Treatment Of Cancer-related Lymphedema Research Articles

The dynamic-lymphaticovenular anastomosis method for breast cancer treatment-related lymphedema: Creation of functional lymphaticovenular anastomoses with use of preoperative dynamic ultrasonography

BackgroundLymphaticovenular anastomosis (LVA) is generally an effective procedure for breast cancer treatment-related upper extremity lymphedema (UEL). Clinical improvement is, however, limited by the degree of sclerosis of the lymphatic vessels. We have developed a method by which we use dynamic ultrasonography to depict vessels through which lymph can be propelled into the LVA under the power of the patient's natural hand movements. MethodsWe assessed the dynamic-LVA method by comparing clinical details of 15 cases of breast cancer treatment-related lymphedema treated by dynamic LVA and 15 corresponding cases treated by conventional LVA. ResultsPlacement of incisions at a total of 90 forearm sites (three per patient) yielded 90 LVAs (32 in “linear ICG lymphography pattern incisions” and 58 in “stardust pattern incisions”). Sclerotic lymphatic vessels were encountered at greater frequency in “linear pattern incisions” in the dynamic LVA group than in the conventional LVA group (7.1% vs. 38.9%, P = 0.030). Postoperative volume reduction was significantly greater in the dynamic LVA group than in the conventional LVA group; the UEL index at 1 month was 8.12 ± 3.08 vs. 3.74 ± 5.82, respectively (P = 0.018), and at 1 year was 10.23 ± 6.16 vs. 2.03 ± 9.36, respectively (P = 0.014). ConclusionsDynamic LVA is clinically beneficial because the imaging guides decisions over the locations where the incisions should be placed so that a patient's natural hand motions can be used to propel lymph into the anastomosis despite the presence of sclerosis and because even early improvements are obtained.

Reference Values for Assessing Localized Hand Lymphedema Using Interhand Tissue Dielectric Constant Ratios.

Early detection and tracking of breast cancer treatment-related lymphedema have been helped by quantitative assessment methods and parameters, including bioelectrical impedance spectroscopy and tissue dielectric constant (TDC). Such measurements are evaluated with respect to interarm differences or ratios that (when exceeding specified thresholds) are suggestive of lymphedema. Specific threshold ratios depend on the assessment method and have been reported for arms. However, there is far less information available on thresholds to assess lymphedema that manifests in at-risk hands and essentially nothing known about TDC ratios in healthy hands. Such information is essential to establish reference values from which lymphedema threshold TDC values may be estimated. The specific aim of this research was to determine such interhand TDC ratios applicable to both young and mature women. A total of 70 women (35 under 30 years of age, YOUNG, and 35 over 50 years of age, MATURE) participated after signing an approved institutional review board informed consent. TDC values of the hand dorsum web were measured bilaterally in triplicate with participants in a supine resting position. Results showed MATURE TDC values to be about 15% less than YOUNG (p < 0.01) on dominant and nondominant hands, but no statistical difference in dominant/nondominant interarm ratios (1.026 ± 0.100). Based on this data set's overall mean and two standard deviation value, an age-independent interhand TDC threshold ratio of 1.23 emerges as potentially useful for lymphedema detection. This is a good initial start threshold that is usable in future clinical and research assessments.

Advances in understanding and management of lymphoedema (cancer, primary).

Despite being neglected both clinically and in research in the past, primary lymphoedema, and lymphoedema secondary to cancer treatment have been the subject of an increasing number of studies in recent years. This review will focus on new developments relevant to clinical practice. The main themes covered by the review include the incidence and prevalence of lymphoedema, early detection and intervention in cancer-related lymphoedema, risk reduction for the development of cancer-related lymphoedema, surgical treatment, palliative care for lymphoedema in advanced cancer and developments in the genetics of primary lymphoedema. Evidence suggests that lymphoedema is more common than has been previously recognized. It continues to be a significant problem for people following cancer treatment. Developments in the early detection and treatment of cancer-related lymphoedema should reduce the future impact for patients. Advice on how to reduce the risk of developing lymphoedema may need to be modified in light of recent research. New treatments such as surgical procedures are still in their infancy but the results seem encouraging for selected patients.

Bilateral Changes in Deep Tissue Environment After Manual Lymphatic Drainage in Patients with Breast Cancer Treatment-Related Lymphedema.

Breast cancer treatment-related lymphedema (BCRL) arises from a mechanical insufficiency following cancer therapies. Early BCRL detection and personalized intervention require an improved understanding of the physiological processes that initiate lymphatic impairment. Here, internal magnetic resonance imaging (MRI) measures of the tissue microenvironment were paired with clinical measures of tissue structure to test fundamental hypotheses regarding structural tissue and muscle changes after the commonly used therapeutic intervention of manual lymphatic drainage (MLD). Measurements to identify lymphatic dysfunction in healthy volunteers (n = 29) and patients with BCRL (n = 16) consisted of (1) limb volume, tissue dielectric constant, and bioelectrical impedance (i.e., non-MRI measures); (2) qualitative 3 Tesla diffusion-weighted, T1-weighted and T2-weighted MRI; and (3) quantitative multi-echo T2 MRI of the axilla. Measurements were repeated in patients immediately following MLD. Normative control and BCRL T2 values were quantified and a signed Wilcoxon Rank-Sum test was applied (significance: two-sided p < 0.05). Non-MRI measures yielded significant capacity for discriminating between arms with versus without clinical signs of BCRL, yet yielded no change in response to MLD. Alternatively, a significant increase in deep tissue T2 on the involved (pre T2 = 0.0371 ± 0.003 seconds; post T2 = 0.0389 ± 0.003; p = 0.029) and contralateral (pre T2 = 0.0365 ± 0.002; post T2 = 0.0395 ± 0.002; p < 0.01) arms was observed. Trends for larger T2 increases on the involved side after MLD in patients with stage 2 BCRL relative to earlier stages 0 and 1 BCRL were observed, consistent with tissue composition changes in later stages of BCRL manifesting as breakdown of fibrotic tissue after MLD in the involved arm. Contrast consistent with relocation of fluid to the contralateral quadrant was observed in all stages. Quantitative deep tissue T2 MRI values yielded significant changes following MLD treatment, whereas non-MRI measurements did not vary. These findings highlight that internal imaging measures of tissue composition may be useful for evaluating how current and emerging therapies impact tissue function.

Lymphedema evaluation using noninvasive 3T MR lymphangiography.

To exploit the long 3.0T relaxation times and low flow velocity of lymphatic fluid to develop a noninvasive 3.0T lymphangiography sequence and evaluate its relevance in patients with lymphedema. A 3.0T turbo-spin-echo (TSE) pulse train with long echo time (TEeffective = 600 msec; shot-duration = 13.2 msec) and TSE-factor (TSE-factor = 90) was developed and signal evolution simulated. The method was evaluated in healthy adults (n = 11) and patients with unilateral breast cancer treatment-related lymphedema (BCRL; n = 25), with a subgroup (n = 5) of BCRL participants scanned before and after manual lymphatic drainage (MLD) therapy. Maximal lymphatic vessel cross-sectional area, signal-to-noise-ratio (SNR), and results from a five-point categorical scoring system were recorded. Nonparametric tests were applied to evaluate study parameter differences between controls and patients, as well as between affected and contralateral sides in patients (significance criteria: two-sided P < 0.05). Patient volunteers demonstrated larger lymphatic cross-sectional areas in the affected (arm = 12.9 ± 6.3 mm2 ; torso = 17.2 ± 15.6 mm2 ) vs. contralateral (arm = 9.4 ± 3.9 mm2 ; torso = 9.1 ± 4.6 mm2 ) side; this difference was significant both for the arm (P = 0.014) and torso (P = 0.025). Affected (arm: P = 0.010; torso: P = 0.016) but not contralateral (arm: P = 0.42; torso: P = 0.71) vessel areas were significantly elevated compared with control values. Lymphatic cross-sectional areas reduced following MLD on the affected side (pre-MLD: arm = 8.8 ± 1.8 mm2 ; torso = 31.4 ± 26.0 mm2 ; post-MLD: arm = 6.6 ± 1.8 mm2 ; torso = 23.1 ± 24.3 mm2 ). This change was significant in the torso (P = 0.036). The categorical scoring was found to be less specific for detecting lateralizing disease compared to lymphatic-vessel areas. A 3.0T lymphangiography sequence is proposed, which allows for upper extremity lymph stasis to be detected in ∼10 minutes without exogenous contrast agents. 1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1349-1360.

Use of a prospective surveillance model to prevent breast cancer treatment-related lymphedema: a single-center experience.

PurposeBreast cancer patients undergoing axillary lymph node dissection (ALND) are at risk of lymphedema (LE). Successful management of LE relies on early diagnosis using sensitive modalities. In the current study, we explored the effectiveness of a surveillance program for lymphedema management (SLYM) compared to standard care.Methods Breast cancer patients who underwent ALND in Seoul National University Bundang Hospital from January 2008 to December 2015 were included in this prospective study. The SLYM commenced in May 2011. The LE outcomes of patients treated prior to initiation of the SLYM were compared with those of patients after SLYM implementation.Results A total of 707 patients were included, 390 in the SLYM group and 317 in the historical control (HC) group. A total of 203 patients (28.7 %) had episodes of all-stage LE during follow-up. Of these, 126 (19.7 %) were in the surveillance group and 77 (24.3 %) in the HC group. The overall 5-year cumulative incidence of LE (greater than stage 3) was 25 (95 % CI 15.4–34.6) (6.4 %) in the SLYM group and 48 (95 % CI, 15.4–34.6) (15.1 %) in the HC group. In the SLYM group, poor compliance had a significant impact on LE incidence (OR = 2.98, P = 0.002). Low level of self-monitoring and insight scores were significantly related to LE incidence (OR = 1.31, P = 0.025) after adjusting for age, body mass index, the type of surgery chosen, radiation therapy, and chemotherapy. With a cut-off of 29.5 days from operation to the first visit to the LE clinic, the sensitivity was 60 % and the specificity 61 % in terms of predicting a LE event.ConclusionsSurveillance improves LE prevention compared to clinical evaluation. The first visit to the LE clinic should be made within 1 month after surgery. In the first year, visits should be made at intervals of less than 3 months.Electronic supplementary materialThe online version of this article (doi:10.1007/s10549-016-3993-7) contains supplementary material, which is available to authorized users.

Bioimpedance to screen for abdominal fat in patients with breast cancer treatment-related lymphedema.

One of the dreaded complications after the treatment of breast cancer is lymphedema. Therapies used in the treatment of breast cancer such as surgery, radiotherapy, hormone therapy and chemotherapy may be adversely affected by obesity. The objective of this study was to use bioimpedance to assess abdominal fat in women with breast cancer treatment-related lymphedema and suggest this as a screening method. Forty-five female patients with clinical diagnosis of breast cancer treatment-related lymphedema were evaluated in this quantitative cross-sectional study. A control group, composed of 38 patients with varicose veins and women attending a social support group, was matched for age and body mass index (BMI). All participants were submitted to a bioimpedance evaluation (In Body S 10), with particular attention being paid to abdominal fat and their BMI. The unpaired t -test, Fisher Exact test and Mann-Whitney test were used for statistical analysis and an alpha error of 5%. There was no significant difference (p -value = 0.23) in the mean BMI between the study group (27.79kg∕m2) and the control group (28.80kg∕m2). The mean abdominal circumference, a measure of abdominal fat, of the women in the study group was 130.54cm2 and for the control group it was 102.24cm2 (p -value = 0.0037). Thus the study group had more abdominal fat (p -value = 0.0003). Moreover, on comparing obese patients in the two groups, the study group had more abdominal fat (p -value = 0.02). However, no significant difference was observed comparing non-obese patients (p -value = 0.6). The comparison of obese patients with non-obese patients in the control group identifies an association between obesity and abdominal fat (p -value < 0.04). Overweight and obese women with breast cancer treatment-related lymphedema are more likely to have increased abdominal fat than the general population with bioimpedance.

Abdominal Respiration Induces Hemodilution and Related Reduction in ADH Concentration of Blood.

To establish effective lymph drainage methods and develop concise and accurate clinical techniques for evaluating lymph drainage in healthy individuals and patients with cancer treatment-related lymph edema, we investigated the numbers of red (RBC) and white (WBC) blood cells, and platelets (PLT) in blood, hematocrit (Ht), and the blood concentrations of total protein (TP), albumin (Alb), and anti-diuretic hormone (ADH) before and after 5 min manual lymph drainage, followed by 30 min rest with or without abdominal respiration in the supine or sitting position in 48 healthy volunteers. The 5 min facial, upper and lower extremities lymph drainage, followed by 30 min rest in the supine position induced significant reductions of the TP and Alb in all subjects, and their RBC and Ht levels in some subjects. The 30 min rest only in the supine position without lymph drainage produced also significant reductions of blood TP and Alb. In addition, abdominal respiration in the supine position without manual lymph drainage caused more significant hemodilution, being significant reductions of TP, Alb, RBC, Ht, and ADH in all volunteers. These findings may be related to effective lymph drainage from the chylocyst. Furthermore, it also resulted in a significantly increased micturition desire. In conclusion, abdominal respiration during 30 min rest in the supine position is effective at inducing lymph drainage, and the associated induction of hemodilution and lowering of the blood ADH concentration (and increased micturition desire in some cases) can be used to accurately assess the extent of lymph drainage.

Experimental and Analytical Comparisons of Tissue Dielectric Constant (TDC) and Bioimpedance Spectroscopy (BIS) in Assessment of Early Arm Lymphedema in Breast Cancer Patients after Axillary Surgery and Radiotherapy.

Early diagnosis of breast cancer treatment-related lymphedema (BCRL) is of great importance for longstanding treatment results. Tissue dielectric constant (TDC) and bioimpedance spectroscopy (BIS) both have a potential for early diagnosis, but have not been compared. One hundred women, treated for breast cancer with breast surgery, axillary dissection, and radiotherapy, were examined within one year after breast cancer treatment, as part of the follow-up procedure. Affected/at-risk and contralateral arms were measured with the TDC technique specific to localized skin water content and the BIS technique assessing arm extracellular fluid (ECF). Thirty-eight patients were clinically diagnosed for lymphedema (38.0%). The sensitivity and specificity for the TDC method were 65.8% and 83.9%, and for BIS method 42.1% and 93.5%, (p < 0.001 and NS), respectively. Of all lymphedema, 18.4% were detected only by TDC and 2.6% by BIS. Affected arm to contralateral arm TDC ratios for upper arm and forearm, 1.56 ± 0.49 and 1.28 ± 0.33, demonstrating the localized feature of the TDC measurements were significantly greater than the BIS arm ratio 1.12 ± 0.12 (both p < 0.001). Discrepancies between TDC and BIS techniques in assessing lymphedema are related to different measurement techniques and assessed tissue water components. Independently of selected technique-specific threshold limit, the TDC technique was more sensitive than the BIS technique in the early assessment of BCRL and demonstrated that nearly 20% of early lymphedema are only superficially localized. The results further supported the complementary role of TDC and arm volume measurements as a highly diagnostic method for early lymphedema.

Breast Cancer Survivors With Lymphedema

Breast cancer survivors with lymphedema experience physical, psychosocial, and quality-of-life difficulties. Cancer treatment-related lymphedema often is viewed as a disabling condition, and that assumption has fostered an environment in which oncology nurses are not actively involved in the care of patients with lymphedema. Little is known about how breast cancer survivors with lymphedema structure their daily lives. This article describes an effort to determine whether lymphedema truly is a disabling condition by collecting symptom data and self-generated narratives from breast cancer survivors with lymphedema regarding their eating habits, daily activities, substance use, and future plans. Although the sample experienced multiple symptoms, lymphedema duration and degree of extracellular arm fluid did not appear to influence those symptoms. In addition, participants led full, rich, busy lives. The findings do not support the notion that patients with lymphedema live as disabled people. A disability model may not be optimal to guide research design or patient care; rather, a symptom management model better explains the findings and implies that active involvement by nurses in lymphedema patient care and education is indicated.

Cancer Treatment–Related Lymphedema in Geriatrics

Cancer treatment—related lymphedema is a chronic, incurable disorder that can significantly affect quality of life. It is caused by a mechanical alteration of the lymphatic system during surgery and/or radiation therapy for the treatment of cancer. Lymphedema can have several adverse effects to include increased risk of cellulitis, decreased productivity, disability, psychosocial impacts, and poor body image issues. The purpose of this article is to discuss current clinical practices for risk reduction, identification, treatment, and maintenance of this condition.

Body mass index and breast cancer treatment-related lymphedema

The main purpose was to examine longitudinally the influence of body mass index (BMI) and obesity on the development of breast cancer treatment-related lymphedema. We asked, does elevated BMI increase lymphedema risk? A secondary analysis was conducted on de-identified data collected from 138 newly diagnosed breast cancer survivors who had arm-volume measurements and symptom assessment at pre-treatment baseline and measurements up to 30months post-surgery in a prospective longitudinal parent study. Arm volume and weight data, part of the information collected during each participant visit, were examined. Breast cancer survivors whose BMI was ≥30 at the time of breast cancer treatment were approximately 3.6 times more likely to develop lymphedema at 6months or greater after diagnosis than those with a BMI < 30 at the time of cancer treatment (95% confidence interval, C.I., for odds ratio, O.R., 1.42-9.04; p = 0.007). Those with a general BMI increase or a BMI rise to 30 or greater during their first 30months of survivorship were not more likely to develop late-onset lymphedema than those who did not have similar changes in BMI. Pre-treatment BMI may be a risk factor for lymphedema. Weight gain post-treatment may not be. Further research is warranted.

A prospective cohort study defining utilities using time trade‐offs and the Euroqol‐5D to assess the impact of cancer‐related lymphedema

The devastating impact of lymphedema on cancer survivors' quality of life has prompted consideration of several changes in medical and surgical care. Unfortunately, our understanding of the benefits gained from these approaches relative to their cost remains limited. This study was designed to estimate utilities for lymphedema and characterize how utilities differ between subgroups defined by lymphedema etiology and distribution. A consecutive sample of 236 subjects with lymphedema seen at a lymphedema clinic completed both a time trade-off (TTO) exercise and the Euroqol 5D. Responses were adjusted in multivariate regression models for demographic factors, comorbidities, and lymphedema severity/location. Most participants (167 of 236, 71%) had lymphedema as a consequence of cancer treatment; 123 with breast cancer and upper extremity involvement. Mean TTO utility estimates were consistently higher than Euroqol 5D estimates. Unadjusted TTO (0.85; standard deviation [SD], 0.21) and Euroqol 5D (0.76; SD, 0.18) scores diminished with increasing lymphedema stage and patient body mass index (BMI). Adjusted utility scores were lowest in patients with cancer-related lower extremity lymphedema (TTO=0.82; SD, 0.04 and Euroqol 5D=0.80; SD, 0.03). Breast cancer patients also had lower adjusted Euroqol 5D scores (0.80; SD, 0.02). Lymphedema-associated utilities are in the range of 0.80. Lower utilities are observed for patients with higher lymphedema stages, elevated BMI, and cancer-related lymphedema. Greater expenditures for the prevention and treatment of cancer-related lymphedema are warranted.

Breast cancer treatment-related lymphedema self-care: Education, practices, symptoms, and quality of life

The primary purpose of this study was to cross-sectionally examine breast cancer treatment-related lymphedema self-care education, self-care practices, and perceived self-care barriers, burdens, and benefits. We also explored the associations among self-care education, practices, symptoms, and quality of life (QOL) in breast cancer survivors with known lymphedema. A cross-sectional design was used to obtain data about lymphedema self-care education, self-care practices, perceived self-care barriers, burdens, and benefits, symptoms, and QOL. Frequency distributions and Spearman rank-order correlations were used to analyze quantitative data. Thematic qualitative analysis of perceived barriers, benefits, and burdens of self-care was also undertaken. Surveys were completed and returned by 51 of 58 eligible individuals. Of the 51 responding, 48 had received some self-care education, but three did not think it was adequate. Wearing a compression garment was the most frequently cited self-care activity, and 18 of the 51 required help with self-care. Thirty-three percent, 17/51, spent 15 minutes or less per day on self-care. Multiple barriers to self-care were identified. Those with more symptoms spent more time on self-care activities and had a poorer QOL. Opportunities exist to improve lymphedema self-care education. Breast cancer survivors with lymphedema experience symptoms beyond that of simple swelling of the affected limb. Self-care is burdensome. Barriers to providing lymphedema self-care exist and may vary across patients. A multidisciplinary approach to lymphedema management, including self-care education and monitoring, is likely needed to improve QOL in this population.

Local Tissue Water in At-Risk and Contralateral Forearms of Women with and without Breast Cancer Treatment-Related Lymphedema

Quantitative measurements to help detect incipient or latent lymphedema in patients at risk for breast cancer treatment-related lymphedema (BCRL) are potentially useful supplements to clinical assessments. Suitable measurements for routine use include arm volumes, arm bioimpedance, and local tissue water (LTW) determined from the tissue dielectric constant (TDC). Because BCRL initially develops in skin and subcutis, measures that include whole arms may not be optimally sensitive for detecting the earliest changes. Thus, there is also a need for a local measurement in which tissues most likely to demonstrate early lymphedematous changes can be more selectively assessed. The TDC method satisfies this criterion. Our goal was to use this method to compare arm-to-arm differences in LTW within and among women grouped as healthy normal (HN), diagnosed with breast cancer (BC), but prior to surgery and established unilateral lymphedema (LE). LTW was determined on both anterior forearms to a measurement depth of 2.5 mm in 30 women of each group. TDC arm ratios were determined as dominant/nondominant for HN and BC, at-risk/contralateral for BC, and lymphedematous/contralateral for LE. Results showed that TDC values for all arms except lymphedematous arms were very similar and insignificantly different with values among arms (mean +/- SD) ranging from 24.9 +/- 3.8 to 25.7 +/- 3.8. Arm ratios did not differ between HC and BC whereas dominant/non-dominant arm ratios for HN and BC separately and combined (1.006 +/- 0.085) were significantly less than the lymphedematous/contralateral ratio of the LE group (1.583 +/- 0.292). The findings indicate that LTW of at-risk arms is not affected by breast cancer and that lymphedema does not significantly affect LTW of contralateral arms as measured with the TDC method. Further, based on the standard deviation of measured arm ratios, an at-risk/contralateral TDC ratio of 1.26 is suggested as a possible threshold for detecting preclinical or latent lymphedema.

Aqua lymphatic therapy in women who suffer from breast cancer treatment-related lymphedema: a randomized controlled study

Aqua lymphatic therapy in women who suffer from breast cancer treatment-related lymphedema: a randomized controlled study

Aqua lymphatic therapy in women who suffer from breast cancer treatment-related lymphedema: a randomized controlled study

Lymphedema is an adverse effect of breast cancer surgery. Aqua lymphatic therapy (ALT) is a novel treatment for limb volume reduction. The aim of this study was to examine whether ALT is a safe method and whether there are differences in adherence, limb volume, and quality of life between women who perform only self-management treatment and women who participate as well in ALT. Design of the study was single-blind randomized clinical trial. The setting was in a hydrotherapy pool, 1.2 m depth, and a temperature of 32-33 degrees capital ES, Cyrillic. Forty-eight women (56 +/- 10 years), with a 12.8% lymphedema relative volume, participated in the study. The control group was instructed to perform the self-management treatment. The study group joined a weekly session of ALT for 3 months in addition to the self-management therapy. Adherence was assessed by a self-reported diary, limb volume by a water displacement device, quality of life by the Upper Limb Lymphedema Questionnaire (ULL27), prior to, and after the intervention period. There was no episode of arm infection or aggravation in limb volume during the study period. ALT had a positive, statistically and clinically significant immediate effect on limb volume but no long-term effect was noted. The adherence rate to ALT was significantly higher than the adherence to self-management therapy. QOL improved in the study group. ALT was found to be a safe method, with high adherence, in treating women who suffer from mild to moderate lymphedema. A significant immediate and insignificant long-term effect on limb volume was noted.

Self-Reported Comorbid Conditions and Medication Usage in Breast Cancer Survivors With and Without Lymphedema

To compare the self-reported comorbid conditions and medication usage between breast cancer survivors with and without breast cancer treatment-related lymphedema. Descriptive, cross-sectional. A community-based study conducted in a major metropolitan area and surrounding rural counties in the southeastern United States. A convenience sample of 64 breast cancer survivors with lymphedema and 64 breast cancer survivors without lymphedema who were age matched within three years and recruited for a parent study. Twenty-one additional non-age-matched breast cancer survivors with or without lymphedema also were included. Self-reported survey instruments and height and weight measurement. Lymphedema, demographic information, self-reported comorbid diseases or medical issues, and medication usage. Breast cancer survivors with lymphedema experienced more comorbid conditions. Statistically significant group differences were found in body mass index, orthopedic issues, cardiac medications, hormone blockers, and osteoporosis medication or calcium supplement usage. Co-occurrence of diabetes and carpal tunnel syndrome approached statistical significance. Breast cancer survivors with lymphedema were older and had lower incomes. Comorbid conditions may influence the development of breast cancer treatment-related lymphedema. Further research, particularly a longitudinal study, is indicated. Healthcare professionals who care for breast cancer survivors need to routinely assess them for the presence of comorbid conditions and the development of lymphedema. Obese breast cancer survivors may benefit from weight reduction interventions to possibly decrease their risk of developing lymphedema and improve their overall health status. Patients with arthritis and orthopedic and cardiac issues such as hypertension may warrant careful monitoring.

Quality of life and a symptom cluster associated with breast cancer treatment-related lymphedema

The aim of this study was to compare quality of life and symptoms between breast cancer survivors who have developed and undergone treatment for chronic lymphedema with those who have not developed lymphedema. The cross-sectional, mixed-methods design included 64 breast cancer survivors with lymphedema and 64 breast cancer survivors without lymphedema. Variables assessed quantitatively included sociodemographic information, medical data, body mass index (BMI), arm extracellular fluid volume, quality of life (QOL), and physical and emotional symptoms. For the qualitative component, individuals with lymphedema responded in writing to the question: During the past week what other difficulties have you experienced because of your lymphedema? Compared with those without lymphedema, breast cancer survivors with lymphedema reported poorer QOL. A symptom cluster that included alteration in limb sensation, loss of confidence in body, decreased physical activity, fatigue, and psychological distress was identified. Perception of limb size influenced the cumulative symptom experience more than objective arm volume. Qualitative data revealed multiple QOL, physical health, and psychological concerns. BMI correlated with multiple outcomes. Findings suggest that current lymphedema treatments, although beneficial, may not provide complete relief of symptoms associated with lymphedema and complementary interventions are needed. The poorer QOL in breast cancer survivors with lymphedema may relate to the presence of an untreated symptom cluster.

Pretreatment lymphedema education and identified educational resources in breast cancer patients

Objective In 1998, the American Cancer Society (ACS) Lymphedema Workshop, called for a three phase approach to patient lymphedema education: (1) pretreatment, (2) postoperatively, and (3) continuing education. The objectives of this study were: to compare recalled pretreatment lymphedema education before and after the 1998 ACS call; compare recalled lymphedema pretreatment education between women with and without breast cancer treatment-related lymphedema; and identify breast cancer survivors perceived sources of lymphedema education. Methods One hundred and forty-nine breast cancer survivors (74 with lymphedema and 75 without lymphedema) were asked: (1) Prior to having breast cancer treatment did anyone talk to you about your risk for lymphedema? If yes, who? (2) Prior to having breast cancer treatment did anyone talk to you about ways to decrease your risk for lymphedema? If yes, who? (3) If you want to learn more about lymphedema occurring after breast cancer treatment who would you ask or where would you look for information? Results Individuals with lymphedema consistently recalled receiving less education and a decline in recalled risk reduction education in the lymphedema group occurred after 1998. Discussion Barriers exist to the integration of ACS suggested pretreatment lymphedema educational protocols and risk reduction education may influence risk of developing lymphedema. Conclusion Pretreatment lymphedema education may improve breast cancer survivor's recall of educational information received about lymphedema. Practice implications Healthcare providers must be well versed about breast cancer treatment-related lymphedema and communicate this knowledge to patients on a consistent basis.