primary lymphedema and 255 had secondary lymphedema due to cancer history. Staging revealed 28 patients in stage I, 137 in stage II, and 75 in stage III. The majority of patients (83%) were female and mostly the lower extremity was affected. Age, International Society of Lymphology (ISL)-stage, and BMI were significantly correlated with reduced QoL in seven, six, and eleven out of thirteen subscales of the respective scores. The LYMQOL analysis revealed, that patients with upper limb lymphedema (ULL) demonstrated higher QoL compared to those with lower limb lymphedema (LLL). When compared to the general population, individuals with ULL exhibited reduced QoL in five out of eight SF-36 domains (p<0.05). Conversely, LLL patients showed decreased QoL across all eight SF-36 subscales (p<0.01). In comparison to diseases like myocardial infarction or malignant diseases, patients with lymphedema experience a significant, diminished QoL. Conclusions: By 2024, lymphedema patients continue to experience significantly lower QoL compared to the general population or common diseases in Germany. LLL patients exhibit a reduced QoL compared to individuals with ULL.
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Affiliation(s)
- Torsten Schulz
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Germany
| | - Mary Lee Warg
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Germany
| | - Olga Kurow
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Germany
| | - Stefan Langer
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Germany
| | - Rima Nuwayhid
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Germany
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Hossain L, Gomes KP, Safarpour S, Gibson SB. The microenvironment of secondary lymphedema. The key to finding effective treatments? Biochim Biophys Acta Mol Basis Dis 2025; 1871:167677. [PMID: 39828048 DOI: 10.1016/j.bbadis.2025.167677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Revised: 01/02/2025] [Accepted: 01/15/2025] [Indexed: 01/22/2025]
Abstract
Lymphedema is characterized by the swelling of extremities due to the accumulation of interstitial fluids. It is a painful and devastating disease that increases the risk of infections and destroys patients' quality of life. Secondary lymphedema is caused by damage to the lymphatic system due to infections, obesity, surgery, and cancer treatments. This damage fails to be repaired and leads to fluid accumulation, tissue remodeling, inflammation, and ultimately fibrosis. The lymphedema microenvironment is altered by stress, immune dysfunction, and changes in metabolism. Stress in the microenvironment includes increased hypoxia and oxidative stress but how this contributes to lymphedema progression is unclear. The immune system plays a critical role in lymphedema through T cell helper type 2 (Th2) immune responses and the infiltration of macrophages into lymphedematous tissue. The inflammatory cytokines released by immune cells lead to tissue remodeling and fibrosis. There are also changes in metabolism in the lymphedema microenvironment with altered lipid oxidation, ketone body oxidation, and glycolysis. How these changes affect lymphedema and treatment interventions has been the focus of clinical trials. Lymphedema is also associated with cancer and obesity through damage to the lymphatic system. This review will illustrate microenvironmental changes in lymphedema and how this relates to cancer and obesity. In addition, we will discuss new therapeutic strategies to treat lymphedema. Finally, we will address the prospects of lymphedema research in the context of the microenvironment.
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Affiliation(s)
- Lazina Hossain
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - Karina P Gomes
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - Samaneh Safarpour
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - Spencer B Gibson
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada.
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Ramadan MR, Rifai DA, Atmodiwirjo P, Panigoro SS, Arina MN, Djohan R. The Translation and Cultural Adaptation of LYMPH-Q Upper Extremity Module to the Indonesian Language. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2025; 13:e6608. [PMID: 40092504 PMCID: PMC11908756 DOI: 10.1097/gox.0000000000006608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2024] [Accepted: 01/22/2025] [Indexed: 03/19/2025]
Abstract
Background The LYMPH-Q Upper Extremity module is a patient-reported outcome measurement tool developed by the Q-Portfolio team at McMaster University, Canada, and is widely used to determine the health-related quality of life of patients with upper extremity lymphedema. However, the translation of these patient-reported outcome measurement tools to the Indonesian language has not been attempted by any institution. Methods The Indonesian translation of the LYMPH-Q Upper Extremity module was performed according to the International Society of Pharmacoeconomics and Outcomes Research guidelines. The steps included forward translation and reconciliation, back translation and review, and cognitive debriefing with cultural adaptation. The respondents in this study were recruited from Dr. Cipto Mangunkusumo Hospital and the Indonesian LYMPH-Q project community. Results A total of 2.94% of the forward-translated items were discordant at the reconciliation meeting. During the back translation review, 4 of 102 items were discordant between the original items and the back translation result. This study also emphasized Indonesian respondents' understanding of the translated items, which were influenced by sociodemographics and religious beliefs tailored specifically to Indonesian characteristics. Conclusions The Indonesian translation of the LYMPH-Q Upper Extremity module has already been conducted according to the International Society of Pharmacoeconomics and Outcomes Research guidelines, and future validation studies are necessary.
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Affiliation(s)
- Mohamad Rachadian Ramadan
- From the Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, Dr. Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Diana Ashilah Rifai
- From the Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, Dr. Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Parintosa Atmodiwirjo
- From the Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, Dr. Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Sonar Soni Panigoro
- Division of Surgical Oncology, Department of Surgery, Dr. Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Maryam Nur Arina
- From the Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, Dr. Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Risal Djohan
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
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Xing C, Sun J, Liu Y, Zhou J, Bai X, Li J, Zhao H. A New Secondary Chronic Lymphedema Rat Model Improved by High-Fat Diet. Lymphat Res Biol 2025. [PMID: 39964776 DOI: 10.1089/lrb.2024.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2025] Open
Abstract
Purpose: Secondary chronic lymphedema is a complication that seriously affects the quality of life of cancers survivors which is urgent to be studied. However, the current animal models generally have some defects such as short duration that affect the research process. To acquire an animal model which is easier to accomplish as well as higher success rate is the main goal of our experiment. Methods: The hind limb model of rats with secondary chronic lymphedema was established by near infrared fluorescence-guided lymphatic system destruction combined with high-fat diet innovation. The model was evaluated by limb circumference, volume, near-infrared fluorescence imaging of lymphatic vessels, and a series of histopathological staining. Results: The model was successfully established by operation combined with a high-fat diet and kept persistent effective lasting up to 16 weeks. Compared with the normal diet group, the high-fat group received a higher success rate (77.77% vs. 55.55%), a more obvious degree of limb swelling, and a more significant level of subcutaneous inflammatory factor infiltration at the edema site. Based on it, we kept research and found out that there was no significant difference in the process of subcutaneous fibrosis between the two groups. Conclusions: High-fat diet may improve secondary chronic lymphedema rat model success rate as well as effectiveness by changing the level of inflammatory infiltration in the site of lymphedema.
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Affiliation(s)
- Chan Xing
- Department of Breast Surgery, The Second Hospital of Dalian Medical University, Dalian, China
| | - Jie Sun
- Department of Breast Surgery, The Second Hospital of Dalian Medical University, Dalian, China
| | - Yaqian Liu
- Department of Breast Surgery, The Second Hospital of Dalian Medical University, Dalian, China
| | - Jialin Zhou
- Department of Breast Surgery, The Second Hospital of Dalian Medical University, Dalian, China
| | - Xue Bai
- Department of Breast Surgery, The Second Hospital of Dalian Medical University, Dalian, China
| | - Jun Li
- Department of Breast Surgery, The Second Hospital of Dalian Medical University, Dalian, China
| | - Haidong Zhao
- Department of Breast Surgery, The Second Hospital of Dalian Medical University, Dalian, China
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Kappos EA, Haas Y, Schulz A, Peters F, Savanthrapadian S, Stoffel J, Katapodi MC, Mucklow R, Kaiser B, Haumer A, Etter S, Cattaneo M, Staub D, Ribi K, Shaw J, Handschin TM, Eisenhardt S, Visconti G, Franceschini G, Scardina L, Longo B, Vetter M, Zaman K, Plock JA, Scaglioni M, Gonzalez EG, Quildrian SD, Felmerer G, Mehrara BJ, Ayala JM, Pons G, Kalbermatten DF, Sacks JM, Halle M, Muntean MV, Taylor EM, Mani M, Jung FJ, di Summa PG, Demiri E, Dionyssiou D, Groth AK, Heine N, Vorstenborsch J, Isaac KV, Qiu SS, Engels PE, Serre A, Eberhardt AL, Ebner S, Schwenkglenks M, Stoel Y, Leo C, Horch RE, Blondeel P, Behr B, Kneser U, Prantl L, Boll DT, Granziera C, Hemkens L, Lindenblatt N, Haug M, Schaefer DJ, Hirche C, Pusic AL, Seidenstuecker K, Harder Y, Weber W. The LYMPH trial: comparing microsurgical with conservative treatment for chronic breast cancer-associated lymphoedema - study protocol of a pragmatic randomised international multicentre superiority trial. BMJ Open 2025; 15:e090662. [PMID: 39961719 PMCID: PMC11836839 DOI: 10.1136/bmjopen-2024-090662] [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: 06/30/2024] [Accepted: 12/31/2024] [Indexed: 02/21/2025] Open
Abstract
INTRODUCTION Up to one-fifth of breast cancer survivors will develop chronic breast cancer-related lymphoedema (BCRL). To date, complex physical decongestion therapy (CDT) is the gold standard of treatment. However, it is mainly symptomatic and often ineffective in preventing BCRL progression. Lymphovenous anastomosis (LVA) and vascularised lymph node transfer (VLNT) are microsurgical techniques that aim to restore lymphatic drainage. This international randomised trial aims to evaluate advantages of microsurgical interventions plus CDT versus CDT alone for BCRL treatment. METHODS AND ANALYSIS The effectiveness of LVA and/or VLNT in combination with CDT, which may be combined with liposuction, versus CDT alone will be evaluated in routine practice across the globe. Patients with BCRL will be randomly allocated to either surgical or conservative therapy. The primary end point of this trial is the patient-reported quality of life (QoL) outcome 'lymphoedema-specific QoL', which will be assessed 15 months after randomisation. Secondary end points are further patient-reported outcomes (PROs), arm volume measurements, economic evaluations and imaging at different time points. A long-term follow-up will be conducted up to 10 years after randomisation. A total of 280 patients will be recruited in over 20 sites worldwide. ETHICS AND DISSEMINATION This study will be conducted in compliance with the Declaration of Helsinki and the International Council for Harmonisation-Good Clinical Practice (ICH-GCP) E6 guideline. Ethical approval has been obtained by the lead ethics committee 'Ethikkommission Nordwest- und Zentralschweiz' (2023-00733, 22 May 2023). Ethical approval from local authorities will be sought for all participating sites. Regardless of outcomes, the findings will be published in a peer-reviewed medical journal. Metadata detailing the dataset's type, size and content will be made available, along with the full study protocol and case report forms, in public repositories in compliance with the Findability, Accessibility, Interoperability and Reuse principles. TRIAL REGISTRATION NUMBER NCT05890677.
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Affiliation(s)
- Elisabeth A Kappos
- Department of Plastic, Reconstructive, Aesthetic and Handsurgery, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Yvonne Haas
- Department of Plastic, Reconstructive, Aesthetic and Handsurgery, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Alexandra Schulz
- University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Florian Peters
- University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Shakuntala Savanthrapadian
- University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Julia Stoffel
- Department of Plastic, Reconstructive, Aesthetic and Handsurgery, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Maria C Katapodi
- Department of Clinical Research, Founding Member Patient Advocacy Group Oncoplastic Breast Consortium, University Hospital Basel, Basel, Switzerland
| | - Rosine Mucklow
- Patient Advocacy Group, Oncoplastic Breast Consortium, Basel, Switzerland
| | - Benedict Kaiser
- Department of Plastic, Reconstructive, Aesthetic and Handsurgery, University Hospital Basel, Basel, Switzerland
| | - Alexander Haumer
- Department of Plastic, Reconstructive, Aesthetic and Handsurgery, University Hospital Basel, Basel, Switzerland
| | - Stephanie Etter
- Department of Plastic, Reconstructive, Aesthetic and Handsurgery, University Hospital Basel, Basel, Switzerland
| | - Marco Cattaneo
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Daniel Staub
- Department of Angiology, University Hospital Basel, Basel, Switzerland
| | - Karin Ribi
- Quality of Life Office, International Breast Cancer Study Group, A Division of ETOP IBCSG Partners Foundation, Careum, Bern, Switzerland
| | - Jane Shaw
- Patient Advocacy Group, Oncoplastic Breast Consortium, Basel, Switzerland
| | - Tristan M Handschin
- Department of Plastic, Reconstructive, Aesthetic and Handsurgery, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Steffen Eisenhardt
- Department of Plastic and Hand Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Giuseppe Visconti
- Department of Woman and Child Health and Public Health, Division of Plastic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gianluca Franceschini
- Department of Woman, Child Health and Public Health, Division of Breast Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lorenzo Scardina
- Department of Woman, Child Health and Public Health, Division of Breast Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Benedetto Longo
- Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, Roma, Italy
| | - Marcus Vetter
- Department of Oncology, Cantonal Hospital Basel-Landschaft, Liestal, Switzerland
| | - Khalil Zaman
- Department of Medical Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Jan A Plock
- Department of Plastic Surgery and Hand Surgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Mario Scaglioni
- Department of Hand and Plastic Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
- Center for Plastic Surgery, Center for Breast Cancer Surgery, Klinik Pyramide am See, Zurich, Switzerland
| | - Eduardo G Gonzalez
- Division of Oncoplastic Surgery, Buenos Aires British Hospital, University of Buenos Aires, Instituto de Oncología Angel H Roffo, Buenos Aires, Argentina
| | - Sergio D Quildrian
- Division of Oncoplastic Surgery, Buenos Aires British Hospital, University of Buenos Aires, Instituto de Oncología Angel H Roffo, Buenos Aires, Argentina
| | - Gunther Felmerer
- Department of Trauma Surgery, Orthopedic Surgery and Plastic Surgery, University Medical Center Göttingen, Gottingen, Germany
| | - Babak J Mehrara
- Department of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Jaume Masia Ayala
- Department of Plastic Surgery, Universitat Autònoma de Barcelona, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gemma Pons
- Department of Plastic Surgery, Universitat Autònoma de Barcelona, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Daniel F Kalbermatten
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Justin M Sacks
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Martin Halle
- Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Maximillian V Muntean
- Department of Plastic Surgery, Institute of Oncology, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Erin M Taylor
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Maria Mani
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Florian J Jung
- Department of Plastic and Hand Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | - Efterpi Demiri
- Department of Plastic Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitris Dionyssiou
- Department of Plastic Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anne K Groth
- Department of Plastic Surgery, Hospital Erasto Gaertner, Curitiba, Brazil
| | - Norbert Heine
- Department of Plastic Surgery, Caritas Hospital St. Josef, Regensburg, Germany
| | | | - Kathryn V Isaac
- Division of Plastic Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Shan Shan Qiu
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Patricia E Engels
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Axelle Serre
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Anna-Lena Eberhardt
- Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - Sonja Ebner
- Department of Obstetrics and Gynecology, Cantonal Hospital Basel-Landschaft, Liestal, Switzerland
| | - Matthias Schwenkglenks
- Health Economics Facility, Department of Public Health, University of Basel, Basel, Switzerland
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
| | - Yvette Stoel
- Institute of Therapies and Rehabilitation, Division of Physiotherapy, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Cornelia Leo
- Breast Center, Kantonsspital Baden AG, Baden, Switzerland
| | - Raymund E Horch
- Department of Plastic and Hand Surgery, Erlangen University Hospital, Erlangen, Germany
| | - Phillip Blondeel
- Department of Plastic and Reconstructive Surgery, University Hospital Ghent, Gent, Belgium
| | - Bjoern Behr
- Department of Plastic, Reconstructive and Aesthetic Surgery, KEM Kliniken Essen-Mitte, Essen, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, University Hospital Heidelberg, BG Klinik Ludwigshafen, Ludwigshafen, Germany
| | - Lukas Prantl
- Department of Plastic Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Daniel T Boll
- Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Cristina Granziera
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Lars Hemkens
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Pragmatic Evidence Lab, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University of Basel, Basel, Switzerland
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
| | - Nicole Lindenblatt
- Department of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Martin Haug
- Department of Plastic, Reconstructive, Aesthetic and Handsurgery, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Dirk J Schaefer
- Department of Plastic, Reconstructive, Aesthetic and Handsurgery, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Christoph Hirche
- Department of Plastic, Hand and Reconstructive Microsurgery, Hand Trauma and Replantation Centre, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Yves Harder
- Department of Plastic and Hand Surgery, CHUV, Lausanne, Switzerland
- Faculty of Biology and Medicine, Universite de Lausanne, Lausanne, Switzerland
| | - Walter Weber
- University of Basel, Basel, Switzerland
- Breast Center, University Hospital Basel, Basel, Switzerland
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9
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Haas Y, Williams OP, Masia J, Pons G, Taylor EM, Katapodi MC, Staub D, Eisenhardt SU, Visconti G, Longo B, Plock J, Jung F, Gonzalez E, Kaiser B, Zehnpfennig L, Stoffel J, Halbeisen FS, Appenzeller-Herzog C, Hilbig-Vlatten L, Stoel Y, Horch RE, Mani M, Ribi K, Vorstenbosch J, Isaac KV, Qiu SS, Behr B, Hemkens LG, Lindenblatt N, Schaefer DJ, Seidenstuecker K, Harder Y, Hirche CR, Weber WP, Kappos EA. Microsurgical versus complex physical decongestive therapy for chronic breast cancer-related lymphoedema. Cochrane Database Syst Rev 2025; 2:CD016019. [PMID: 39945379 PMCID: PMC11822882 DOI: 10.1002/14651858.cd016019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2025]
Abstract
OBJECTIVES This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of microsurgery versus complex physical decongestive therapy in people with chronic breast cancer-related lymphoedema.
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Affiliation(s)
- Yvonne Haas
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Jaume Masia
- Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gemma Pons
- Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Erin M Taylor
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachussetts, USA
| | - Maria C Katapodi
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Patient Advocacy Group, Oncoplastic Breast Consortium, Basel, Switzerland
| | - Daniel Staub
- Department of Angiology, University Hospital Basel, Basel, Switzerland
| | - Steffen U Eisenhardt
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Medical Faculty of the University of Freiburg, Freiburg, Germany
| | - Giuseppe Visconti
- Department of Woman and Child Health and Public Health, Division of Plastic Surgery, Fondazione Policlinico Universitario "A Gemelli" IRCCS, Rome, Italy
| | - Benedetto Longo
- Department of surgical sciences - Division of Plastic Surgery, Tor Vergata University Hospital, Rome, Italy
| | - Jan Plock
- Department of Plastic Surgery and Hand Surgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Florian Jung
- Department of Plastic and Hand Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - Eduardo Gonzalez
- Division of Oncoplastic Surgery, Oncologic Institute Instituto de Oncología Ángel H Roffo, Buenos Aires British Hospital, University of Buenos Aires, Buenos Aires, Argentina
| | - Benedict Kaiser
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | | | - Julia Stoffel
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Florian S Halbeisen
- Surgical Outcome Research Center, University Hospital Basel, Basel, Switzerland
| | | | | | - Yvette Stoel
- Institute of Therapies and Rehabilitation, Division of Physiotherapy, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - Raymund E Horch
- Department of Plastic and Hand Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Maria Mani
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Karin Ribi
- Quality of Life Office, International Breast Cancer Study Group, a division of ETOP IBCSG Partners Foundation, Bern, Careum School of Health, part of the Kalaidos University of Applied Sciences, Zürich, Switzerland
| | - Joshua Vorstenbosch
- Department of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Kathryn V Isaac
- Division of Plastic Surgery, University of British Columbia, Vancouver, Canada
| | - Shan Shan Qiu
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Björn Behr
- Department of Plastic,- Reconstructive and Aesthetic Surgery, Kliniken Essen-Mitte (KEM), Essen, Germany
| | - Lars G Hemkens
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Pragmatic Evidence Lab, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford CA, USA
| | - Nicole Lindenblatt
- Department of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Dirk J Schaefer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Yves Harder
- Department of Plastic, Reconstructive and Aesthetic Surgery and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Christoph R Hirche
- Department of Plastic Surgery, Hand and Reconstructive Microsurgery, Hand Trauma and Replantation Centre, BG Unfallklinik Frankfurt am Main, Frankfurt, Germany
| | - Walter P Weber
- University of Basel, Basel, Switzerland
- Breast Center, University Hospital Basel, Basel, Switzerland
| | - Elisabeth A Kappos
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
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10
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Campbell AC, Baik JE, Sarker A, Brown S, Park HJ, Kuonqui KG, Shin J, Pollack BL, Roberts A, Ashokan G, Rubin J, Kataru RP, Dayan JH, Barrio AV, Mehrara BJ. Breast Cancer-Related Lymphedema Results in Impaired Epidermal Differentiation and Tight Junction Dysfunction. J Invest Dermatol 2025; 145:85-97.e4. [PMID: 38879154 DOI: 10.1016/j.jid.2024.05.017] [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: 11/04/2023] [Revised: 05/10/2024] [Accepted: 05/15/2024] [Indexed: 07/19/2024]
Abstract
Breast cancer-related lymphedema (BCRL) is characterized by skin changes, swelling, fibrosis, and recurrent skin infections. Clinical studies have suggested that lymphedema results in skin barrier defects; however, the underlying cellular mechanisms and the effects of bacterial contamination on skin barrier function remain unknown. In matched biopsies from patients with unilateral BCRL, we observed decreased expression of FLG and the tight junction protein ZO-1 in skin affected by moderate lymphedema or by subclinical lymphedema in which dermal backflow of lymph was identified by indocyanine green lymphography, relative to those in the controls (areas without backflow and from the unaffected arm). In vitro stimulation of keratinocytes with lymph fluid obtained from patients undergoing lymphedema surgery led to the same changes as well as increased expression of keratin 14, a marker of immature keratinocytes. Finally, using mouse models of lymphedema, we showed that similar to the clinical scenario, the expression of skin barrier proteins was decreased relative to that in normal skin and that colonization with Staphylococcus epidermidis bacteria amplified this effect as well as lymphedema severity. Taken together, our findings suggest that lymphatic fluid stasis contributes to skin barrier dysfunction in lymphedema.
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Affiliation(s)
- Adana-Christine Campbell
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jung Eun Baik
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Biotechnology, Levatio Therapeutics, San Diego, California, USA
| | - Ananta Sarker
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Stav Brown
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Hyeung Ju Park
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kevin G Kuonqui
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jinyeon Shin
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Bracha L Pollack
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Arielle Roberts
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gopika Ashokan
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jonathan Rubin
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Raghu P Kataru
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Joseph H Dayan
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andrea V Barrio
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Babak J Mehrara
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
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11
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Alyamani S, Alghamdi R, Rayes R, Yassin H, Alhamed L, Almadani A, Jabbad H, Aljaaly H. Assessing Levels of Lymphedema Awareness Among Women With Breast Cancer in King Abdulaziz University Hospital, Jeddah. Cureus 2025; 17:e78046. [PMID: 40013189 PMCID: PMC11862979 DOI: 10.7759/cureus.78046] [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] [Accepted: 01/26/2025] [Indexed: 02/28/2025] Open
Abstract
Introduction Breast cancer poses a global health challenge, requiring a comprehensive approach beyond diagnosis and treatment. Postoperative complications, especially upper limb lymphedema, present intricate challenges for survivors, impacting physical, emotional, and daily life aspects. Our research in Jeddah, Saudi Arabia, delves into cultural and healthcare dynamics, exploring demographic influences on lymphedema. Materials and methods A descriptive quantitative study with a cross-sectional design was conducted among female patients with breast cancer in Saudi Arabia. It included patients who underwent unilateral breast surgery with lymph node excision. Data was analyzed using the SPSS program (IBM Corp., Armonk, NY). Results Our study included 76 participants. Lymphedema was diagnosed in 38.2% of participants. More than half (52.8%) of participants had some knowledge of lymphedema. For instance, 52.6% recognized the impact of hygiene, and 81.6% understood the heightened risk of arm damage. Awareness percentages were also notable for factors like tight shirt pressure (71.1%), straining the arms (86.8%), and the association of being overweight with lymphedema (55.3%). Almost half of the participants recognized the physical therapy and rehabilitation department to be responsible for lymphedema treatment. The mean awareness score was 5.34 ± 1.56. Only 9.2% achieved a good awareness level, while 59.2% had fair awareness, and 31.6% had poor awareness. Conclusion The prevalence of lymphedema, coupled with proactive healthcare-seeking behavior, underscores the need for targeted educational interventions. While the majority recognized the importance of treatment, awareness gaps persisted, especially regarding risk-reduction activities.
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Affiliation(s)
- Sarah Alyamani
- Medical School, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Reem Alghamdi
- Medical School, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Raghad Rayes
- Medical School, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Heba Yassin
- Medical School, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Latifah Alhamed
- Medical School, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Aminah Almadani
- Medical School, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Husain Jabbad
- Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Hattan Aljaaly
- Plastic Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
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12
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Shen A, Zhang Z, Ye J, Wang Y, Zhao H, Li X, Wu P, Qiang W, Lu Q. Arm symptom pattern among breast cancer survivors with and without lymphedema: a contemporaneous network analysis. Oncologist 2024; 29:e1656-e1668. [PMID: 39180465 PMCID: PMC11630752 DOI: 10.1093/oncolo/oyae217] [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: 03/10/2024] [Accepted: 07/11/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Arm symptoms commonly endure in post-breast cancer period and persist into long-term survivorship. However, a knowledge gap existed regarding the interactions among these symptoms. This study aimed to construct symptom networks and visualize the interrelationships among arm symptoms in breast cancer survivors (BCS) both with and without lymphedema (LE). PATIENTS AND METHODS We conducted a secondary analysis of 3 cross-sectional studies. All participants underwent arm circumference measurements and symptom assessment. We analyzed 17 symptoms with a prevalence >15%, identifying clusters and covariates through exploratory factor and linear regression analysis. Contemporaneous networks were constructed with centrality indices calculated. Network comparison tests were performed. RESULTS 1116 cases without missing data were analyzed, revealing a 29.84% prevalence of LE. Axillary lymph node dissection [ALND] (vs sentinel lymph node biopsy [SLNB]), longer post-surgery duration, and radiotherapy significantly impacted overall symptom severity (P < .001). "Lymphatic Stasis," "Nerve Injury," and "Movement Limitation" symptom clusters were identified. Core symptoms varied: tightness for total sample network, firmness for non-LE network, and tightness for LE network. LE survivors reported more prevalent and severe arm symptoms with stronger network connections than non-LE group (P = .010). No significant differences were observed among different subgroups of covariates (P > .05). Network structures were significantly different between ALND and SLNB groups. CONCLUSION Our study revealed arm symptoms pattern and interrelationships in BCS. Targeting core symptoms in assessment and intervention might be efficient for arm symptoms management. Future research is warranted to construct dynamic symptom networks in longitudinal data and investigate causal relationships among symptoms.
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Affiliation(s)
- Aomei Shen
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University Ministry of Education, Tianjin, 300060, People’s Republic of China
- Peking University School of Nursing, Beijing, 100191, People’s Republic of China
| | - Zhongning Zhang
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University Ministry of Education, Tianjin, 300060, People’s Republic of China
- Tianjin Medical University School of Nursing, Tianjin, 300070, People’s Republic of China
| | - Jingming Ye
- Department of Thyroid and Breast Surgery, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Yue Wang
- Department of Thyroid and Breast Surgery, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Hongmeng Zhao
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University Ministry of Education, Tianjin, 300060, People’s Republic of China
| | - Xin Li
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University Ministry of Education, Tianjin, 300060, People’s Republic of China
| | - Peipei Wu
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University Ministry of Education, Tianjin, 300060, People’s Republic of China
| | - Wanmin Qiang
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University Ministry of Education, Tianjin, 300060, People’s Republic of China
| | - Qian Lu
- Peking University School of Nursing, Beijing, 100191, People’s Republic of China
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13
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Desai A, Dahl V, De Castro Silva I, Clark M, Xu KY, Kesmodel SB, Goel N, Rojas KE, Crystal J, Mella-Catinchi JR. Larger recipient vein caliber during lymphatic microsurgical preventive healing approach (LYMPHA) is associated with lower lymphedema rates. Surgery 2024; 176:1485-1491. [PMID: 39237435 DOI: 10.1016/j.surg.2024.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 06/19/2024] [Accepted: 07/18/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND The lymphatic microsurgical preventive healing approach reduces the risk of lymphedema after axillary lymph node dissection. We identified surgical factors of Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) that influence lymphedema rates focusing on the vein caliber used. METHODS A single-institution retrospective cohort study included breast cancer patients undergoing axillary lymph node dissection and LYMPHA (April 2021-November 2022) with a follow-up of at least 1 year. Lymphedema was defined as an increase of ≥10 units in the lymphedema index (measured using bioimpedance spectroscopy) from baseline. The primary outcome was the correlation between the lymphedema index of patients with a vein caliber of ≤2 mm vs > 2 mm. RESULTS Forty-eight patients with documented vein caliber were analyzed. The median baseline lymphedema index in patients with a vein caliber ≤2 mm was 2 (SD 3.04) and 2.2 (SD 2.03) for vein caliber >2 mm. (P = .57). After 1-year follow-up, the L-dex was 6.20 (SD 7.48) for vein caliber ≤2 mm and 1.60 (SD 5.85) for vein caliber >2 mm (P = .02). The L-dex difference from baseline was higher for vein caliber ≤2 mm compared to >2 mm (2.9 vs 0.10, P = .02). Larger vein caliber was associated with a lower L-dex at 3 months (P = .04) and a lesser difference from the baseline after 1 year (P = .03). This was maintained on univariate analysis and multivariate analysis controlling for radiation, chemotherapy, and number of lymph nodes excised. CONCLUSION Vein caliber >2 mm during LYMPHA axillary lymph node dissection is associated with a lower postoperative lymphedema index. These results can be enhanced by a multi-institutional study to improve standardization of this technique.
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Affiliation(s)
- Anshumi Desai
- Division of Plastic and Reconstructive Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL.
| | - Victoria Dahl
- Division of Plastic and Reconstructive Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL
| | - Iago De Castro Silva
- Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL
| | | | - Kyle Y Xu
- Division of Plastic and Reconstructive Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL
| | - Susan B Kesmodel
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL. https://twitter.com/SueKesmodelMD
| | - Neha Goel
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL
| | - Kristin E Rojas
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL. https://twitter.com/kristinrojasmd
| | - Jessica Crystal
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL
| | - Juan R Mella-Catinchi
- Division of Plastic and Reconstructive Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL
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14
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Zapata-Ospina A, Lopera-Muñetón C, Betancur-Bedoya SP, Ángel-Bustos IC, Vásquez-Montoya MG. Effectiveness of Lymphovenular Anastomosis and Complex Decongestive Therapy for the Treatment of Lymphedema in Patients with Breast Cancer: A Systematic Review. Lymphat Res Biol 2024; 22:232-240. [PMID: 39320336 DOI: 10.1089/lrb.2024.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2024] Open
Abstract
Background: Lymphedema is a common breast cancer side effect, with an average incidence of 30%. The gold standard conservative treatment for lymphedema is complex decongestive therapy (CDT), which includes manual lymphatic drainage, compression therapy, skin care, and exercise. Lymphovenular anastomosis (LVA) is a microsurgical technique that intends to redirect excess lymphatic fluid to the venous circulation; this procedure is usually performed when conservative treatment fails. Therefore, the objective of this study is to evaluate the effectiveness of LVA and CDT for the treatment of breast cancer-related lymphedema (BCRL). Methods and Results: The search was performed in CENTRAL, MEDLINE, Embase, PsycINFO, SCOPUS, and LILACS. Inclusion criteria were (1) population: women with BCRL; (2) intervention: treated with LVA and CDT; and (3) outcome: primary outcome was lymphedema reduction. Secondary outcome was quality of life. Risk of bias and quality of study reporting were also assessed. The search found 3872 articles, with 5 articles meeting the PICO (population, intervention, comparison, outcomes) criteria, 4 pre-post studies, and one observational cohort study. The total sample included 2763 patients. Follow-up was variable. The follow-up varies from 7.8 to 120 months, with an average of 35 months. Lymphedema reduction was obtained in the five studies. Conclusion: The present systematic review suggests that for patients with lymphedema secondary to breast cancer, the combination of both treatments is effective in reducing the size of the limb and improving quality of life. Low-quality evidence was found for both limb circumference reduction and quality of life. Additional research effort is needed to reduce bias and improve the quality of evidence, in order to better inform clinical practice and enhance the care and well-being of patients with BCRL.
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Affiliation(s)
- Alejandro Zapata-Ospina
- Lymphatic Surgeon at Hospital Pablo Tobón Uribe, Research Center Plastic Surgery and Supermicrosurgery, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - Catalina Lopera-Muñetón
- School of Physiotherapy, Research center (FISIOTER), Fundación Universitaria María Cano, Medellín, Colombia
| | - Silvia P Betancur-Bedoya
- School of Physiotherapy, Research center (FISIOTER), Fundación Universitaria María Cano, Medellín, Colombia
| | - Isabel C Ángel-Bustos
- School of Physiotherapy, Research center (FISIOTER), Fundación Universitaria María Cano, Medellín, Colombia
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15
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Luo X, Zhang L, Chen J, Zhang Y, Yan J. The Predictive Role of Illness Perception on Lymphedema Risk-Management Behaviors in Women After Breast Cancer Surgery: A Longitudinal Study. Cancer Nurs 2024; 47:358-367. [PMID: 36881651 DOI: 10.1097/ncc.0000000000001225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Illness perception affects lymphedema risk-management behaviors. However, little is known about these behavioral changes within 6 months after surgery and how illness perception predicts behavioral trajectories. OBJECTIVE The aim of this study was to explore the trajectories of lymphedema risk-management behaviors in breast cancer survivors within 6 months after surgery and the predictive role of illness perception. METHODS Participants were recruited from a cancer hospital in China and completed a baseline survey (Revised Illness Perception Questionnaire) and follow-up assessments (Lymphedema Risk-Management Behavior Questionnaire and the physical exercise compliance dimension of the Functional Exercise Adherence Scale) at the first, third, and sixth months postoperatively. RESULTS A total of 251 women were analyzed. Regarding the Lymphedema Risk-Management Behavior Questionnaire, the total scores were stable. The scores of the "lifestyle" and "skin care" dimensions showed upward trends; the scores of the "avoiding compression and injury" and "other matters needing attention" dimensions showed downward trends. For "physical exercise compliance," scores remained stable. Furthermore, key illness perceptions (especially "personal control" and "causes") at baseline could predict the starting levels of and changes in behavioral trajectories. CONCLUSION Different lymphedema risk-management behaviors exhibited different trajectories and could be predicted by illness perception. IMPLICATIONS FOR PRACTICE Oncology nurses should focus on the early development of behaviors related to "lifestyle" and "skin care" and the later maintenance of "avoiding compression and injury" and "other matters needing attention" during follow-up, as well as help women strengthen their personal control beliefs and correctly understand the causes of lymphedema during hospitalization.
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Affiliation(s)
- Xia Luo
- Author Affiliations: School of Nursing, Sun Yat-sen University (Mss Luo, Chen, and Y. Zhang, and Dr Yan); and Department of Breast Oncology, Sun Yat-sen University Cancer Center (Mrs L. Zhang), Guangzhou, China
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16
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Iftekhar N, Kelecy M, Ezeanolue E, Mehta A, Claman BZ, Goldman J. What's Lymph Got to Do with It? PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6045. [PMID: 39119059 PMCID: PMC11309599 DOI: 10.1097/gox.0000000000006045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 06/17/2024] [Indexed: 08/10/2024]
Affiliation(s)
- Noama Iftekhar
- From the Department of General Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, Nev
| | - Matthew Kelecy
- From the Department of General Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, Nev
| | - Edozie Ezeanolue
- Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, Nev
| | - Aradhana Mehta
- Department of Plastic Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, Nev
| | - Barry Z. Claman
- Department of Plastic Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, Nev
| | - Joshua Goldman
- Department of Plastic Surgery, Vegas Plastic Surgery Institute, Las Vegas, Nev
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17
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Young S, Geary A, Zhao X, Kenzik K, Cassidy M, Newman R, Merrill AL. Assessing breast cancer-related lymphedema screening and treatment gaps in a safety-net hospital. J Surg Oncol 2024; 130:204-209. [PMID: 38873777 DOI: 10.1002/jso.27735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 05/16/2024] [Accepted: 06/06/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND AND OBJECTIVES We evaluated the unmet breast cancer-related lymphedema (BCRL) treatment and education needs at New England's largest safety-net hospital serving a diverse population by assessing prevalence, risk factors, and treatment. METHODS This was a retrospective cohort study examining breast cancer surgery patients from September 2016 to September 2021. The primary outcome was BCRL diagnosis. Secondary outcomes included BCRL risk factors, and physical and occupational therapy (PT/OT) referral frequency and completion. RESULTS Of 639 patients, 17% of patients had documented BCRL, which was significantly associated with axillary lymph node dissection (ALND). There were no racial, insurance, breast radiation, or BMI category differences between patients with and without a BCRL diagnosis. Of those with BCRL, 58% received a PT/OT referral, and 56% completed their referral. There were no racial, insurance, or BMI category differences between those who received a PT/OT referral and those who did not. CONCLUSION In our high-risk population, rates of documented BCRL were higher than expected, approaching rates of ALND, despite the majority undergoing sentinel lymph node biopsy (SLNB). PT/OT referral and completion rates were low, concerning for an unmet BCRL treatment and education need. No disparities in care delivery were seen, but a program that addresses treatment gaps and ensures accessible and patient-centered BCRL care is urgently needed.
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Affiliation(s)
- Sara Young
- Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Alaina Geary
- Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Xuewei Zhao
- Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Kelly Kenzik
- Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Michael Cassidy
- Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Robin Newman
- Department of Occupational Therapy, Boston University Sargent College, Boston, Massachusetts, USA
| | - Andrea L Merrill
- Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA
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Horisawa N, Yoshimura A, Oze I, Sawaki M, Hattori M, Kotani H, Kataoka A, Ozaki Y, Nozawa K, Endo Y, Takatsuka D, Isogai A, Iwata H. Supraclavicular Irradiation Induces Lymphedema in Breast Cancer Patients Treated with Axillary Lymph Node Dissection and Taxane-Containing Chemotherapy. Breast J 2024; 2024:3250143. [PMID: 39742367 PMCID: PMC11306681 DOI: 10.1155/2024/3250143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 07/03/2024] [Accepted: 07/18/2024] [Indexed: 01/03/2025]
Abstract
Purpose Breast cancer-related lymphedema (LE) significantly impairs the patients' quality of life. Axillary lymph node dissection (ALND) is a strong risk factor for LE in breast cancer surgery. In addition, postoperative administration of docetaxel (DTX) has been reported to be a risk factor for LE in patients who undergo ALND. Herein, we performed the risk of objective LE after ALND. Methods Patients who visited the medical follow-up clinic between 12 November 2018 and 11 January 2019 and at least one year postoperatively were eligible for this study. The risk factors for objective LE according to taxane-containing regimen, radiation therapy, and body mass index and the effects of a taxane-containing regimen followed by supraclavicular irradiation on LE were examined. Results A total of 214 patients were included in this analysis, and objective LE was observed in 52 patients (24%). Univariate and multivariate analyses showed that only supraclavicular field irradiation was a statistically significant risk factor for objective LE. In addition, the sequential use of taxane-containing regimens and supraclavicular RT was shown to be a more likely risk factor for LE than ALND alone. We also compared each taxane regimen with supraclavicular RT and found that DTX was more likely to be a risk factor for LE in cases of sequential use of supraclavicular RT than with ALND alone. However, when comparing DTX with supraclavicular RT and PTX with supraclavicular RT directly, there was no statistically significant difference in the risk of objective LE between the two groups. Conclusion The risk for LE was more likely to be higher with the sequential use of taxane-containing chemotherapy and supraclavicular field irradiation. Therefore, management of LE is important in these cases.
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Affiliation(s)
- Nanae Horisawa
- Department of Breast OncologyAichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya 464-8681, Aichi, Japan
- Department of Breast SurgeryNagoya City University, 1, Kawasumi, Mizuhocho, Mizuho-ku, Nagoya 467-8601, Aichi, Japan
| | - Akiyo Yoshimura
- Department of Breast OncologyAichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya 464-8681, Aichi, Japan
| | - Isao Oze
- Division of Cancer Epidemiology and PreventionDepartment of Preventive MedicineAichi Cancer Center Research Institute, 1-1, Kanokoden, Chikusa-ku, Nagoya 464-8681, Aichi, Japan
| | - Masataka Sawaki
- Department of Breast OncologyAichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya 464-8681, Aichi, Japan
| | - Masaya Hattori
- Department of Breast OncologyAichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya 464-8681, Aichi, Japan
| | - Haruru Kotani
- Department of Breast OncologyAichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya 464-8681, Aichi, Japan
| | - Ayumi Kataoka
- Department of Breast OncologyAichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya 464-8681, Aichi, Japan
| | - Yuri Ozaki
- Department of Breast OncologyAichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya 464-8681, Aichi, Japan
| | - Kazuki Nozawa
- Department of Breast OncologyAichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya 464-8681, Aichi, Japan
| | - Yuka Endo
- Department of Breast OncologyAichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya 464-8681, Aichi, Japan
| | - Daiki Takatsuka
- Department of Breast OncologyAichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya 464-8681, Aichi, Japan
| | - Ayaka Isogai
- Department of Breast OncologyAichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya 464-8681, Aichi, Japan
| | - Hiroji Iwata
- Department of Breast OncologyAichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya 464-8681, Aichi, Japan
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Gökçe E, Pirinççi CŞ, Arı F, Dalyan M. Complex decongestive therapy improves finger tapping score in patients with breast cancer-related lymphedema. Support Care Cancer 2024; 32:527. [PMID: 39026084 DOI: 10.1007/s00520-024-08743-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 07/15/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE Breast cancer-related lymphedema (BCRL) impairs upper limb function and cognitive performance. This study aimed to evaluate the effects of fifteen sessions of complex decongestive therapy (CDT) on fine motor performance and information processing speed in women with BCRL. METHODS Thirty-eight women with BCRL (54.97 ± 10.78 years) were recruited in the study. Participants either received five times weekly CDT consisting of manual lymphatic drainage, skin care, compression bandaging, and remedial exercises (n = 19) or served as a wait-list control group (n = 19). We used the Finger Tapping Task to assess fine motor performance and the Digit Symbol Substitution Test to assess information processing speed. ANCOVA was performed to analyze the effect of CDT on the dependent variables, adjusting for covariates and baseline values. RESULTS CDT significantly improved finger tapping score (p < 0.001) compared to the wait-list to the control group, whereas information processing speed did not significantly change (p = 0.673). CONCLUSION The findings suggest that CDT is an effective conservative therapeutic approach to improve upper extremity fine motor function in women with BCRL. Future studies are needed to investigate the effect of CDT on different cognitive domains.
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Affiliation(s)
- Evrim Gökçe
- Normandie Univ, UNICAEN, COMETE UMR 1075, Caen, France.
- Department of Physical Medicine and Rehabilitation, Ankara City Hospital, Ankara, Turkey.
| | - Cansu Şahbaz Pirinççi
- Gülhane Faculty of Physiotherapy and Rehabilitation, University of Health Sciences, Ankara, Turkey
| | - Fikret Arı
- Department of Electrical and Electronics Engineering, Faculty of Engineering, Ankara University, Ankara, Turkey
| | - Meltem Dalyan
- Department of Physical Medicine and Rehabilitation, Ankara City Hospital, Ankara, Turkey
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20
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Yao M, Peng P, Ding X, Sun Q, Chen L. Comparison of Intermittent Pneumatic Compression Pump as Adjunct to Decongestive Lymphatic Therapy against Decongestive Therapy Alone for Upper Limb Lymphedema after Breast Cancer Surgery: A Systematic Review and Meta-Analysis. Breast Care (Basel) 2024; 19:155-164. [PMID: 38894955 PMCID: PMC11182636 DOI: 10.1159/000538940] [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: 09/05/2023] [Accepted: 04/15/2024] [Indexed: 06/21/2024] Open
Abstract
Background Breast cancer is among the most prevalent malignancies in women worldwide, with substantial morbidity and mortality. Upper limb lymphedema (ULL) is a common complication after breast cancer surgery that affects patients' daily activities and quality of life. Decongestive lymphatic therapy (DLT) and intermittent pneumatic compression (IPC) therapy are 2 primary treatment methods for ULL. Objectives This study aimed to compare the efficacy of DLT with IPC versus DLT alone in the management of ULL following breast cancer surgery. Method PubMed Central, SCOPUS, EMBASE, MEDLINE, Cochrane Trial Registry, Google Scholar, and Clinicaltrials.gov databases were comprehensively searched for randomized controlled trials (RCTs) comparing DLT with IPC and DLT alone in patients with breast cancer-related ULL. The risk of bias was evaluated using the RoB 2 tool. Pooled effect sizes were calculated using random-effects models. Results A total of 1,894 citations were identified by the systematic search. Of them, 9 RCTs were included in the analysis. The pooled standardized mean difference (SMD) for percentage volume reduction was 0.63 (95% confidence interval [CI]: -0.24 to 1.50; I 2 = 90.9%), showing no significant difference between the DLT alone and DLT combined with IPC (p = 0.15). Pain and heaviness scores were also comparable between the groups. However, there was a significant difference in external rotation joint mobility (SMD = 0.62; 95% CI: 0.08-1.16; I 2 = 23.8%), favoring DLT with IPC. Conclusions Our findings suggest that DLT with IPC and DLT alone showed similar findings in managing ULL after breast cancer surgery, with DLT with IPC showing a greater impact on external rotation joint mobility. Healthcare providers should consider patient preferences and individual factors when selecting the most appropriate treatment modality for ULL management.
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Affiliation(s)
- Min Yao
- Department of Breast Surgery, Huzhou Maternity and Child Health Care Hospital, Huzhou, China
| | - Puchao Peng
- Department of Breast Surgery, Huzhou Maternity and Child Health Care Hospital, Huzhou, China
| | - Xiufang Ding
- Department of Breast Surgery, Huzhou Maternity and Child Health Care Hospital, Huzhou, China
| | - Qinfang Sun
- Department of Breast Surgery, Huzhou Maternity and Child Health Care Hospital, Huzhou, China
| | - Lijie Chen
- Department of Breast Surgery, Huzhou Maternity and Child Health Care Hospital, Huzhou, China
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21
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Park JS, Kim YS, Kim HY, Choi Y. Lymphedema after regional nodal irradiation for breast cancer: a retrospective cohort study. Ann Surg Treat Res 2024; 106:337-343. [PMID: 38868589 PMCID: PMC11164658 DOI: 10.4174/astr.2024.106.6.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/23/2024] [Accepted: 04/08/2024] [Indexed: 06/14/2024] Open
Abstract
Purpose We aimed to analyze the occurrence of lymphedema as a side effect in patients who underwent regional nodal irradiation (RNI) following surgery for breast cancer. Methods This retrospective study was conducted on patients with breast cancer who underwent surgery from July 2014 to October 2020 at Inje University Busan Paik Hospital. The analysis included 113 cT1-3N1-3M0 breast cancer patients who underwent RNI as part of radiotherapy (RT). Mostly, surgeries were performed using breast-conserving surgery (n = 99, 87.6%), except for 14 patients with modified radical mastectomy. The total RT dose for RNI was 45-60 Gy, and the fraction size was 1.8-2.0 Gy. Most patients underwent chemotherapy (n = 98, 86.7%), including taxanes (n = 92, 81.4%). Results The median follow-up was 61.1 months (range, 5.0-110.5 months). Lymphedema occurred in 54 patients (47.8%) after surgery. Twenty of them (17.7%) developed a new onset of lymphedema after RT, while 34 (30.1%) detected lymphedema before the completion of RT. Over the follow-up, 16 patients (14.2%) experienced recurrence. High radiation dose (>50.4 Gy) for RNI (P = 0.003) and taxane use (P = 0.038) were related to lymphedema occurrence after RT. Moreover, lymphedema occurrence after RT was also related to recurrence after surgical resection (P = 0.026). Breast-conserving surgery was related to early-onset lymphedema before the completion of RT (P = 0.047). Furthermore, the degree of lymph node dissection (≤4) was related to the overall occurrence of lymphedema (P = 0.045). Conclusion Considering a reduction in RNI dose may be beneficial in mitigating the incidence of lymphedema after RT in patients with breast cancer.
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Affiliation(s)
- Ji Sun Park
- Department of Nuclear Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Young Suk Kim
- Department of Radiation Oncology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - Hee Yeon Kim
- Department of General Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yunseon Choi
- Department of Radiation Oncology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Liu L, Lv J, Piao W, Liu X, Li S, Lu X. Research on the influence of yogalates comprehensive rehabilitation training on postoperative recovery of breast cancer patients. Explore (NY) 2024; 20:340-346. [PMID: 37770360 DOI: 10.1016/j.explore.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/26/2023] [Accepted: 09/18/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND In the present study, we analyzed the effects of comprehensive yogalates rehabilitation training on side effects caused by postoperative adjuvant treatment and postoperative physical and mental health in breast cancer patients who had undergone radical mastectomy.The purpose of this investigation was to test the hypothesis that 12 weeks of yogalates training would reduce the peripheral diameter of the upper arm, improve flexibility and posture, and improve sleep quality compared with a non-treated control group. METHODS 36 women with breast cancer who had undergone radical mastectomy in Shanghai were selected and randomly divided into the experimental group (n=20) and the control group (n=16). The patients in the experimental group underwent yogalates comprehensive rehabilitation training, while the control group did not participate in yogalates course. Anthropometric measurements and the "Pittsburgh Sleep Quality Index (PSQI)" questionnaire were administered to both the experimental and control groups before and after the training sessions. RESULTS The experimental group corrected the hunchback posture through yogalates training. Spine extension increased their height and decreased their BMI. The range of motion of upper arm joints in extension, bending and abduction increased. The peripheral diameter of the upper arm decreased, the grip strength increased, and the sleep quality gradually improved. CONCLUSION (1)Prolonging the period of yogalates training stabilized and improve the physical and mental health of patients. (2)In yogalates course, providing proper guidance to patients for diaphragmatic breathing and incorporating yoga relaxation techniques can effectively enhance the sleep quality of patients.(3)Exercise regimens must be designed taking into account individual differences.
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Affiliation(s)
- Lu Liu
- Department of Physical Education and Sport, Shanghai Ocean University, Shanghai 201306, China
| | - Jinke Lv
- College of Information Technology, Shanghai Ocean University, Shanghai 201306, China
| | - Wenting Piao
- College of Economics&Management, Shanghai Ocean University, Shanghai 201306,China
| | - Xinran Liu
- College of Foreign Languages, Shanghai Ocean University, Shanghai 201306, China
| | - Shaojing Li
- Department of Gynecology and Obstetrics, Shanghai Fengxian District Central Hospital, Shanghai 201400, China.
| | - Xi Lu
- Department of Public Physical Art Education, Zhejiang University, Hangzhou 310058, China
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Brown JA, Olshan AF, Bae-Jump VL, Ogunleye AA, Smith S, Black-Grant S, Nichols HB. Lymphedema self-assessment among endometrial cancer survivors. Cancer Causes Control 2024; 35:771-785. [PMID: 38175324 PMCID: PMC11045305 DOI: 10.1007/s10552-023-01838-0] [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: 09/08/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Lower extremity lymphedema (LEL), which causes ankle, leg, and feet swelling, poses a significant challenge for endometrial cancer survivors, impacting physical functioning and psychological well-being. Inconsistent LEL diagnostic methods result in wide-ranging LEL incidence estimates. METHODS We calculated the cumulative incidence of LEL based on survivor-reported Gynecologic Cancer Lymphedema Questionnaire (GCLQ) responses in addition to survivor- and nurse-reported leg circumference measurements among a pilot sample of 50 endometrial cancer survivors (27 White, 23 Black) enrolled in the ongoing population-based Carolina Endometrial Cancer Study. RESULTS Self-leg circumference measurements were perceived to be difficult and were completed by only 17 survivors. Diagnostic accuracy testing measures (sensitivity, specificity, positive and negative predictive value) compared the standard nurse-measured ≥ 10% difference in leg circumference measurements to GCLQ responses. At a mean of ~11 months post-diagnosis, 54% of survivors met established criteria for LEL based on ≥ 4 GCLQ cutpoint while 24% had LEL based on nurse-measurement. Percent agreement, sensitivity, and specificity approximated 60% at a threshold of ≥ 5 GCLQ symptoms. However, Cohen's kappa, a measure of reliability that corrects for agreement by chance, was highest at ≥ 4 GCLQ symptoms (κ = 0.27). CONCLUSION Our findings emphasize the need for high quality measurements of LEL that are feasible for epidemiologic study designs among endometrial cancer survivors. Future studies should use patient-reported survey measures to assess lymphedema burden and quality of life outcomes among endometrial cancer survivors.
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Affiliation(s)
- Jordyn A Brown
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2104F McGavran-Greenberg Hall, CB #7435, 135 Dauer Drive, Chapel Hill, NC, 27599-7435, USA
| | - Andrew F Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2104F McGavran-Greenberg Hall, CB #7435, 135 Dauer Drive, Chapel Hill, NC, 27599-7435, USA
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Victoria L Bae-Jump
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adeyemi A Ogunleye
- Division of Plastic Surgery and Reconstructive Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shawn Smith
- Endometrial Cancer Action Network for African Americans, Seattle, WA, USA
| | | | - Hazel B Nichols
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2104F McGavran-Greenberg Hall, CB #7435, 135 Dauer Drive, Chapel Hill, NC, 27599-7435, USA.
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
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Knoedler L, Huelsboemer L, Hollmann K, Alfertshofer M, Herfeld K, Hosseini H, Boroumand S, Stoegner VA, Safi AF, Perl M, Knoedler S, Pomahac B, Kauke-Navarro M. From standard therapies to monoclonal antibodies and immune checkpoint inhibitors - an update for reconstructive surgeons on common oncological cases. Front Immunol 2024; 15:1276306. [PMID: 38715609 PMCID: PMC11074450 DOI: 10.3389/fimmu.2024.1276306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 04/05/2024] [Indexed: 05/23/2024] Open
Abstract
Malignancies represent a persisting worldwide health burden. Tumor treatment is commonly based on surgical and/or non-surgical therapies. In the recent decade, novel non-surgical treatment strategies involving monoclonal antibodies (mAB) and immune checkpoint inhibitors (ICI) have been successfully incorporated into standard treatment algorithms. Such emerging therapy concepts have demonstrated improved complete remission rates and prolonged progression-free survival compared to conventional chemotherapies. However, the in-toto surgical tumor resection followed by reconstructive surgery oftentimes remains the only curative therapy. Breast cancer (BC), skin cancer (SC), head and neck cancer (HNC), and sarcoma amongst other cancer entities commonly require reconstructive surgery to restore form, aesthetics, and functionality. Understanding the basic principles, strengths, and limitations of mAB and ICI as (neo-) adjuvant therapies and treatment alternatives for resectable or unresectable tumors is paramount for optimized surgical therapy planning. Yet, there is a scarcity of studies that condense the current body of literature on mAB and ICI for BC, SC, HNC, and sarcoma. This knowledge gap may result in suboptimal treatment planning, ultimately impairing patient outcomes. Herein, we aim to summarize the current translational endeavors focusing on mAB and ICI. This line of research may serve as an evidence-based fundament to guide targeted therapy and optimize interdisciplinary anti-cancer strategies.
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Affiliation(s)
- Leonard Knoedler
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, United States
| | - Lioba Huelsboemer
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, United States
| | - Katharina Hollmann
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Faculty of Medicine, University of Wuerzbuerg, Wuerzburg, Germany
| | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians University Munich, Munich, Germany
| | - Konstantin Herfeld
- Department of Internal Medicine III (Oncology and Haematology), University Hospital Regensburg, Regensburg, Germany
- Leibniz Institute for Immunotherapy, Regensburg, Germany
| | - Helia Hosseini
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, United States
| | - Sam Boroumand
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, United States
| | - Viola A. Stoegner
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, United States
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany
| | - Ali-Farid Safi
- Craniologicum, Center for Cranio-Maxillo-Facial Surgery, Bern, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Markus Perl
- Department of Internal Medicine III (Oncology and Haematology), University Hospital Regensburg, Regensburg, Germany
- Leibniz Institute for Immunotherapy, Regensburg, Germany
| | - Samuel Knoedler
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, United States
| | - Bohdan Pomahac
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, United States
| | - Martin Kauke-Navarro
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, United States
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25
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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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Humar P, Moroni E, Raghuram A, Balogun Z, Nguyen XM, Zhang C, De La Cruz C. Upper Extremity Functional Outcomes After Breast Cancer Treatment: An Analysis of DASH Score in Breast Reconstruction Patients. Aesthet Surg J 2024; 44:396-403. [PMID: 38019776 DOI: 10.1093/asj/sjad352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 11/05/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Patients undergoing postoncologic breast reconstruction can experience upper extremity (UE) functional deficits. OBJECTIVES In this study, we utilized the disabilities of the arm, shoulder, and hand (DASH) questionnaire to identify patient factors that impacted UE functional recovery. METHODS Patients who underwent oncologic followed by reconstructive surgery by a single surgeon from 2014 to 2019 and completed the DASH survey were included. A DASH score was calculated for each patient, with values ranging from 0 (no impairment) to 100 (severe impairment). Regression analysis was conducted to identify significant predictors for DASH score with a significance level for entry and stay set at P = .15. RESULTS Among 289 patients who underwent breast reconstruction, 157 completed the questionnaire. The average patient age was 52.6yrs ± 8.6 at the time of reconstruction. A total of 111 had implant-based reconstruction, 15 had autologous reconstruction, and 24 had a combination of both. Average DASH score was 7.7 (range 0.0-52.5), with 74.1% of patients having a score greater than 0. Regression analysis showed 5 variables associated with significantly higher DASH scores: age between 50 and 60 years (P = .13), history of radiation (P = .01), placement of a subpectoral implant (P = .06), postoperative complications (P = .10), and lymphedema (P < .01). Autologous breast reconstruction (P = .04) was associated with a significantly lower DASH score. CONCLUSIONS Implant-based reconstruction, radiation history, postoperative complications, and age at reconstruction were associated with increased UE functional impairment in patients who underwent breast reconstructive surgery. Identification of these factors can inform areas for potential practice changes and improve patient counseling regarding postoperative expectations. LEVEL OF EVIDENCE: 3
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de Valois B, Young T, Zollman C, Appleyard I, Ben-Arye E, Cummings M, Green R, Hoffman C, Lacey J, Moir F, Peckham R, Stringer J, Veleber S, Weitzman M, Wode K. Acupuncture in cancer care: recommendations for safe practice (peer-reviewed expert opinion). Support Care Cancer 2024; 32:229. [PMID: 38483623 PMCID: PMC10940387 DOI: 10.1007/s00520-024-08386-6] [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: 09/06/2023] [Accepted: 02/16/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Up-to-date recommendations for the safe practice of acupuncture in integrative oncology are overdue with new cancer treatments and an increase in survivors with late effects of disease; 17 years have elapsed since Filshie and Hester's 2006 guidelines. During 2022/2023 an expert panel assembled to produce updated recommendations aiming to facilitate safe and appropriate care by acupuncturists working with people with cancer. METHODS A core development team comprising three integrative oncology professionals comprehensively updated pre-existing unpublished recommendations. Twelve invited international experts (senior acupuncturists with and without experience of working in oncology settings, oncologists, physicians and nurses trained in integrative oncology, researchers, academics, and professional body representatives) reviewed the recommendations. In multiple iterations, the core team harmonised comments for final ratification. To aid dissemination and uptake the panel represents national and international integrative oncology associations and major cancer treatment centres in Europe, USA, Australia, and the Middle East. RESULTS These recommendations facilitate safe care by articulating contra-indications, cautions, and risks for patients both on and off treatment (surgery, SACT, radiotherapy). Situations where acupuncture may be contra-indicated or practices need adapting are identified. "Red and Amber Flags" highlight where urgent referral is essential. CONCLUSION These are the first international, multidisciplinary peer-reviewed recommendations for safe acupuncture practice in integrative oncology. Concerns about safety remain a significant barrier to appropriate referral from oncology teams, to use by acupuncturists and to uptake by patients. Disseminating trustworthy, widely accessible guidance should facilitate informed, confident practice of acupuncture in and outside of oncology healthcare settings.
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Affiliation(s)
- Beverley de Valois
- Supportive Oncology Research Team (SORT), East and North Hertfordshire NHS Trust Incorporating Mount Vernon Cancer Centre, Northwood, Middlesex, UK.
| | - Teresa Young
- Supportive Oncology Research Team (SORT), East and North Hertfordshire NHS Trust Incorporating Mount Vernon Cancer Centre, Northwood, Middlesex, UK
| | | | | | | | - Mike Cummings
- British Medical Acupuncture Society, London Office, London, UK
| | - Ruth Green
- Imaging, Royal National Orthopaedic NHS Trust, Stanmore, Middlesex, UK
| | | | - Judith Lacey
- Supportive Care and Integrative Oncology, Chris O'Brien Lifehouse Comprehensive Cancer Hospital, Sydney, NSW, Australia
| | | | | | | | - Susan Veleber
- Integrative Medicine, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Matthew Weitzman
- Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kathrin Wode
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Hing JX, Chua YN, Tan PT, Tan MSL, Mok CW, Seet MYL, Lin ZC, Seah CM, Lee WP, Tan SM. Defining breast cancer-related lymphedema (BCRL) prevalence and risk factors: A pragmatic approach to lymphedema surveillance. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2024; 53:80-89. [PMID: 38920232 DOI: 10.47102/annals-acadmedsg.2023264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Introduction We presented the key findings from Singapore's Changi General Hospital Breast Centre's lymphedema surveillance strategy that used patients' reported symptoms, standard arm circumference measurements and clinical assessment in the diagnosis of breast cancer-related lymphedema (BCRL). Our secondary aim was to highlight and discuss important elements of a surveillance strategy that can be implemented to track this outcome measure of breast cancer treatment for future research. Method We conducted a cross-sectional study of 511 breast cancer patients to assess the prevalence of BCRL and its associated risk factors. We defined BCRL prevalence rates based on patients' self-reporting, objective arm circumference measure-ments and clinical diagnosis based on International Society of Lymphology (ISL) staging. Results The median follow-up of patients was 88.8 months. The cumulative prevalence rate in the cohort was 30.9%. The cohort of BCRL patients were older (58.4 versus [vs] 54.9 years), had higher mean Body Mass Index (27.7 vs 25.2), higher proportion of mastectomy (77% vs 64.3%), axillary clearance, less likely breast reconstruction, higher-grade tumour, more lymph nodes excised, more advanced nodal disease, and had undergone adjuvant chemotherapy. However, clinically apparent BCRL was only 6.5% (33 out of 511 patients). The proportion of clinically significant BCRL in patients undergoing sentinel lymph node biopsy (SLNB) or axillary sampling was 1.7% compared to 9.9% in patients who had undergone axillary clearance. Majority of the BCRL were subclinical or mild in severity. Conclusion Our study showed that our rates of BCRL were comparable to international rates and highlighted similar patient profiles who were at risk of developing the disease. Having a comprehensive lymphedema surveillance strategy is paramount in paving the way for future studies.
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Affiliation(s)
- Jun Xian Hing
- Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore
- SingHealth-Duke NUS Breast Centre
| | - Yen Nee Chua
- Department of Nursing, Changi General Hospital, Singapore
| | - Pei Ting Tan
- Clinical Trials and Research Unit, Changi General Hospital, Singapore
| | | | - Chi Wei Mok
- Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore
- SingHealth-Duke NUS Breast Centre
| | - Melissa Yert Li Seet
- Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore
- SingHealth-Duke NUS Breast Centre
| | - Zar Chi Lin
- Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore
- SingHealth-Duke NUS Breast Centre
| | - Chin Mui Seah
- Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore
- SingHealth-Duke NUS Breast Centre
| | - Wai Peng Lee
- Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore
- SingHealth-Duke NUS Breast Centre
| | - Su-Ming Tan
- Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore
- SingHealth-Duke NUS Breast Centre
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Iliescu MG, Stanciu LE, Uzun AB, Cristea AE, Motoască I, Irsay L, Iliescu DM, Vari T, Ciubean AD, Caraban BM, Ciufu N, Azis O, Ciortea VM. Assessment of Integrative Therapeutic Methods for Improving the Quality of Life and Functioning in Cancer Patients-A Systematic Review. J Clin Med 2024; 13:1190. [PMID: 38592012 PMCID: PMC10931598 DOI: 10.3390/jcm13051190] [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: 12/27/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Cancer rehabilitation represents a series of measures adopted for the recovery of psychological, emotional, social, and financial functioning in the case of cancer patients. The purpose of this study is to identify the main elements of therapeutic management in the field of medical rehabilitation, as well as integrative, complementary medicine and holistic approaches that can be performed on the oncological patient. Methods: This systematic literature review follows the methodology outlined in the "Preferred Reporting Items for Systematic Reviews and Meta-Analysis" ("PRISMA") statement, which is an internationally recognized and widely accepted standard. Results: Active rehabilitative therapies offer therapeutic options for improving the functioning and quality of life of oncological patients; these therapies comprehensively address both the physical and psychological aspects of the disease. This review also includes the latest novelties and nanotechnologies applied in oncological rehabilitation, for example, drugs (or supplements) inspired by nature. Conclusions: Physical and rehabilitation medicine, mostly using stimulating therapeutic methods, was recently added to the list of contraindications in the management of oncological patients, both as an approach to the pathological concept itself and as an approach to the main clinical consequences and functional aspects of oncological therapies. Integrative, complementary medicine presents an important therapeutic resource in the case of oncological patients. Advanced studies are needed in the future to further ascertain the role of these therapies.
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Affiliation(s)
- Mădălina Gabriela Iliescu
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ovidius University of Constanta, 1 University Alley, Campus-Corp B, 900470 Constanta, Romania
- Medical Doctoral School, Faculty of Medicine, Ovidius University of Constanta, 1 University Alley, Campus-Corp B, 900470 Constanta, Romania
| | - Liliana-Elena Stanciu
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ovidius University of Constanta, 1 University Alley, Campus-Corp B, 900470 Constanta, Romania
| | - Andreea-Bianca Uzun
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ovidius University of Constanta, 1 University Alley, Campus-Corp B, 900470 Constanta, Romania
- Medical Doctoral School, Faculty of Medicine, Ovidius University of Constanta, 1 University Alley, Campus-Corp B, 900470 Constanta, Romania
| | - Adelina-Elena Cristea
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ovidius University of Constanta, 1 University Alley, Campus-Corp B, 900470 Constanta, Romania
- Medical Doctoral School, Faculty of Medicine, Ovidius University of Constanta, 1 University Alley, Campus-Corp B, 900470 Constanta, Romania
| | - Irina Motoască
- Department of Rehabilitation Medicine, University of Medicine and Pharmacy "Iuliu Hatieganu", 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
| | - Laszlo Irsay
- Department of Rehabilitation Medicine, University of Medicine and Pharmacy "Iuliu Hatieganu", 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
| | - Dan Marcel Iliescu
- Department of Anatomy, Faculty of Medicine, Ovidius University of Constanta, 1 University Alley, Campus-Corp B, 900470 Constanta, Romania
| | - Titus Vari
- Department of Rehabilitation Medicine, University of Medicine and Pharmacy "Iuliu Hatieganu", 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
| | - Alina Deniza Ciubean
- Department of Rehabilitation Medicine, University of Medicine and Pharmacy "Iuliu Hatieganu", 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
| | - Bogdan Marian Caraban
- Department of Plastic Surgery, Faculty of Medicine, Ovidius University of Constanta, 1 University Alley, Campus-Corp B, 900470 Constanta, Romania
| | - Nicolae Ciufu
- Department of General Surgery, Faculty of Medicine, Ovidius University of Constanta, 1 University Alley, Campus-Corp B, 900470 Constanta, Romania
| | - Olgun Azis
- Department of Urology, Faculty of Medicine, Ovidius University of Constanta, 1 University Alley, Campus-Corp B, 900470 Constanta, Romania
| | - Viorela Mihaela Ciortea
- Department of Rehabilitation Medicine, University of Medicine and Pharmacy "Iuliu Hatieganu", 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
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Jonis YMJ, Wolfs JAGN, Hummelink S, Tielemans HJP, Keuter XHA, van Kuijk S, Ulrich DJO, van der Hulst RRWJ, Qiu SS. The 6 month interim analysis of a randomized controlled trial assessing the quality of life in patients with breast cancer related lymphedema undergoing lymphaticovenous anastomosis vs. conservative therapy. Sci Rep 2024; 14:2238. [PMID: 38278856 PMCID: PMC10817972 DOI: 10.1038/s41598-024-52489-3] [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: 03/16/2023] [Accepted: 01/19/2024] [Indexed: 01/28/2024] Open
Abstract
Breast cancer related lymphedema (BCRL) is a chronic condition with a detrimental impact on psychosocial and physical well-being. Lymphaticovenous anastomosis has shown promising results in alleviating physical symptoms and increasing quality of life in patients with BCRL. The aim of the study is to evaluate the effect on health related quality of life (HrQol) after LVA surgery versus conservative treatment in patients with BCRL. The study is a prospective, multicenter randomized controlled trial. Adult women with unilateral BCRL, with early stage lymphedema and viable lymphatic vessels were included. The primary outcome measure was HrQol measured by the lymphedema functioning disability and health (Lymph-ICF) questionnaire. The secondary outcomes were volume difference measured by the water displacement method; the Upper Extremity Lymphedema (UEL) index; and daily use of the compression garments after 3 and 6 months. For this interim analysis 46 patients per group were included. There was a significant improvement in the domains in physical and mental function in the Lymph-ICF questionnaire in the LVA group after 6 months, (- 16.46 ± 18.5, p < 0.05, - 10.12 ± 29.5, p < 0.05 respectively). However, there was no statistical difference in the total score of the Lymph-ICF after 6 months in both groups (LVA-group; - 8.57 ± 22.6, p > 0.05, CDT-group; - 2.65 ± 18.2, p < 0.05). Furthermore, there was no significant volume reduction in both groups (LVA-group: 20.04 ± 196.40, p = 0.497, CDT: 33.98 ± 189.87, p = 0.236). In the LVA group, 41% partially of completely stopped wearing the compression garments after six months whereas in the CDT group 0% discontinued to use of compression garments. LVA resulted in improvement of the domains physical and mental function of the Lymph-ICF. Limb volume did not significantly improve after 6 months. However, around 42% could completely or partially stopped with the use of compression garments in the LVA group. The current results are promising, however longer follow up is required to assess long term effect of LVA for secondary lymphedema. Clinical Trial Registration: NCT02790021 registered on 03/06/2016.
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Affiliation(s)
- Y M J Jonis
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, 6229HX, Maastricht, The Netherlands
| | - J A G N Wolfs
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, 6229HX, Maastricht, The Netherlands
| | - S Hummelink
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, 6500 HB, Nijmegen, The Netherlands
| | - H J P Tielemans
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, 6500 HB, Nijmegen, The Netherlands
| | - X H A Keuter
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, 6229HX, Maastricht, The Netherlands
| | - S van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - D J O Ulrich
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, 6500 HB, Nijmegen, The Netherlands
| | - R R W J van der Hulst
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, 6229HX, Maastricht, The Netherlands
| | - S S Qiu
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, 6229HX, Maastricht, The Netherlands.
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Pagliara D, Grieco F, Rampazzo S, Pili N, Serra PL, Cuomo R, Rubino C. Prevention of Breast Cancer-Related Lymphedema: An Up-to-Date Systematic Review of Different Surgical Approaches. J Clin Med 2024; 13:555. [PMID: 38256688 PMCID: PMC10817002 DOI: 10.3390/jcm13020555] [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: 12/08/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Breast cancer-related lymphedema (BCRL) affects approximately 20% of women after breast cancer therapy. Advances in treatment have increased the life expectancy; thus, the prevalence of BCRL will continue to rise with the number of cancer survivors, hence the need to develop strategies to prevent this condition. We provide a systematic review of the literature on the primary prevention of BCRL by prophylactic lymphatic surgery (PLS). Between June and August 2022, we conducted a search of PubMed, Google Scholar and Cochrane. In the end, a total of eighteen papers were selected. The eleven studies without a control group reported only 15 of 342 patients who developed lymphedema at least six months after PLS (4.59%). The seven studies with a control group included 569 patients, 328 cases and 241 controls. Among the cases, 36 (10%) developed lymphedema. In contrast, the incidence of lymphedema in the controls was 40% (98 of 241 patients). The formulation of definite recommendations in favor of PLS is hindered by low-quality studies. There is no consensus on which technique should be preferred, nor on whether adjuvant radiotherapy might affect the efficacy of PLS. Randomized controlled trials are mandatory to conceive evidence-based recommendations.
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Affiliation(s)
- Domenico Pagliara
- Plastic-Reconstructive and Lymphedema Microsurgery Center, Mater Olbia Hospital, 07026 Olbia, Italy;
| | - Federica Grieco
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy; (S.R.); (N.P.); (P.L.S.); (C.R.)
| | - Silvia Rampazzo
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy; (S.R.); (N.P.); (P.L.S.); (C.R.)
| | - Nicola Pili
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy; (S.R.); (N.P.); (P.L.S.); (C.R.)
| | - Pietro Luciano Serra
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy; (S.R.); (N.P.); (P.L.S.); (C.R.)
| | - Roberto Cuomo
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy;
| | - Corrado Rubino
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy; (S.R.); (N.P.); (P.L.S.); (C.R.)
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Shukla A, Gonnade N, Kamal M. Management of Lymphoedema and Lymphorrhoea with Wrap around Compression in Breast Secondary to Carcinoma Breast: A Case Report. Indian J Palliat Care 2024; 30:85-88. [PMID: 38633681 PMCID: PMC11021050 DOI: 10.25259/ijpc_165_2023] [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: 07/07/2023] [Accepted: 10/25/2023] [Indexed: 04/19/2024] Open
Abstract
Lymphoedema secondary to breast cancer is one of the most unfortunate outcomes, and lymphoedema secondary to breast cancer in the ipsilateral upper extremity and its management, has been described in the literature. We are reporting a case of lymphoedema and lymphorrhoea in the breast itself, managed by compression bandaging with limited resources and the use of active pharmacological agents in the palliative care unit of a tertiary care hospital. Lymphoedema and lymphorrhoea in the breast are not very common to see in clinics, but management of this case even though no protocol available, was done by modification of bandaging techniques available for limb lymphoedema management.
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Affiliation(s)
- Aradhana Shukla
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Nitesh Gonnade
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Manoj Kamal
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Rockson SG, Skoracki R. Effectiveness of a Nonpneumatic Active Compression Device in Older Adults with Breast Cancer-Related Lymphedema: A Subanalysis of a Randomized Crossover Trial. Lymphat Res Biol 2023; 21:581-584. [PMID: 37729078 PMCID: PMC10753982 DOI: 10.1089/lrb.2022.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
Background: A recently completed clinical trial compared a novel nonpneumatic compression device (NPCD) with a traditional advanced pneumatic compression device (APCD) for the treatment of breast cancer-related lymphedema (BCRL); the study revealed that the NPCD produced superior clinical and quality-of-life (QOL) outcomes. In this subanalysis, we sought to examine these results within the subset of trial subjects aged ≥65 years. Methods: A randomized crossover head-to-head trial was conducted to compare the NPCD with a commercially available APCD. Patients were randomly assigned to one or the other device for 28 days of use, followed by a 4-week washout period before a comparable 28-day utilization of the alternate device. Limb edema, adherence to daily device use, and QOL measures were collected at day 0 and 28 of each period. Results: A total of 14 subjects were aged ≥65. During NPCD use, subjects experienced a mean decrease in limb edema of 100.3% (p = 0.0082) as well as improvements in mean overall and subscale scores of the Lymphedema Quality of Life Questionnaire (LYMQOL). By comparison, during APCD use limb edema decreased by a mean of 2.9% (p = 0.8899) with no significant changes in any LYMQOL scores. Mean adherence was significantly higher during NPCD use (96.6%) than during APCD use (58.3%, p < 0.0001). Conclusions: The novel NPCD produced superior clinical and QOL outcomes in older subjects with BCRL. ClinicalTrials.gov ID: NCT04908254.
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Affiliation(s)
- Stanley G. Rockson
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Roman Skoracki
- Department of Plastic Surgery, The Ohio State University Medical Center, Columbus, Ohio, USA
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Trinh XT, Chien PN, Long NV, Van Anh LT, Giang NN, Nam SY, Myung Y. Development of predictive models for lymphedema by using blood tests and therapy data. Sci Rep 2023; 13:19720. [PMID: 37957217 PMCID: PMC10643602 DOI: 10.1038/s41598-023-46567-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
Lymphedema is a disease that refers to tissue swelling caused by an accumulation of protein-rich fluid that is usually drained through the lymphatic system. Detection of lymphedema is often based on expensive diagnoses such as bioimpedance spectroscopy, shear wave elastography, computed tomography, etc. In current machine learning models for lymphedema prediction, reliance on observable symptoms reported by patients introduces the possibility of errors in patient-input data. Moreover, these symptoms are often absent during the initial stages of lymphedema, creating challenges in its early detection. Identifying lymphedema before these observable symptoms manifest would greatly benefit patients by potentially minimizing the discomfort caused by these symptoms. In this study, we propose to use new data, such as complete blood count, serum, and therapy data, to develop predictive models for lymphedema. This approach aims to compensate for the limitations of using only observable symptoms data. We collected data from 2137 patients, including 356 patients with lymphedema and 1781 patients without lymphedema, with the lymphedema status of each patient confirmed by clinicians. The data for each patient included: (1) a complete blood count (CBC) test, (2) a serum test, and (3) therapy information. We used various machine learning algorithms (i.e. random forest, gradient boosting, decision tree, logistic regression, and artificial neural network) to develop predictive models on the training dataset (i.e. 80% of the data) and evaluated the models on the external validation dataset (i.e. 20% of the data). After selecting the best predictive models, we created a web application to aid medical doctors and clinicians in the rapid screening of lymphedema patients. A dataset of 2137 patients was assembled from Seoul National University Bundang Hospital. Predictive models based on the random forest algorithm exhibited satisfactory performance (balanced accuracy = 87.0 ± 0.7%, sensitivity = 84.3 ± 0.6%, specificity = 89.1 ± 1.5%, precision = 97.4 ± 0.7%, F1 score = 90.4 ± 0.4%, and AUC = 0.931 ± 0.007). We developed a web application to facilitate the swift screening of lymphedema among medical practitioners: https://snubhtxt.shinyapps.io/SNUBH_Lymphedema . Our study introduces a novel tool for the early detection of lymphedema and establishes the foundation for future investigations into predicting different stages of the condition.
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Affiliation(s)
- Xuan-Tung Trinh
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea
| | - Pham Ngoc Chien
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea
| | - Nguyen-Van Long
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea
| | - Le Thi Van Anh
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea
| | - Nguyen Ngan Giang
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea
- Department of Medical Device Development, College of Medicine, Seoul National University, Seoul, 03080, Republic of Korea
| | - Sun-Young Nam
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea.
| | - Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea.
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Gülören G, Doğan Y, Özgül S, Gürşen C, Çinar GN, İpekten F, Akbayrak T. Acute Effects of Remedial Exercises with and without Compression on Breast-Cancer-Related Lymphedema. Healthcare (Basel) 2023; 11:2949. [PMID: 37998441 PMCID: PMC10671079 DOI: 10.3390/healthcare11222949] [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: 09/21/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
Remedial exercises are an important part of the treatment for lymphedema, but there is little evidence to support the acute effects of remedial exercises with or without compression. The aim of this study was to investigate whether and how daily (performed within 24 h) remedial exercises with and without compression bandaging acutely affect the severity of lymphedema and its symptoms in breast-cancer-related lymphedema (BCRL). In total, 34 patients with BCRL completed three sets of remedial exercises (within 24 h) with and without compression bandaging in a randomized order separated by a 3-day wash-out period. The severity of lymphedema and extracellular water ratio were assessed before and 24 h post exercise by using bilateral circumferential measurements and bioimpedance spectroscopy (in L-dex score), respectively, and the severity of self-reported symptoms (swelling, heaviness, and tightness) was assessed using a visual analogue scale. While there was no difference in all outcomes at 24 h post exercise without compression (p > 0.05), all outcomes decreased significantly compared to baseline at 24 h after the exercise with compression (p < 0.001). The remedial exercises performed in the absence of compression within 24 h do not acutely increase the lymphedema and symptoms in BCRL. These are important preliminary findings, which can be used to inform future prospective evaluation of the long-term effects of remedial exercise performed without compression.
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Affiliation(s)
- Gülbala Gülören
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara 06100, Turkey; (Y.D.); (S.Ö.); (C.G.); (G.N.Ç.); (T.A.)
| | - Yahya Doğan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara 06100, Turkey; (Y.D.); (S.Ö.); (C.G.); (G.N.Ç.); (T.A.)
| | - Serap Özgül
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara 06100, Turkey; (Y.D.); (S.Ö.); (C.G.); (G.N.Ç.); (T.A.)
| | - Ceren Gürşen
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara 06100, Turkey; (Y.D.); (S.Ö.); (C.G.); (G.N.Ç.); (T.A.)
| | - Gamze Nalan Çinar
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara 06100, Turkey; (Y.D.); (S.Ö.); (C.G.); (G.N.Ç.); (T.A.)
| | - Funda İpekten
- Department of Biostatistics, Faculty of Medicine, Erciyes University, Kayseri 38039, Turkey;
| | - Türkan Akbayrak
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara 06100, Turkey; (Y.D.); (S.Ö.); (C.G.); (G.N.Ç.); (T.A.)
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Toprak Celenay S, Barut O, Bayramoglu Demirdogen E, Cigdem Karacay B, Ozer Kaya D. Health-related physical fitness parameters in women with breast cancer-related lymphedema: a case-control study. Support Care Cancer 2023; 31:667. [PMID: 37921928 DOI: 10.1007/s00520-023-08139-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/23/2023] [Indexed: 11/05/2023]
Abstract
PURPOSE This study aimed to compare health-related physical fitness parameters of women with breast cancer-related lymphedema (BCRL) to a matched control group. METHODS Thirty women with unilateral BCRL (lymphedema group, age = 55.00 (40.00-65.00) years) and 32 healthy women (control group, age = 49.00 (44.00-64.00) years) were included. Cardiorespiratory fitness with the UKK 2-km walk test, grip strength with a hand dynamometer, trunk muscle endurance with the McGill trunk muscle endurance tests, flexibility with the sit and reach test, body composition with a body composition analyzer, and waist-to-hip ratio were assessed. RESULTS In the lymphedema group, 36.7% of women had mild lymphedema, 36.7% had moderate, and 26.7% had severe lymphedema. It was found that maximal oxygen consumption, physical fitness index, grip strength, trunk extensor and lateral flexor muscle endurance, and flexibility scores were higher in the control group than in the lymphedema group (p < 0.05). In addition, body mass index, body fat percentage, and waist-to-hip ratio were found to be lower in the control group compared to the lymphedema group (p < 0.05). There was no significant difference between the trunk flexor muscle endurance scores (p > 0.05). CONCLUSIONS It was found that the health-related physical fitness parameters were adversely affected in women with BCRL compared to healthy women. The changes of physical fitness may be important for the assessment and the treatment of BCRL.
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Affiliation(s)
- Seyda Toprak Celenay
- Ankara Yildirim Beyazit University, Health Sciences Faculty, Department of Physiotherapy and Rehabilitation, Ankara, Turkey.
| | - Ozge Barut
- Kirsehir Ahi Evran University, Rectorship, Pilot University Coordinatorship of Health, Kirsehir, Turkey
| | | | - Basak Cigdem Karacay
- Kirsehir Ahi Evran University, Faculty of Medicine, Department of Physical Therapy and Rehabilitation, Kirsehir, Turkey
| | - Derya Ozer Kaya
- Izmir Katip Celebi University, Health Sciences Faculty, Department of Physiotherapy and Rehabilitation, Izmir, Turkey
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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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38
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Shen A, Wu P, Qiang W, Fu X, Zhu F, Pang L, Wang F, Lu Q. Factors associated with lymphedema self-management behaviours among breast cancer survivors: A cross-sectional study. J Clin Nurs 2023; 32:7330-7345. [PMID: 37491890 DOI: 10.1111/jocn.16833] [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: 07/18/2022] [Revised: 05/05/2023] [Accepted: 07/10/2023] [Indexed: 07/27/2023]
Abstract
AIMS AND OBJECTIVES The purpose of this empirical study was to explore the current status and associated factors of lymphedema self-management behaviours among Chinese breast cancer survivors. BACKGROUND Breast cancer-related lymphedema is a lifetime concern for survivors and is currently incurable. Lifetime lymphedema self-management takes a significant role in preventing development and progression of lymphedema. Understanding influencing factors of lymphedema self-management behaviours can help to develop targeted intervention programs. DESIGN A multicentre cross-sectional study. METHODS From December 2021 to April 2022, a convenience sample of 586 participants were recruited at four tertiary hospitals in four cities in China. Self-reported questionnaires were used to measure socio-demographic characteristics, disease-and treatment-related characteristics, lymphedema self-management behaviours, lymphedema knowledge, illness perception, self-efficacy, self-regulation and social support. Descriptive analysis, bivariate analysis and hierarchical multiple regression were conducted. This study was registered at Chinese Clinical Trial Registry (ChiCTR2200057084), and was reported followed the STROBE checklist. RESULTS Breast cancer survivors reported moderate level of lymphedema self-management behaviours. Promotion of lymph reflux management was ranked the least performed self-management behaviours, while the affected limb protection management ranked the most. 36.2% of self-management behaviours was explained by exercise regularly, level of attention on lymphedema prevention, unclear about the tumour stage (vs. stage I), knowledge, self-efficacy, emotional illness representation and social support. CONCLUSIONS Lymphedema self-management behaviours of breast cancer survivors was insufficient. Performance of lymphedema self-management varied with different socio-demographic characteristics, along with different levels of knowledge, self-efficacy, perception and social support. All these identified predictors should be reckoned in assessment and intervention of lymphedema self-management behaviours. RELEVANCE TO CLINICAL PRACTICE This study addressed that breast cancer survivors' lymphedema self-management behaviours should be promoted. Focusing on identified predictors, further lymphedema surveillance, knowledge education or social facilitation programs are recommended to enhance their self-management performance and adherence.
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Affiliation(s)
- Aomei Shen
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Peipei Wu
- Lymphedema Clinic, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Wanmin Qiang
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Xin Fu
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Fei Zhu
- School of Nursing, Hebei University, Baoding, China
| | - Lisha Pang
- School of Nursing, Hebei University, Baoding, China
| | - Fangfang Wang
- Department of Nursing, Shanxi Provincial Cancer Hospital, Taiyuan, China
| | - Qian Lu
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
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Montagna G, Barrio AV. Managing the Morbidity: Individualizing Risk Assessment, Diagnosis, and Treatment Options for Upper Extremity Lymphedema. Surg Oncol Clin N Am 2023; 32:705-724. [PMID: 37714638 DOI: 10.1016/j.soc.2023.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
In the setting where breast cancer-related lymphedema (BCRL) remains a feared and common complication of breast cancer, here we review important factors for the development, diagnosis, prevention, and treatment of BCRL. We find that race/ethnicity affect BCRL development risk, that future studies should focus on understanding the biological reasons behind the increased susceptibility of certain racial minorities to BCRL, that surveillance, early detection, exercise programs, and arm compression can reduce the risk of BCRL, and that surgical techniques to preserve and restore lymphatic drainage being evaluated in randomized trials may become transformative in reducing BCRL risk for high-risk patients.
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Affiliation(s)
- Giacomo Montagna
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA
| | - Andrea V Barrio
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA.
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Anik AR, Hasan K, Islam MM, Hasan MM, Ali MF, Das SK. Non-Invasive Portable Technologies for Monitoring Breast Cancer Related Lymphedema to Facilitate Telehealth: A Scoping Review. IEEE J Biomed Health Inform 2023; 27:4524-4535. [PMID: 37247315 DOI: 10.1109/jbhi.2023.3280196] [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: 05/31/2023]
Abstract
Breast cancer related lymphedema (BCRL) is a common, debilitating condition that can affect up to one in five breast cancer surviving patients (BCSP). BCRL can significantly reduce the quality of life (QOL) of patients and poses a significant challenge to healthcare providers. Early detection and continuous monitoring of lymphedema is crucial for the development of client-centered treatment plans for post-cancer surgery patients. Therefore, this comprehensive scoping review aimed to investigate the current technology methods used for the remote monitoring of BCRL and their potential to facilitate telehealth in the treatment of lymphedema. Initially, five electronic databases were systematically searched and analyzed following the PRISMA flow diagram. Studies were included, specifically if they provided data on the effectiveness of the intervention and were designed for the remote monitoring of BCRL. A total of 25 included studies reported 18 technological solutions to remotely monitor BCRL with significant methodological variation. Additionally, the technologies were categorized by method of detection and wearability. The findings of this comprehensive scoping review indicate that state-of-the-art commercial technologies were found to be more appropriate for clinical use than home monitoring, with portable 3D imaging tools being popular (SD 53.40) and accurate (correlation 0.9, p 0.05) for evaluating lymphedema in both clinic and home settings with expert practitioners and therapists. However, wearable technologies showed the most future potential for accessible and clinical long-term lymphedema management with positive telehealth outcomes. In conclusion, the absence of a viable telehealth device highlights the need for urgent research to develop a wearable device that can effectively track BCRL and facilitate remote monitoring, ultimately improving the quality of life for patients following post-cancer treatment.
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Duygu-Yildiz E, Bakar Y, Hizal M. The effect of complex decongestive physiotherapy applied with different compression pressures on skin and subcutaneous tissue thickness in individuals with breast cancer-related lymphedema: a double-blinded randomized comparison trial. Support Care Cancer 2023; 31:383. [PMID: 37285046 DOI: 10.1007/s00520-023-07843-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/24/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE The aim of this study was to evaluate the effect of compression bandage applied with different pressures on the skin and subcutaneous thickness in individuals with breast cancer-related lymphedema (BCRL). METHODS 21 individuals with stage 2 unilateral BCRL participated in the study. Individuals were randomly allocated into two groups as low-pressure bandage (20-30 mmHg) (n: 11) and high-pressure bandage (45-55 mmHg) (n: 10). Skin and subcutaneous tissue thickness, extremity volume, sleep quality, treatment benefit, and comfort were evaluated by ultrasound from 6 reference points (as hand dorsum, wrist volar, forearm volar, arm volar, forearm dorsum, and arm dorsum), volumetric measurement, Pittsburgh Sleep Quality Index, Patient Benefit Index-Lymphedema, and visual analog scale, respectively. Complex decongestive physiotherapy was applied to both groups. Compression bandage was applied according to their group. Individuals were evaluated at the baseline, 1st session, 10th session, 20th session, and at 3-month follow-up. RESULTS Skin thickness decreased significantly in the volar reference points of the extremity in the high-pressure bandage group (p = 0.004, p = 0.031, and p = 0.003). Subcutaneous tissue thickness significantly decreased at all reference points in the high-pressure bandage group (p < 0.05). In the low-pressure bandage group, skin thickness only decreased in the forearm dorsum and the arm dorsum (p = 0.002, p = 0.035) and subcutaneous tissue thickness changed for all points (p < 0.05) except for hand and arm dorsum (p = 0.064, p = 0.236). Edema decreased in a shorter time in the high-pressure bandage group (p < 0.001). No significant differences were found in sleep quality, treatment benefit, and comfort for both groups (p = 0.316, p = 0.300, and p = 0.557, respectively). CONCLUSION High pressure was more effective in reducing subcutaneous tissue thickness in the dorsum of hand and arm. The usage of high-pressure can be recommended especially in cases which have edema in the dorsum of hand and arm which is difficult to resolve. Also, high-pressure bandage can provide faster edema resolution and can be used in rapid volume reduction as desired. Treatment outcomes may improve with high-pressure bandage without any impairment in comfort, sleep quality, and treatment benefit. TRIAL REGISTRATION NUMBER AND DATE NCT05660590, 12/26/2022 retrospectively registered.
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Affiliation(s)
- Elif Duygu-Yildiz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bolu Abant Izzet Baysal University, Bolu, Turkey.
| | - Yesim Bakar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Bakircay University, Izmir, Turkey
| | - Mustafa Hizal
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Bolu Abant Izzet Baysal University, Bolu, Turkey
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Bustos VP, Friedman R, Pardo JA, Granoff M, Fu MR, Singhal D. Tracking Symptoms of Patients With Lymphedema Before and After Power-Assisted Liposuction Surgery. Ann Plast Surg 2023; 90:616-620. [PMID: 36881732 DOI: 10.1097/sap.0000000000003430] [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: 03/09/2023]
Abstract
PURPOSE Lymphedema negatively impacts patients from a psychosocial standpoint and consequently affects patient's quality of life. Debulking procedures using power-assisted liposuction (PAL) are currently deemed an effective treatment for fat-dominant lymphedema and improves anthropometric measurements as well as quality of life. However, there have been no studies specifically evaluating changes in symptoms related to lymphedema after PAL. An understanding of how symptoms change after this procedure would be valuable for preoperative counseling and to guide patient expectations. METHODS A cross-sectional study was performed in patients with extremity lymphedema who underwent PAL from January 2018 to December 2020 at a tertiary care facility. A retrospective chart review and follow-up phone survey were conducted to compare signs and symptoms related to lymphedema before and after PAL. RESULTS Forty-five patients were included in this study. Of these, 27 patients (60%) underwent upper extremity PAL and 18 patients (40%) underwent lower extremity PAL. The mean follow-up time was 15.5±7.9 months. After PAL, patients with upper extremity lymphedema reported having resolved heaviness (44%), as well as improved achiness (79%) and swelling (78%). In patients with lower extremity lymphedema, they reported having improved all signs and symptoms, particularly swelling (78%), tightness (72%), and achiness (71%). CONCLUSIONS In patients with fat-dominant lymphedema, PAL positively impacts patient-reported outcomes in a sustained fashion over time. Continuous surveillance of postoperative studies is required to elucidate factors independently associated with the outcomes found in our study. Moreover, further studies using a mixed method approach will help us better understand patient's expectations to achieve informed decision and adequate treatment goals.
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Affiliation(s)
- Valeria P Bustos
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Rosie Friedman
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jaime A Pardo
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Melisa Granoff
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Mei R Fu
- School of Nursing-Camden, Rutgers University, Camden, NJ
| | - Dhruv Singhal
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Hirsch T, Friedman R, Granoff M, Tsai LL, Critchlow JF, Sharma R, Singhal D. Omental vascularized lymph node transplant for the treatment of breast lymphedema: A case report. Microsurgery 2023; 43:387-391. [PMID: 36645346 PMCID: PMC10202086 DOI: 10.1002/micr.31004] [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: 07/29/2022] [Revised: 11/21/2022] [Accepted: 12/22/2022] [Indexed: 01/17/2023]
Abstract
Breast lymphedema is a type of breast cancer related lymphedema that leads to significant discomfort and negative impact on body image. Conservative therapy and lymphovenous bypass have been previously described as possible treatment methods for breast lymphedema, however, a unified approach to treatment is lacking. The current report describes a case of breast lymphedema successfully treated with vascularized lymph node transfer (VLNT) after failed attempt at management with conservative therapy. The patient is a 48-year-old female with right-sided breast cancer who underwent breast conservation therapy in 2015 and subsequently developed pain and swelling of the right breast. The diagnosis of breast lymphedema was supported by clinical evaluation as well as MRI, lymphoscintigraphy, and lymphography. In consultation with a breast surgeon, breast lymphedema was determined not to be an indication for mastectomy. The patient was offered and underwent an omental VLNT to the right breast. A 20 cm segment of omentum with associated gastroepiploic vessels and lymph nodes was harvested, transferred to the right axilla and gastroepiploic vessels were anastomosed to the recipient thoracodorsal vessels. The patient tolerated the procedure well and there were no complications. Additional donor sites were considered, such as the groin and submental regions, but an omental flap was favored in this case because of the lower risk of donor site lymphedema. In the years following, the patient reported significant improvement in symptoms as well as objective reduction of edema on MRI. We propose the consideration of VLNT for breast lymphedema refractory to other methods of management.
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Affiliation(s)
- Thomas Hirsch
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rosie Friedman
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Melisa Granoff
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Leo L. Tsai
- Division of Magnetic Resonance Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jonathan F. Critchlow
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ranjna Sharma
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Dhruv Singhal
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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44
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Kim Y, Park EY, Lee H. The effect of myofascial release in patients with breast cancer-related lymphedema: a cross-over randomized controlled trial. Eur J Phys Rehabil Med 2023; 59:85-93. [PMID: 36637800 PMCID: PMC10035446 DOI: 10.23736/s1973-9087.22.07698-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AIM This study aimed to compare the effects of myofascial release (MFR) on upper extremity volume in patients with breast cancer-related lymphedema (BCRL). DESIGN A randomized, single-blinded, cross-over, controlled trial. SETTING An outpatient rehabilitation clinical setting. POPULATION Thirty patients with BCRL. METHODS Within a crossover design with randomized treatment sequences, fifteen subjects received MFR for 4 weeks, followed by 4 weeks of washout period, and then received placebo MFR and the other fifteen subjects received interventions in the reverse order. Each session had a 60 min process including either MFR or placebo MFR for 30 min, followed by complete decongestive therapy for 30 min twice a week. Upper limb volume as the primary outcome and subjective pain, shoulder range of motion (ROM), chest mobility, shoulder function, and quality of life as secondary outcomes were assessed before and at the end of each intervention period. RESULTS There were significant differences in upper limb volume after both MFR and placebo MFR (P<0.05) while no significant difference between MFR and placebo MFR treatments was found (P>0.05). MFR-based treatment also achieved a greater improvement than placebo MFR-based treatment in subjective pain and shoulder ROM (P<0.05), except for internal rotation, and shoulder function. CONCLUSIONS MFR-based treatment showed clinical improvement in shoulder function, induced by decreased edema volume and pain, and improved ROM and chest mobility. However, a further study with parallel randomized controlled trials to confirm what was achieved in the present study. CLINICAL REHABILITATION IMPACT MFR-based treatment is considered an important part of BCRL rehabilitation. Moreover, MFR-based treatment may be safe for patients with BCRL.
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Affiliation(s)
- Yena Kim
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon, South Korea
| | - Eun Y Park
- College of Nursing, Gachon University, Incheon, South Korea
| | - Haneul Lee
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon, South Korea -
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45
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Guliyeva G, Huayllani MT, Boczar D, Avila FR, Lu X, Forte AJ. Age as a risk factor for breast cancer-related lymphedema: a systematic review. J Cancer Surviv 2023; 17:246-253. [PMID: 33486706 DOI: 10.1007/s11764-021-00994-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/15/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Breast cancer-related lymphedema (BCRL) has been widely reported in the medical literature. Various patient characteristics, including age, have been investigated as possible risk factors for this disease entity, but the existence and direction of the cause-and-effect relationship are still unclear. In this review, we aimed to evaluate the effect of age on development of BRCL. METHODS PubMed, Scopus, and Ovid MEDLINE were searched for relevant articles, which were found to be published between 1974 and 2020. RESULTS Twenty-six studies involving 19,396 patients were selected. The average age of patients was 54.9. 26 studies were included in the final analysis, and 13 articles reported no association between age and BCRL development. CONCLUSIONS Though studies presented different findings, the majority did not identify age as a risk factor for development of lymphedema. However, the level of evidence of individual studies was low. In this article, we call attention to the need for uniform design of lymphedema studies and diagnosis. IMPLICATIONS FOR CANCER SURVIVORS All patients should be informed and screened regularly for lymphedema during and after the treatment independent of their age.
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Affiliation(s)
- Gunel Guliyeva
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Maria T Huayllani
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Daniel Boczar
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Francisco R Avila
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Xiaona Lu
- Section of Plastic Surgery, Yale University, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Antonio Jorge Forte
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
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Vang AR, Shaitelman SF, Rasmussen JC, Chan W, Sevick-Muraca EM, Aldrich MB. Plasma Cytokines/Chemokines as Predictive Biomarkers for Lymphedema in Breast Cancer Patients. Cancers (Basel) 2023; 15:676. [PMID: 36765631 PMCID: PMC9913278 DOI: 10.3390/cancers15030676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 01/25/2023] Open
Abstract
Breast cancer-related lymphedema (BCRL) occurs in ~ 40% of patients after axillary lymph node dissection (ALND), radiation therapy (RT), or chemotherapy. First-line palliative treatment utilizes compression garments and specialized massage. Reparative microsurgeries have emerged as a second-line treatment, yet both compression and surgical therapy are most effective at early stages of LE development. Identifying patients at the highest risk for BCRL would allow earlier, more effective treatment. Perometric arm volume measurements, near-infrared fluorescent lymphatic imaging (NIRF-LI) data, and blood were collected between 2016 and 2021 for 40 study subjects undergoing treatment for breast cancer. Plasma samples were evaluated using MILLIPLEX human cytokine/chemokine panels at pre-ALND and at 12 months post-RT. A Mann-Whitney t-test showed that G-CSF, GM-CSF, IFN-2α, IL-10, IL-12p40, IL-15, IL-17A, IL-1β, IL-2, IL-3, IL-6, and MIP-1β were significantly higher at pre-ALND in those presenting with BCRL at 12 months post-RT. MIP-1β and IL-6 were significantly higher at pre-ALND in those who developed dermal backflow, but no BCRL, at 12 months post-RT. Plasma IL-15, IL-3, and MIP-1β were elevated at 12 months after RT in those with clinical BCRL. These findings establish BCRL as a perpetual inflammatory disorder, and suggest the use of plasma cytokine/chemokine levels to predict those at highest risk.
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Affiliation(s)
- Anna R. Vang
- UT Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, Houston, TX 77030, USA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA
| | | | - John C. Rasmussen
- UT Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, Houston, TX 77030, USA
| | - Wenyaw Chan
- UT Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, Houston, TX 77030, USA
| | - Eva M. Sevick-Muraca
- UT Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, Houston, TX 77030, USA
| | - Melissa B. Aldrich
- UT Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, Houston, TX 77030, USA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA
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Cheon H, Gelvosa MN, Kim SA, Song H, Jeon JY. Lymphatic channel sheet of polydimethylsiloxane for preventing secondary lymphedema in the rat upper limb model. Bioeng Transl Med 2023; 8:e10371. [PMID: 36684082 PMCID: PMC9842043 DOI: 10.1002/btm2.10371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/20/2022] [Accepted: 06/12/2022] [Indexed: 01/25/2023] Open
Abstract
Secondary lymphedema is a severe complication of cancer treatment, but there is no effective curative method yet. Lymph node dissection and radiation therapy for cancer treatment may lead to secondary lymphedema, which is a chronic disease induced by malfunction of lymphatic flow. The lymphatic channel sheet (LCS) is an artificial micro-fluidic structure that was fabricated with polydimethylsiloxane to maintain lymphatic flow and induce lymphangiogenesis. The structure has two-dimensional multichannels that increase the probability of lymphangiogenesis and allow for relatively easy application. We verified the efficacy of the lymphatic channel sheet through macroscopic and microscopic observation in small animal models, which underwent brachial lymph node dissection and irradiation. The lymphatic channel sheet enabled the successful transport of lymphatic fluid from the distal to the proximal area in place of the removed brachial lymph nodes. It prevented swelling and abnormal lymphatic drainage during the follow-up period. Lymphangiogenesis was also identified inside the channel by histological analysis after 8 weeks. According to these experimental results, we attest to the roles of the lymphatic channel sheet as a lymphatic pathway and scaffold in the rat upper limb model of secondary lymphedema. The lymphatic channel sheet maintained lymphatic flow after lymph node dissection and irradiation in an environment where lymph flow is cut off. It also relieved symptoms of secondary lymphedema by providing a lymph-friendly space and inducing lymphangiogenesis.
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Affiliation(s)
- Hwayeong Cheon
- Biomedical Engineering Research CenterAsan Institute for Life Sciences, Asan Medical CenterSeoulRepublic of Korea
| | - Ma. Nessa Gelvosa
- Department of Rehabilitation MedicineAsan Medical Center, University of Ulsan College of MedicineSeoulRepublic of Korea
| | - Sang Ah Kim
- Department of Rehabilitation MedicineAsan Medical Center, University of Ulsan College of MedicineSeoulRepublic of Korea
| | - Ho‐Young Song
- Department of Minimal‐Invasive InterventionThe Affiliated Cancer Hospital of Zhengzhou UniversityZhengzhou CityChina
| | - Jae Yong Jeon
- Department of Rehabilitation MedicineAsan Medical Center, University of Ulsan College of MedicineSeoulRepublic of Korea
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Invited Commentary from the Authors of: Kuruvilla AS, et al. Risk Factors Associated With Postmastectomy Breast Cancer Lymphedema: Amulticenter Retrospective Analysis. Ann Plast Surg 2022; 89:716-717. [DOI: 10.1097/sap.0000000000003311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rockson SG, Whitworth PW, Cooper A, Kania S, Karnofel H, Nguyen M, Shadduck K, Gingerich P, Armer J. Safety and effectiveness of a novel nonpneumatic active compression device for treating breast cancer-related lymphedema: A multicenter randomized, crossover trial (NILE). J Vasc Surg Venous Lymphat Disord 2022; 10:1359-1366.e1. [PMID: 35952956 DOI: 10.1016/j.jvsv.2022.06.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/06/2022] [Accepted: 06/15/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Advanced pneumatic compression devices (APCDs) have been shown to be an effective intervention for lymphedema when used as part of a self-care maintenance treatment regimen. However, adherence to self-care has been poor, and APCDs require patients to be immobile during treatment. We evaluated the safety and efficacy of a novel nonpneumatic compression device (NPCD) for treating lymphedema vs an APCD. METHODS A randomized, crossover head-to-head investigation was performed at five U.S. sites in 2021. The patients had been randomized to either the NPCD or a commercially available APCD. The patients used the randomly assigned initial device for 28 days with a 4-week washout period before a comparable 28-day use of the second device. RESULTS Data from 50 adult women with unilateral breast cancer-related lymphedema were analyzed. Compared with the APCD, the NPCD was associated with a greater mean reduction in the limb edema volume (64.6% vs 27.7%; P < .001), significantly greater mean improvements in quality of life scores, greater adherence (95.6% vs 49.8%; P < .001), and greater satisfaction with the device (90% vs 14%; P < .001). The patients indicated that use of the NPCD facilitated exercise and was convenient for travel. No adverse events were reported. CONCLUSIONS The results have shown that the novel NPCD is an effective maintenance treatment for reducing the limb volume in patients with breast cancer-related lymphedema. The NPCD device was more effective than an APCD and resulted in greater adherence to self-care interventions and greater patient satisfaction.
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Affiliation(s)
- Stanley G Rockson
- Falk Cardiovascular Research Center, Stanford University, Stanford, CA.
| | | | | | - Sarah Kania
- Good Samaritan Hospital, Mission Oaks Campus, Los Gatos, CA
| | | | | | | | | | - Jane Armer
- Ellis Fischel Cancer Center, University of Missouri, Columbia, MO
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50
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Nurlaila I, Roh K, Yeom CH, Kang H, Lee S. Acquired lymphedema: Molecular contributors and future directions for developing intervention strategies. Front Pharmacol 2022; 13:873650. [PMID: 36386144 PMCID: PMC9640931 DOI: 10.3389/fphar.2022.873650] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 10/13/2022] [Indexed: 08/05/2023] Open
Abstract
Lymphedema is a debilitating chronic disease that mostly develops as an adverse reaction to cancer treatment modalities such as chemotherapy, surgery, and radiotherapy. Lymphedema also appears to be a deteriorating consequence of roundworm infections, as best represented by filariasis. According to its origin, lymphedema is classified as primary lymphedema and acquired lymphedema. The latter is an acquired condition that, hitherto, received a considerably low attention owing to the less number of fatal cases been reported. Notably, despite the low mortality rate in lymphedema, it has been widely reported to reduce the disease-free survival and thus the quality of life of affected patients. Hence, in this review, we focused on acquired lymphedema and orchestration of molecular interplays associated with either stimulation or inhibition of lymphedema development that were, in vast majority, clearly depicted in animal models with their specific and distinct technical approaches. We also discussed some recent progress made in phytochemical-based anti-lymphedema intervention strategies and the specific mechanisms underlying their anti-lymphedema properties. This review is crucial to understand not only the comprehensive aspects of the disease but also the future directions of the intervention strategies that can address the quality of life of affected patients rather than alleviating apparent symptoms only.
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Affiliation(s)
- Ika Nurlaila
- Department of Integrative Biotechnology, Sungkyunkwan University, Suwon, South Korea
- Department of Vaccine and Drugs, The National Research and Innovation Agency, Jakarta, Indonesia
| | - Kangsan Roh
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Division of Cardiology and Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | | | - Hee Kang
- Humanitas College, Kyung Hee University, Yongin, South Korea
| | - Sukchan Lee
- Department of Integrative Biotechnology, Sungkyunkwan University, Suwon, South Korea
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