Abstract
PurposesThe purposes of this study were to investigate the incidence of lymphedema in patients with breast cancer during and after adjuvant treatment with docetaxel, doxorubicin, and cyclophosphamide (TAC), to identify predictors for development of lymphedema, and to describe consequences in daily life in relation to lymphedema.MethodsThis is a prospective study with measurements before chemotherapy (T0), during chemotherapy before cycle 2 (T1), cycle 4 (T2), and 1 month after completion of treatment (T3). Volume change was monitored using tape measurements. Lymphedema was defined as ≥ 10% volume difference. Linear mixed-effect models were estimated to analyze differences in arm volume and consequences in daily life (total score and domain scores of the Lymph-International Classification of Functioning (ICF) questionnaire) over time and to identify treatment and patient characteristics as predictors for changes in volume.ResultsForty-eight patients completed all measurements. Volume did not change during TAC treatment. One month after treatment, volume was significantly increased compared to T0-T2, and 12 patients (25%) had developed lymphedema. Axillary lymph node dissection was associated with lymphedema (ES 2.9, 95% CI 0.02–5.7; p < 0.05). In patients with and without lymphedema, 1 month after completion (T3), the Lymph-ICF questionnaire showed significant limitations in physical function compared to T0-T2. In patients with lymphedema at T3, a significant association between volume and total score on the Lymph-ICF questionnaire on physical function and mobility activities was observed.ConclusionsOne month after treatment in 12 patients (25%), volume difference increased over 10%. Axillary lymph node dissection was predictive for development of lymphedema. All patients, but more patients with lymphedema, perceived difficulties in activities in daily life after treatment.
Highlights
Patients with lymphedema suffer from swelling and from other impairments in functions and limitations in activities in daily life, as described in the core set lymphedema based on the International Classification of Functioning (ICF) [2]
The estimated incidence of lymphedema 5 years after breast cancer treatment is 16.6%, and increase in arm volume is related to axillary lymph node dissection, the number of Support Care Cancer (2018) 26:1383–1392 lymph nodes dissected, mastectomy, radiotherapy to the axilla, and a body mass index over 25 kg/m2 [1, 6]
The purpose of this study is to answer the following questions: (1) what is the change in arm volume during adjuvant treatment with TAC, and do patients develop lymphedema as defined by a volume difference between upper extremities of ≥ 10%, (2) which predictors for development of lymphedema can be identified, and (3) which consequences in daily life are related to the presence of lymphedema?
Summary
Lymphedema is a common side effect of breast cancer treatment, usually starting within 2 years after treatment [1]. Lymphedema is defined as a volume difference between upper extremities of ≥ 10% [3], resulting in limitations in arm use during daily activities, emotional distress, restrictions in social activities, and limited work abilities [2, 4, 5]. The estimated incidence of lymphedema 5 years after breast cancer treatment is 16.6%, and increase in arm volume is related to axillary lymph node dissection, the number of Support Care Cancer (2018) 26:1383–1392 lymph nodes dissected, mastectomy, radiotherapy to the axilla, and a body mass index over 25 kg/m2 [1, 6]. Adjuvant chemotherapy has been shown to improve survival in patients with early-stage breast cancer. A frequently used third generation regimen consists of docetaxel, doxorubicin, and cyclophosphamide (TAC) [16]
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