Abstract
Background: Cancer treatment-related lymphedema (CTRL) affects patients physically, psychologically and emotionally, and remains a significant quality of life issue among patients with cancer. Reliable methods to measure changes in lymphedema are required for early detection, acute intensive treatment, and long-term management. Here, we evaluated the use of bioimpedance analysis (BIA) as a tool to measure lymphedema before and after treatment.Patients and Methods: Patients with CTRL who were admitted to a secondary university hospital between October 2017 and July 2018 for complex decongestive therapy (CDT) were eligible for this prospective cohort study. Circumferential measure (CM) and BIA were used to evaluate lymphedema at admission (initial) and before discharge (follow-up, FU). Volume was calculated from the CM using the truncated cone formula. The inter-limb ratios (ILRs) of the circumference, volume, and impedance were also calculated as the unaffected limb to affected limb. Each parameter before and after treatment and correlations between parameters also were analyzed.Results: A total of 29 patients (12 upper- and 17 lower-extremity CTRL) completed were included in this analysis. Absolute value and the ILRs of circumference, volume or impedance, and extracellular water/total body water (ECW/TBW) were significantly improved at FU (p < 0.01, p < 0.05). The initial and FU absolute values, ILRs, ECW/TBW correlated significantly with each other (p < 0.01, p < 0.05). The cutoff values of ECW/TBW for moderate and severe degree of CTRL were 0.3855 and 0.3955, respectively. The changes of ILRs between initial and FU assessments were significantly different among three groups according to lymphedema severity (p < 0.01, p < 0.05).Conclusions: BIA data correlates significantly with clinical measurement, and therefore can be a practical tool in monitoring outcome measure after lymphedema treatment. In addition, BIA is more sensitive to subtle changes in lymphedema, and therefore can be useful for the long-term maintenance of lymphedema.
Highlights
As survival among patients with breast and gynecological cancers has improved over the past few decades [1,2,3], greater emphasis has been directed toward long-term cancer treatment sequelae, such as lymphedema
The reported incidence varies across studies, 13–42% of patients with breast cancer and 20–50% of patients with gynecologic cancer are reported to suffer from lymphedema [4,5,6,7,8]
A measuring tape is used for circumferential measurement (CM) of the affected limb
Summary
As survival among patients with breast and gynecological cancers has improved over the past few decades [1,2,3], greater emphasis has been directed toward long-term cancer treatment sequelae, such as lymphedema. Due to its significant impact on quality of life [9,10,11], early detection and intensive treatment of CTRL is needed. There are major concerns with CM, including the variance in inter-rater and intra-rater reliability and the difficulty in detecting early lymphedema changes. Imaging methods, such as lymphoscintigraphy and magnetic resonance (MR) lymphangiography, have several drawbacks, including pain, cost, and time. Cancer treatment-related lymphedema (CTRL) affects patients physically, psychologically and emotionally, and remains a significant quality of life issue among patients with cancer. Reliable methods to measure changes in lymphedema are required for early detection, acute intensive treatment, and long-term management. We evaluated the use of bioimpedance analysis (BIA) as a tool to measure lymphedema before and after treatment
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