Breast Cancer Lymphedema Research Articles

A virtual environment to evaluate the arm volume for lymphedema affected patients

Background and ObjectiveThe paper presents a novel procedure based on 3D scanning and 3D modelling to automatically assess linear and volumetric measurements of an arm and to be further applied to patients affected by post breast cancer lymphedema. The aim is the creation of a virtual platform easily usable by medical personnel to get more objective evaluations during the lymphedema treatment. MethodsThe procedure is based on the 3D scanning of the arm using the Occipital Structure Sensor and an ad-hoc developed application, named Lym 3DLab. Lym 3DLab emulates the traditional measurement methods, which consist in taking manual circumference measurements or using the water displacement method. These measurements are also used to design the compression stockings, the typical orthopaedic device used for lymphedema treatment. A validation test has been performed to compare the measurements computed by Lym 3DLab with both water displacement and manual circumference measurements. Eight volunteers have been involved who are not affected by lymphedema. Furthermore, a specific usability test has been performed to evaluate the 3D scanning procedure by involving four physiotherapists. ResultsThe comparison between the volumes has highlighted how all the 3D acquired models have their volumes inside a range of acceptability. This range has been defined by considering the sensitivity error of the tape measure used to measure the water displacement. The comparison between the perimeters of cross sections computed with Lym 3DLab and the circumference measurements has shown results that are very accurate with an average difference of 2 mm. The measure errors have been considered negligible by the medical personnel who have evaluated the proposed procedure more accurate than the traditional ones. The test with physiotherapists has shown a high level of usability of the whole virtual environment, but the 3D scanning procedure requires an appropriate training of the personnel to make the 3D acquisition as fast and efficient as possible. ConclusionsThe achieved results and the physiotherapists’ feedback allow planning a future test with patients affected by lymphedema in collaboration with the hospital. A further test has been planned to use the computed measurements to design orthopaedic compression stockings.

Exercise And Compression Therapy To Improve Lymphedema In Breast Cancer: A Pilot Randomized Controlled Trial

Breast cancer related lymphedema (BCRL) is a chronic swelling that may develop in breast, trunk and arm on the side of the surgery. More than one in five women with breast cancer develop BCRL. Recent studies in BCRL have demonstrated that resistance exercise can improve symptoms and quality of life without worsening the lymphedema. Few studies, however, have controlled for the use of a compression garment during or following exercise. Moreover, no studies have explored the potential of combining resistance exercise with therapeutic strategies to help reduce arm lymphedema volume. We hypothesize that a progressive resistance exercise program that incorporates compression therapy and follows the decongestive exercise sequence (DPRE) has the potential to reduce arm lymphedema volume. PURPOSE: To investigate the feasibility of a 12-week DPRE with compression therapy among women with BCRL. METHODS: A randomized controlled pilot trial was conducted involving 20 women with stable BCRL, recruited through the Cross Cancer Institute in Edmonton, Canada. As per standard of care, all women were required to wear their day-time compression sleeve daily for 12 hours. Women were randomly assigned to one of three groups: (i) Standard care: home decongestive exercise regimen (n=6), (ii) DPRE plus use of a daytime compression sleeve during exercise (n=7), and (iii) DPRE plus use of an adjustable compression wrap (AC) garment during exercise (n=7). Approval was obtained from the Health Research Ethics Board. Feasibility outcomes were analyzed descriptively. Due to the pilot nature of the study and the small sample size, no inferential analyses were performed. RESULTS: Feasibility data demonstrate high study completion (95%), attendance (94%) and adherence to prescribed protocol of DPRE program (97%). A mean reduction in arm lymphedema volume of 35 mls (-5.1%) was observed in the DPRE with day-time sleeve group and a 45 mls (-6.7%) in the DPRE with AC group. In contrast, a mean increase of 68 ml (+14.6%) was observed in the standard care group. CONCLUSION: DPRE with use of compression is feasible and shows promise in reducing arm lymphedema volume. A large-scale RCT is being conducted to examine the efficacy of this program on arm lymphedema volume, with the addition of imaging techniques to further inform changes to tissue composition.

Implementing a prospective surveillance and early intervention model of care for breast cancer-related lymphedema into clinical practice: application of the RE-AIM framework.

Chronic lymphedema following breast cancer (BC) affects individuals physically, functionally, psychologically, and financially. Despite national guidelines and evidence-based research supporting a prospective surveillance and early intervention model of care (PSM), bridging the gap between research and clinical practice has been difficult. As part of an international randomized controlled trial (RCT), Australian women with BC from four hospitals were recruited, monitored for lymphedema at regular intervals over a 3-year period, and were provided a compression garment if intervention was triggered. The reach, effectiveness, adoption, implementation and maintenance (RE-AIM) evaluation framework was used retrospectively to assess a PSM at the individual and organizational level for those who had completed at least 2-year follow-up (N = 219) in the RCT. The application of the RE-AIM framework retrospectively demonstrated an extensive reach to patients across public and private settings; the effectiveness of prospective surveillance and early intervention was achieved through low progression rates to clinical lymphedema (1.8%), and all hospital sites initially approached adopted the research study. Key implementation strategies necessary for effectiveness of this model of care included education to health professionals and patients, staff acceptability, and development of a referral and care pathway. Maintenance dimensions were evaluated both at the individual level with 92-100% adherence rates for all nonoptional study appointments over the 2-year period, and at the organizational-level, PSM was sustained after recruitment ceased for the research study. The PSM for lymphedema in BC can be successfully implemented using the RE-AIM framework applied retrospectively. The implementation of the PSM used in the RCT has assisted in changing clinical practices and improving the quality and effectiveness of the health care system.

Research Matters

Lymphatic Research and BiologyVol. 18, No. 3 Research MattersFree AccessResearch MattersPublished Online:16 Jun 2020https://doi.org/10.1089/lrb.2020.29086.wrAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Lymphatic Education & Research Network Responds to COVID-19 PandemicLymphatic Education & Research Network (LE&RN) began revising organizational plans in February as coronavirus made its way around the world. In March, when cases began to grow exponentially in the United States, LE&RN, in partnership with the Lymphoedema Support Network (LSN) in the United Kingdom, developed COVID-19 (Coronavirus) Guidelines for the Lymphatic Disease Community (https://lymphaticnetwork.org/documents/LSN_LERN_Covid19_Guidelines_2020.pdf).Also in March, LE&RN worked with >200 other nonprofit patient advocacy community-based organizations in calling on Congress to include such organizations in any federal aid packages or supplemental appropriations measures, and to make changes to tax laws to give all donors the ability to receive tax incentives for their much-needed donations at this time.Coronavirus Research, Open Access OfferedLE&RN has been able to share a generous offer for researchers from Mary Ann Liebert, Inc., publishers of Lymphatic Research & Biology, the official journal of LE&RN. In response to the COVID-19 pandemic, free access to all articles related to relevant coronavirus research has been made open access in hopes that it can be a useful resource as a successful vaccine is developed and implemented. Here is a direct link to access all coronavirus-related research within the Liebert portfolio: (www.liebertpub.com/coronavirus). Now more than ever, the world is relying on the efforts of the medical research community, and at LE&RN we remain ever-more committed to supporting that crucial work.LE&RN Steps Up Federal Lobbying Efforts and Advocacy on Capitol HillAlthough the national emergency made LE&RN's scheduled late-March lobbying days in Washington, D.C. impossible, LE&RN actually intensified its efforts on this front, calling on supporters to share their stories that LE&RN would then compile in making the community's case for more funding and more research. The response was overwhelming and LE&RN continues to collect these stories on its website. Those living with lymphedema and lymphatic disease (LD), as well as family members, health care workers, and researchers, are asked to contribute. Just visit https://lymphaticnetwork.org/congressLivestream Symposium SeriesIn early April, LE&RN offered a free Livestream Symposium aimed at providing much-needed information regarding COVID-19 as it impacts the LE and LD communities: “Managing LE Under COVID-19 Stay-At-Home Orders,” presented by Kathleen Shillue, PT, DPT, OCS, CLT, Clinical Director and Physical Therapist at Beth Israel Deaconess Medical Center. This presentation was attended by hundreds of viewers around the world. All LE&RN symposiums can be found on LE&RN's website at https://lymphaticnetwork.org/video-resources.National Comprehensive Care Network Guidelines for Breast Cancer Lymphedema Early Detection UpdatedAt the urging of The American Society of Breast Surgeons Foundation, Vanderbilt University School of Nursing, LE&RN, and Impedimed, the National Comprehensive Care Network (NCCN) updated its guidelines to now encourage health care providers to consider pretreatment measurements for patients with lymphedema risk factors. LE&RN, along with these partner organizations, has long advocated for the early detection of lymphedema, which is critical for optimal outcomes. The NCCN guidelines are widely referenced by providers and decision makers when implementing or updating care and coverage of oncology patient services. NCCN guidelines can be found at https://www.nccn.org/disclosures/transparency.aspx.New Video Available on LE&RN's Website“Lymphedema Prevention Program…The Future in Cancer Care,” with Sabrina Korentager, MSN, RN, BS, CLT-UE, is now available on LE&RN's website. All LE&RN symposiums can be found at https://lymphaticnetwork.org/symposium-series.LE&RN Creates Lymphatic Researcher Database for NIHAt NIH's request, LE&RN has created a Lymphatic Researcher Database (https://lymphaticnetwork.org/treating-lymphedema/researchers) to keep NIH informed of the lymphatic research being pursued worldwide. LE&RN now needs all lymphatic researchers to submit information for this webpage by contacting LE&RN at LERN@LymphaticNetwork.org. Research names, institutions, Pub Med weblinks, and brief research descriptions will appear on this page, searchable by name, institution, or topic. All 27 NIH Institutes and Centers have been provided this weblink. This initiative grew out of the efforts of the Trans-NIH Lymphatics Coordinating Committee.LE&RN Offers Free CME Access to Lymphatic Research & Biology SubscribersLE&RN has offered Lymphatic Research & Biology subscribers free access to LE&RN's 7-credit Physician CME: Lymphatic-Vascular Disease: Diagnosis & Treatment. Just use code LR&BFREE20. Read more about LE&RN CME seminars here: (https://lymphaticnetwork.org/treating-lymphedema/cme-seminars).William RepicciPresident and CEOLymphatic Education & Research Network (LE&RN)www.lymphaticnetwork.orgFiguresReferencesRelatedDetails Volume 18Issue 3Jun 2020 InformationCopyright 2020, Mary Ann Liebert, Inc., publishersTo cite this article:Lymphatic Research and Biology.Jun 2020.319-319.http://doi.org/10.1089/lrb.2020.29086.wrPublished in Volume: 18 Issue 3: June 16, 2020Online Ahead of Print:June 3, 2020PDF download

Post-therapeutic lymphedema in breast cancer

Introductions. Lymphedema is an interstitial accumulation of protein-rich lymph fluid, due to the post-therapeutic alteration of lymphatic circulation in the upper limb. The appearance of lymphedema is favoured by a number of risk factors. All of these factors ultimately lead to a process of tissue fibrosis. Materials and methods. This study was carried out in an outpatient regimen, for a period of 12 months, in the kinetotherapy room, using massage elements for lymphatic drainage and kinetotherapy technique. The study group included 15 patients aged 27-65 years.Results and discutions. Patients evaluated the quality of life after surgery based on the physical and mental symptoms, which is why anxiety, pain reduction through massage and kinetotherapy give patients self-confidence as well as confidence in the recovery process. Conclusions. This complex programme that includes lymphatic drainage massage methods and kinetotherapy techniques should be applied individually, progressively, under the control of the kinetotherapist. Key words: lymphedema, kinetotherapy technique, lymphatic drainage massage,

Omental Lymph Node Transfer for Lymphedema Patients: A Systematic Review.

Lymph node transfer is a surgical treatment that is becoming more prevalent. The lymph nodes from the groin and neck are most frequently used. Iatrogenic lymphedema can be a consequence of the dissection of the groin nodes; thus, some surgeons prefer to use the neck as a donor site. Literature reporting surgical algorithms for the treatment of lymphedema is scarce. Thus, we conducted a systematic review of vascularized omentum lymph node transfer (VOLT) in patients with lymphedema to provide more information about this increasingly common procedure. We hypothesize that the analyzed studies will show that VOLT has positive outcomes. Two reviewers (G.J.C., D.B.) performed independent searches using the PubMed database without timeframe limitations initially through title and abstract descriptions and then by full-text review. The search was done using the following keywords: Breast cancer lymphedema OR lymphedema AND lymph node transfer OR lymph node flap OR lymph node graft AND omental OR omentum OR gastroepiploic. Eligibility criteria included publications evaluating patients with lymphedema in the upper extremity and lower extremity, who underwent VOLT. Our search yielded 35 potential papers in the literature, but only six studies fulfilled the study eligibility criteria. The total number of patients was 137. Three studies described single VOLT, two studies described double VOLT and one study described two cohort patients, one that was treated with single VOLT and another one that was treated with double VOLT. Postoperative reduction of arm circumference, arm volume, and symptoms of the upper extremity were reported in all patients. Nonetheless, in one study, seven patients did not notice any extremity circumference reduction during the follow-up period and four patients noticed an increase in arm volume. Flap loss was reported by two authors in a total of two patients. Overall, patients experienced successful lymphedema treatment with VOLT. All authors presented results with reduced circumferential size of the affected upper and lower limbs, as well as reduction of the infectious intercurrences, such as cellulitis, with a small incidence of associated complications.

Obese patients have higher risk of breast cancer-related lymphedema than overweight patients after breast cancer: a meta-analysis.

Increasing scientific evidences suggest that body weight is a risk factor for breast cancer-related lymphedema (LE) in breast cancer patients, but many existing studies have yielded inconclusive results. This meta-analysis aims to provide a more precise estimation of the effects of body mass index (BMI) on LE in breast cancer patients. Two authors searched independently in the main English-language databases, including PubMed, Embase, and Cochrane Central Register of Controlled Trials, and the main Chinese databases, including China National Knowledge Infrastructure and WanFang Data from inception through June 1, 2018 in human. Odds ratios with 95% confidence interval were calculated to evaluate the effect of BMI on LE. Twelve studies were identified with a total of 8,039 breast cancer patients, including 2102 patients who were suffered from LE; therefore, the total incidence of LE was 26.15%.The meta-analysis results reveal that the odds ratios were 1.42 [95% confidence interval (CI), 1.20 to 1.68] for BMI 25-30 kg/m2 versus BMI <25 kg/m2 group, 1.39 (95% CI, 1.21 to 1.60) for BMI ≥30 kg/m2 versus BMI 25-30 kg/m2 group, and 1.84 (95% CI, 1.47 to 2.32) for BMI ≥30 kg/m2 versus BMI <25 kg/m2 group. Our results will generate awareness of LE, especially obese patients should pay more attention to LE after breast cancer than overweight patients. Thus, it is necessary and meaningful to distinguish obese from overweight patients.

Abstract P3-03-35: Prevalence and risk factors associated with development of lymphedema after axillary lymph node dissection among breast cancer patients: Single center retrospective study

Abstract Background: Lymphedema in breast cancer is one of the most important complications, and causes symptoms of arm swelling, heaviness and limited movement. Once lymphedema has occurred, it is difficult to cure. Nowadays, treatment with axillary lymph node dissection (ALND) has been decreasing among breast cancer patients as a result of the ACOSOG Z0011, AMAROS and IBCSG 23-01 trials. However, some cases require ALND for ALN metastasis. ALND increases the risk of lymphedema and detracts from quality of life, but the surgical procedure based on anatomical landmarks has not been changed for several decades. The upper borderline for ALND might cause injury to lymph ducts from arms, and incidence and risk factors for lymphedema after ALND are still unclear. Our aim was to identify prevalence and risk factors associated with development of lymphedema after ALND among breast cancer patients. Methods: This retrospective study was based on data collected from 178 breast cancer patients who underwent ALND in Nagasaki University Hospital, Japan, between 2005 and 2017. Lymphedema was defined as symptomatic arm swelling with &amp;gt;2 cm difference in circumference of the arm compared with that of the contralateral arm. We classified the patients with and without lymphedema, and compared them regarding surgical and pathological findings. Univariate and multivariate analyses were performed to evaluate the risk factors, using the χ2 test, Student's t-test and Cox logistic regression analysis. Results: Prevalence of lymphedema was 16% (28/178 patients) and mean time interval from surgery to development of lymphedema was 463 days. In univariate analysis, there was a significant difference in postmastectomy radiation therapy (PMRT) (p = 0.02) and the number of patients with &amp;gt;18 dissected ALNs (p = 0.02). Body mass index (p = 0.6), administration of docetaxel (p = 0.2), and smoking (p = 0.07) did not significantly increase lymphedema. In multivariate analysis, PMRT (p = 0.01) and dissection of &amp;gt;18 ALNs (p = 0.001) significantly increased the risk of lymphedema, whereas smoking did not (p = 0.4). Conclusion: Our study suggested that PMRT and number of dissected ALNs were risk factors for lymphedema. Aggressive and empiric ALND might be associated with axillary lymph duct damage. Therefore, we plan to introduce axillary reverse mapping using indocyanine green to reduce the risk of lymphedema in breast cancer patients who undergo ALND. Citation Format: Hara Y, Otsubo R, Inamasu E, Matsumoto M, Yano H, Sakimura C, Kuba S, Yamanouchi K, Eguchi S, Nagayasu T. Prevalence and risk factors associated with development of lymphedema after axillary lymph node dissection among breast cancer patients: Single center retrospective study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-03-35.

The Effect of Acupuncture in Breast Cancer-Related Lymphoedema (BCRL): A Systematic Review and Meta-Analysis.

Background: Breast cancer–related lymphedema (BCRL) is hard to control. Management may include lymphatic drainage, skin care, bandaging, or even surgery. Since acupuncture has been proven to affect the neurophysiology and neuroendocrine systems, it has the potential to control BCRL. Aim: To evaluate the effect of acupuncture in BCRL in randomized controlled trials. Design: A literature search was performed, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and without language restrictions. Data Sources: Five databases were searched from inception tthrough September 2018. Only studies that fulfilled the eligibility criteria of evaluating the effect of acupuncture on lymphedema in breast cancer were included. The methodological quality of these trials was assessed using the Cochrane criteria, and meta-analysis software (RevMan 5.3) was used for analysis. Results: We examined 178 breast cancer patients from 6 trials. All included randomized controlled trials had medium to high quality, based on the modified Jadad scale. The systematic review showed that acupuncture is safe and has a trend to improve symptoms, but trials did not consistently measure outcomes. The meta-analysis showed that acupuncture produced no significant improvement in the extent of lymphedema as compared with the control intervention (−1.90; 95% confidence interval = −5.39 to 1.59, P = .29). None of the studies reported severe adverse events. Conclusions: Acupuncture is safe and has a trend to improve the lymphedema related to breast cancer, yet it did not significantly change arm circumference in BCRL. Future studies should include both subjective and objective measurements and large-scale studies are warranted.

Breast Cancer-Related Lymphedema and Genetic Predisposition: A Systematic Review of the Literature.

Background: Secondary lymphedema is a complication following breast cancer therapy and constitutes the main form of lymphedema in the western world. The purpose of the current study was to provide a clear overview of the genetic predisposition and secondary lymphedema. Methods and Results: A systematic search was performed between February and June 2017 in MEDLINE and Embase. Search terms included Genes, Genetic Predisposition to Disease, Lymphedema, Breast Cancer Lymphedema, Secondary Lymphedema, Breast Cancer-Related Lymphedema, and Humans. Only original articles regarding the possible relationship between genetic variation and the development of secondary lymphedema in humans were included in this review. A total of 459 records were collected. After removal of duplicates, non-topic-related publications, and records not presenting original data, six full-text studies were included. Associations between genetic factors and the development of secondary lymphedema were found for variations in HGF, MET, GJC2, IL1A, IL4, IL6, IL10, IL13, VEGF-C, NFKB2, LCP-2, NRP-2, SYK, VCAM1, FOXC2, VEGFR2, VEGFR3, and RORC. Conclusions: In patients with secondary lymphedema following breast cancer therapy, genetic variations were found in 18 genes. These compelling, although preliminary, findings may suggest a possible role for genetic predisposition in the development of lymphedema following breast cancer therapy. This notion may add to the classical, more mechanistic explanation of secondary lymphedema.

Function, Shoulder Motion, Pain, and Lymphedema in Breast Cancer With and Without Axillary Web Syndrome: An 18-Month Follow-Up.

Axillary web syndrome (AWS) can develop following breast cancer surgery and presents as a tight band of tissue in the axilla with shoulder abduction. The objectives were to determine the prevalence and natural history of AWS and the association between AWS and function, range of motion, pain, lymphedema, and body mass index (BMI). This study was a longitudinal prospective cohort study utilizing a repeated measures design. Axillary web syndrome, function, shoulder range of motion, pain, and lymphedema (using circumference, bioimpedance spectroscopy, tissue dielectric constant) were assessed in women at 2, 4, and 12 weeks and 18 months following breast cancer surgery. Prevalence of AWS and the association with the measured outcomes were analyzed. Thirty-six women agreed to participate in the study. The cumulative prevalence of AWS was 50% (18/36) at 18 months following breast cancer surgery. AWS was identified as a risk factor for reduced function. Women with AWS had statistically reduced range of motion, lower BMI, and higher number of lymph nodes removed compared to the non-AWS group. Forty-one percent (13/32) of women had AWS at 18 months. AWS reoccurred in 6 women following resolution, and a new case developed beyond the early postoperative period. The overall prevalence of physical impairments ranged from 66% to 97% within the first 18 months following surgery regardless of AWS. Limitations include a small sample size and potential treatment effect. AWS occurs in approximately 50% of women following breast cancer surgery. It can persist for 18 months and potentially longer, develop beyond the early postoperative time period, and reoccur after resolution. Clinicians need to be aware of the chronicity of AWS and its association with reduced range of motion and function.

The increasing role of breast cancer lymphedema screening, diagnosis, and management as part of evidence-based breast cancer survivorship.

145 Background: With improved outcomes across all stages, breast cancer survivorship represents an increasingly significant oncologic issue. One major facet of breast cancer survivorship is assessment and management of sequelae of treatment including breast cancer related lymphedema (BCRL) which has an incidence of 5-40% depending on locoregional and systemic treatment. BCRL represents a complication associated with physical changes as well as reduction in quality of life and continues to increase in prevalence with new diagnostics (ex. L-Dex, perometry) increasing the sensitivity for detection. Methods: Review of current evidence based guidelines from the National Comprehensive Cancer Network (NCCN), American Society of Clinical Oncology (ASCO), and the American Cancer Society. Results: Evidence based treatment guidelines for breast cancer have evolved in 2015. For the first time, the NCCN guidelines include a reference to BCRL as part of routine treatment stating “to educate, monitor, and refer for lymphedema management” represents a standard component of breast cancer treatment and survivorship and allows for the early diagnosis and treatment of BCRL. At this time, neither the ASCO Breast Cancer nor ASCO survivorship guidelines incorporate BCRL management into routine practice. At this time, BCRL management is not part of ACS survivorship protocols. Conclusions: At this time, due to increasing data on BCRL diagnosis and treatment, evidence based guidelines are beginning to incorporate BCRL education, diagnosis, and treatment into standard breast cancer management plans. With increasing focus on survivorship, prospective BCRL programs are being developed that begin evaluation prior to treatment with screening in place and early intervention to help prevent progression by using diagnostics with increased sensitivity (ex. L-Dex, perometry).

Providing Compassion through Flow

Meg Kral, MS, OTR/L, CLT, is the cover artist for the Summer 2015 issue of The Open Journal of Occupational Therapy. Her untitled piece of art is an oil painting and is a re-creation of a photograph taken while on vacation. Meg is currently supervisor of outpatient services at Rush University Medical Center. She is lymphedema certified and has a specific interest in breast cancer lymphedema. Art and occupational therapy serve similar purposes for Meg: both provide a sense of flow. She values the outcomes, whether it is a piece of art or improved functional status.

The Effects of Upper Limb Exercise Through Yoga on Limb Swelling in Chinese Breast Cancer Survivors – A Pilot Study

Breast cancer is the most common female cancer. The aim of this study was to assess the impact of yoga on lymphedema in breast cancer survivors. Repeated measures before and after the intervention. We enrolled 15 women with breast cancer who had not previously worn elastic clothing to treat lymphedema. The program was led by a certified trainer and consisted of 60-minute sessions, three times a week for 12 weeks. The volumes of the affected and normal limbs were measured. A self-assessed edema score was also recorded. Fifteen patients completed the program, none of whom suffered from complications related to exercise. There was no significant edema after exercise. No significant differences were noted in subgroup analysis by age or the affected arm. Yoga does not induce lymphedema. Lymphedema is usually treated with uncomfortable elastic clothing, and high-resistance exercise may induce edema. Yoga may be suitable for these patients.

Effect of the comprehensive nursing intervention on clinical efficacy of lymphedema after breast cancer surgery

Objective To investigate effect of the comprehensive nursing intervention on clinical efficacy of lymphedema after breast cancer surgery.Methods In our hospital, 157 cases with breast cancer lymphedema appeared were randomly divided into control group （78 cases） and observation group （79 cases）, control group was given routine nursing intervention, observation group was given comprehensive nursing intervention.The upper limb perimeter, the limb function rehabilitation, infection between two groups patients before and after nursing intervention were compared.Results After nursing intervention, double upper limbs perimeter of the patients in observation group was significantly lower than that in the control group （ P〈0.05 ） .hand function recovery proficiency, excellent （ 82.3%, 100%） were significantly higher than those in the control group, infection rate （1.27%） were significantly lower than that in the control group （ P〈0.05, 0.01） .Conclusions Comprehensive nursing intervention can effectively alleviate after radical mastectomy lymphedema symptoms, lower limb skin infection rate, promote the recovery of upper limb function. Key words: Comprehensive nursing intervention; Upper limb function; Lymphedema; Breast cancer

Quantitative and Morphologic Change Associated with Breast Cancer-Related Lymphedema. Comparison of 3.0T MRI to External Measures

Abstract Introduction: Lymphedema is a chronic disease of increasing importance to cancer survivors. A tape measurement tool used for lymphedema relies on indirect volume calculations based on external circumference, which may not reflect the true extent of abnormal fluid accumulation accurately. Fluid-sensitive MRI sequences may be able to delineate the severity of this condition more precisely and thus also monitor response to therapy. Eight patients being followed by physical therapy for clinically diagnosed breast cancer-related lymphedema were recruited to participate in this study. External measurements and upper extremity MRI were performed on all subjects. Arm circumference, arm volume, and lymphedema volumes were calculated for each method. MR imaging detected lymphedema in all study subjects. Correlation was found between external circumferential measurements and with the 3.0T MRI (r=0.9368). There was poor correlation between lymphedema volumes calculated from clinical measurements and MR imaging (r=0.5539). External measurements were not found to be an accurate measure of lymphedema volume associated with breast cancer lymphedema. MRI is a reliable means to obtain upper extremity circumferential and volume measurements. MRI is able to evaluate morphologic change associated with breast cancer-related lymphedema. Lymphedema research requires integrated use of tools to further describe the disease process over time, quantitate the distribution of tissue changes, and improve the sensitivity and specificity of the measurements.

Unilateral upper extremity lymphedema deteriorates the postural stability in breast cancer survivors.

Aim of the studyThere is little known about any change in postural balance caused by asymmetrical volume increase due to unilateral upper extremity lymphedema in patients who underwent breast surgery. The aim of this study was to determine whether there is a change in postural balance by measuring postural sway velocity (PSV), center of gravity (CoG) displacement and directional control (DCL) in patients with unilateral upper extremity lymphedema in breast cancer survivors.Material and methodsEighteen females 38–60 (M = 53) years old diagnosed with upper extremity lymphedema due to breast cancer surgery, and 18 healthy females with similar ages (M = 52.5) were assessed using the Balance Master system (Neuro Com, Clackamas, USA). Unilateral stance (US) and bilateral stance (BS) tests in eyes open and closed conditions and the limit of stability (LOS) test were applied to quantify postural sway velocity (PSV), CoG displacement, and directional control (DCL).ResultsThe lymphedema group showed a significant increase in PSV in the US test on the ipsilateral leg with eyes open (p = 0.02) and eyes closed (p = 0.005) as well as on the contralateral leg with eyes open (p = 0.004) and eyes closed (p = 0.0001). Average displacement and position of the CoG were 25% of LOS (p = 0.0001) towards the lymphedema side and 60.6 degrees respectively. DCL in the lymphedema group was significantly lower in forward (p = 0.0001), back (p = 0.003), ipsilateral (p = 0.002), and contralateral (p = 0.03) directions.ConclusionsThese findings suggest that unilateral upper extremity lymphedema may have challenging effects on postural balance.

Risk Factors of Breast Cancer-Related Lymphedema

Secondary lymphedema is one of the major important long-term complications of breast cancer treatment. The aim of this study is to determine patient- and treatment-related risk factors of lymphedema in breast cancer patients. Patients, who had been operated on for primary breast cancer at Akdeniz University Hospital and followed regularly between August 1984 and December 2009 were included in the study. In order to evaluate the arm swelling objectively, measurements were performed with a flexible tape measure for both arms, and limb volume was calculated using a truncated cone volume formula. Participants, whose volume difference between the two arms was ≥ 5%, were considered as lymphedema-positive patients. The SPSS program (SPSS inc. Chicago, IL) was used for statistical analysis. The mean age of 455 patients was 50.6 years and the median follow-up time was 53 months. Lymphedema was found in 124 (27%) patients. Most of the patients with a history of postoperative wound infection (52%) and lymphangitis (57%) had lymphedema (p=0.003 and p=0.002, respectively). Addition of radiation therapy increased lymphedema risk 1.83 times (p=0.007). The mean duration of the axillary drainage and number of the removed lymph nodes were 7.8 days and 19, respectively. The rate of lymphedema in patients with early stage breast cancer was less than patients with advanced breast cancer (24% and 35.3%, respectively, p=0.018). Most of the patients (92%) with lymphedema had a high body mass index (BMI ≥ 25 kg/m²), and obesity was another important factor for lymphedema (p<0.001). The most important treatment and patient-related risk factors for breast cancer-related lymphedema were obesity (≥ 25 kg/m²), axillary lymph node dissection, postoperative radiotherapy, wound infection, history of lymphangitis, and duration of axillary drainage. Elimination or prevention of these risk factors may reduce the incidence of lymphedema.

Exercise at home may relieve lymphedema in breast cancer

Exercise at home may relieve lymphedema in breast cancer

Risk factors for lymphedema in breast cancer survivors, the Iowa Women's Health Study.

Risk factors for lymphedema and related arm symptoms in breast cancer (BC) survivors have not been examined using a large prospective population-based cohort. The Iowa Women's Health Study (IWHS) collected self-reported data for diagnosed lymphedema in 2004, and data for cancer diagnosis, treatment, behavioral and health characteristics between 1986 and 2003. We studied 1,287 women, aged 55-69 at baseline, who developed unilateral BC: n = 104 (8%) with diagnosed lymphedema, n = 475 (37%) with arm symptoms but without diagnosed lymphedema, and n = 708 without lymphedema. Age- and multivariate-adjusted logistic regression models examined risk factors for lymphedema and related arm symptoms (OR [95% confidence interval]). The mean time between BC and the 2004 survey was 8.1 ± 5.0 (mean ± SD) years. After multivariate adjustment, the following cancer characteristics were positively associated with lymphedema: tumor stage (regional vs. in situ: 3.92 [1.61-9.54]), number of excised nodes (highest vs. lowest quintile: 3.52 [1.32-9.34], P (trend) = 0.003), tumor-positive nodes (yes vs. no 2.12 [1.19, 3.79]), and adjuvant chemotherapy (yes vs. no: 3.05 [1.75-5.30]). Several health characteristics were positively associated with lymphedema: baseline body mass index (highest vs. lowest tertile: 3.24 [1.70-6.21]), waist and hip circumference, and general health (fair/poor vs. excellent: 3.44 [1.30-9.06]). Positive associations with arm symptoms were number of excised nodes (highest vs. lowest quintile: 2.38 [1.41-4.03], P (trend) = 0.007), axillary radiation (yes vs. no: 1.72 [1.15-2.57]), and baseline general health (fair/poor vs. excellent: 4.27 [2.60-7.00]). In the IWHS, obesity, poorer general health, and markers of more advanced cancer were risk factors for lymphedema and related arm symptoms in BC survivors.