Lymphedema In Breast Cancer Patients Research Articles

Abstract PS1-49: The effect of oncoplastic reduction on the incidence of post-operative breast lymphedema in breast cancer patients undergoing lumpectomy

Abstract Purpose / Objectives: In patients with macromastia, breast conservation surgery (BCS) followed by radiation therapy (RT) for the treatment of breast cancer may be associated with a different complication profile than those without macromastia. General complications of BCS followed by RT includes seroma, infection, wound complications, cosmetic deformity, asymmetry, acute versus long term arm and/or breast lymphedema. Oncoplastic reduction mammoplasty (ORM) aims to reduce breast volume while excising the tumor bed and its margins. Since breast volume was found to be a risk factor for chronic breast lymphedema, this study was performed to determine the impact of ORM on chronic breast lymphedema as well as other complications compared to BCS without ORM. Materials / Methods: We performed a retrospective chart review on patients who underwent lumpectomy with RT from 2014 to 2018. Chronic breast lymphedema (CBL) was defined as swelling that persisted >1 year post-RT. Breast volumes (BV) were determined by contoured breast volumes or, if unavailable, estimated by the 95% isodose volumes from the RT treatment planning system. Univariate analysis was used to evaluate various patient factors and treatment outcomes in women with BV ≥1300 cc compared to <1300 cc. These same factors were compared in women who underwent ORM vs. BCS alone. Multivariate regression analysis was used to evaluate factors associated with ≥1 complication. Logistic regression was performed to identify factors associated with the development of CBL. Results: The total population included 1173 patients, of which 51 (4.3%) underwent ORM and 1122 (95.7%) underwent BCS. 440 (37.5%) patients had BV ≥1300 cc and 733 (62.5%) patients had a BV <1300 cc. Multivariate regression analysis demonstrated that patients with BV ≥1300 cc had a higher BMI (OR=1.200, P<0.001), decreased risk of grade 2 radiation dermatitis (OR=0.457, P=0.002), and increased risk of CBL (OR=2.127, P=0.024) compared to patients with BV <1300 cc. However, oncoplastic reduction was associated with an increased risk of hematoma (OR=5.934, P<0.001), increased risk of wound dehiscence (OR=12.433, P<0.001), and decreased risk of seroma (OR=0.201, P<0.001) compared to BCS patients. Conclusions: Our data demonstrates that patients with breast volume > 1300 cc are at increased risk for developing several complications regardless of the presence of ORM. Those who had ORM experienced an increase in wound complications but having undergone ORM appeared to eliminate the increased risk of CBL associated with macromastia. This suggests that ORM should be considered at the time of BCS to reduce their future risk of CBL as there is no cure for this disease. Citation Format: Jenna Nicole Luker, Cara Canella, Sanjay Rama, Kelley Park, Renee Barry, Saheli Ghosh, Simeng Zhu, Yalei Chen, Jessica Bensenhaver, Eleanor Walker, Kenneth Levin, Maristella Evangelista, Dunya Atisha. The effect of oncoplastic reduction on the incidence of post-operative breast lymphedema in breast cancer patients undergoing lumpectomy [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-49.

Manual lymphatic drainage for lymphedema in patients after breast cancer surgery: A systematic review and meta-analysis of randomized controlled trials.

Background:Studies have shown that manual lymphatic drainage (MLD) has a beneficial effect on lymphedema related to breast cancer surgery. However, whether MLD reduces the risk of lymphedema is still debated. The purpose of this systematic review and meta-analysis was to summarize the current evidence to assess the effectiveness of MLD in preventing and treating lymphedema in patients after breast cancer surgery.Methods:From inception to May 2019, PubMed, EMBASE, and Cochrane Library databases were systematically searched without language restriction. We included randomized controlled trials (RCTs) that compared the treatment and prevention effect of MLD with a control group on lymphedema in breast cancer patients. A random-effects model was used for all analyses.Results:A total of 17 RCTs involving 1911 patients were included. A meta-analysis of 8 RCTs, including 338 patients, revealed that MLD did not significantly reduce lymphedema compared with the control group (standardized mean difference (SMD): −0.09, 95% confidence interval (CI): [−0.85 to 0.67]). Subgroup analysis was basically consistent with the main analysis according to the research region, the publication year, the sample size, the type of surgery, the statistical analysis method, the mean age, and the intervention time. However, we found that MLD could significantly reduce lymphedema in patients under the age of 60 years (SMD: −1.77, 95% CI: [−2.23 to −1.31]) and an intervention time of 1 month (SMD: −1.77, 95% CI: [−2.23 to −1.30]). Meanwhile, 4 RCTs including, 1364 patients, revealed that MLD could not significantly prevent the risk of lymphedema (risk ratio (RR): 0.61, 95% CI: [0.29–1.26]) for patients having breast cancer surgery.Conclusions:Overall, this meta-analysis of 12 RCTs showed that MLD cannot significantly reduce or prevent lymphedema in patients after breast cancer surgery. However, well-designed RCTs with a larger sample size are required, especially in patients under the age of 60 years or an intervention time of 1 month.

The Effect of Oncoplastic Reduction on The Incidence of Post-Operative Lymphedema in Breast Cancer Patients Undergoing Lumpectomy

In patients with macromastia, breast conservation surgery (BCS) followed by radiation therapy (RT) may be associated with increased radiation exposure and a different complication profile than those without macromastia. The oncoplastic reduction mammoplasty (ORM) procedure includes breast reduction at the time of BCS. The purpose of this study is to determine if women with macromastia who undergo ORM have a different complication profile compared to those who undergo BCS followed by RT. We performed a retrospective chart review on patients who underwent lumpectomy with RT from 2014 to 2017. Chronic breast lymphedema (CBL) was defined as swelling that persisted >1-year post-RT. Breast volumes (BV) were determined by contoured breast volumes or, if unavailable, estimated by the 95% isodose volumes from the RT treatment planning system. Univariate analysis was used to evaluate various patient factors and treatment outcomes in women with BV ≥1300 cc compared to <1300 cc. These same factors were compared in women who underwent ORM vs. BCS. Multivariate regression analysis was used to evaluate factors associated with ≥1 complication. Logistic regression was performed to identify factors associated with the development of CBL. The total population included 785 patients, of which 28 (3.6%) underwent ORM and 757 (96.4%) underwent BCS. The total population was stratified into two groups, in which 289 (36.8%) patients had BV ≥1300 cc and 496 (63.2%) patients had a BV <1300 cc. Compared to patients with BV<1300 cc, those with BV ≥1300 cc had a higher percentage of African Americans (52.6% vs. 41.5%, P = 0.002), higher median BMI (34.96 vs. 27.87, P<0.001), higher incidence of diabetes (39.8% vs. 27.2%, P<0.001), higher incidence of hypertension (75.4% vs. 63.1%, P<0.001), and higher incidence of CBL (12.5% vs. 4.2%, P<0.001). Compared to BCS patients, ORM patients with BV ≥1300 cc had increased incidence of CBL (36.4% vs. 11.5%, P = 0.035). Logistic regression showed that the incidence of ≥1 complication was associated with BMI, presence of SLNB, and the number of lymph nodes removed in either SLNB or ALND. However, factors such as ORM and BV were not associated with an increased risk of ≥1 complication. Logistic regression demonstrated that having a BV ≥1300 cc was associated with 2.5 times increased odds of CBL compared to those with BV <1300 cc. Even though those who underwent ORM did not change the risk for CBL for the entire cohort, ORM patients with BV ≥1300 had a higher risk of CBL. Ultimately, logistic regression demonstrates that ORM does not increase the risk of CBL when adjusting for BV. In conclusion, axillary surgery contributed most significantly to the incidence of having ≥1 complication. However, BV was associated with an increased risk of CBL, regardless of the presence of ORM. Therefore, women with BV ≥1300 cc should be offered ORM at the time of lumpectomy in order to reduce their future risk of CBL.

Limb Lymphoedema in Breast Cancer Patients Receiving Radiation Therapy: A Pilot Study

Limb Lymphoedema in Breast Cancer Patients Receiving Radiation Therapy: A Pilot Study

Baseline Inflammatory Markers Are Associated with Upper Extremity Lymphedema in Breast Cancer Patients

Baseline Inflammatory Markers Are Associated with Upper Extremity Lymphedema in Breast Cancer Patients

Lymphedema Prevention Surgery: Improved Operating Efficiency Over Time.

Lymphedema prevention surgery (LPS), which identifies, preserves, and restores lymphatic flow via lymphaticovenous bypasses (LVB), has demonstrated potential to decrease lymphedema in breast cancer patients requiring axillary lymph node dissection. Implementing this new operating technique requires additional operating room (OR) time and coordination. This study sought to evaluate the improvement of LPS technique and OR duration over time. A prospective database of patients who underwent LPS at our institution from 2016 to 2019 was queried. Type of breast and reconstruction surgery, number of LVB performed, and OR times were collected. LPS details were compared by surgical group and year performed. Ninety-four patients underwent LPS, and 88 had complete OR time data available for analysis. Average age was 51years, body mass index of 28, with an average of 15 lymph nodes removed. Reconstructive treatment groups included prosthetic reconstruction 56% (49), oncoplastic reduction 10% (9), and no reconstruction 34% (30). The number of patients undergoing LPS increased significantly from 2016 to 2019, and average number of LVB per patient doubled. In patients without reconstruction, the average time for LPS improved significantly from 212 to 87min from 2016 to 2019 (p = 0.015) and similarly in patients undergoing LPS with prosthetic reconstruction from 238 to 160min (p = 0.022). LVB is an emerging surgical lymphedema prevention technique. While requiring additional surgical time, our results show that with refinement of technique, over 4years, we were able to perform double the number of LVB per patient in half the OR time.

Abstract P2-12-15: Efficacy of Lymphdiaral™ in breast cancer patients with lymphedema

Abstract Background: Lymphedema has been a prevalent and often severe side effect for patients receiving treatment for breast cancer typically resulting in physical and psychosocial distress as well as decreased quality of life. With no widely effective or safe drug treatment(s) for lymphedema, this study aimed to assess the efficacy of combined Lymphdiaral™ drops and ointment for treatment-related lymphedema. Methods: This open label, randomized, parallel-group trial ran over 12 weeks with a final follow-up visit at 24 weeks. One hundred and thirty-four (n = 134) patients were consented to the study. Of these, 119 patients were randomized to either standard care group (compression garment) or treatment group (compression garment plus Lymphdiaral™ drops and ointment) and follow-up data was obtained. The primary objective was the reduction in lymphedema as measured by change in arm volume. Results: The values for the arm volumes did not show a statistically significant decrease in both the standard care or treatment groups. Additionally, there was no statistical difference in arm volume reduction between the groups. Conclusions: This first randomized trial shows, that the homeopathic drug combination of Lymphdiaral™ drops and ointment does not improve lymphedema in breast cancer patients. Citation Format: Jawaid Younus, Morgan Black, Lyn Kligman, Brenda Leung. Efficacy of Lymphdiaral™ in breast cancer patients with lymphedema [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-12-15.

Lymphoedema After Breast Cancer Treatment is Associated With Higher Body Mass Index: A Systematic Review and Meta-Analysis

Background: Excess body weight has been identified as an important risk factor for lymphoedema following breast cancer treatment, however it remains unclear how much risk increases as weight increases. We conducted a meta-analysis to assess the relationship between body mass index (BMI) and risk of lymphoedema in breast cancer patients, and to estimate the level of risk by BMI category. Methods: We conducted a systematic search of all articles published through May 2018 in PubMed and the Cochrane library. Studies that included data on BMI and lymphoedema in breast cancer patients were included in the meta-analysis. We compared risk of lymphoedema in BMI groups as: BMI<25 versus BMI≥25, BMI<25 versus BMI≥30, BMI≥25 to <30 versus BMI≥30, BMI<30 versus BMI≥30, BMI<25 versus BMI≥25 to BMI<30. Results: After exclusion of ineligible studies, 57 studies were included in the meta-analysis. The mean difference in BMI between patients with lymphoedema compared to those without lymphoedema was 1.7 (95% CI, 1.3 - 2.2). Compared to patients with a BMI 25 to 25 to 30 (OR 1.5; 95% CI,1.4 to 1.8). Conclusion: Excess body weight is a risk factor for lymphoedema following treatment of breast cancer, with the magnitude of risk increasing across higher categories of BMI.

The Diagnostic Approach to Lymphedema: a Review of Current Modalities and Future Developments

Breast cancer–related lymphedema (BCRL) is a chronic disease that results from a disruption or obstruction in the lymphatic system and affects 15 in 100 individuals in the USA with newly diagnosed breast cancer. As no curative therapy exists for lymphedema, early detection is crucial in order to reduce the risk of developing late stage symptoms, such as swelling, decreased limb flexibility, disfigurement, and impaired function of the extremity. The objective of this review is to discuss current modalities and devices as well as highlight promising advancements intended to aid in diagnosing secondary lymphedema in breast cancer patients. Imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) can offer high resolution of the lymphatics but are expensive and time-consuming. Single photon emission computed tomography (SPECT) is an alternative that reveals organ function as opposed to organ structure. Other imaging methods, such as color duplex ultrasound (CDU), laser scanner 3D (LS3D), and dual-energy X-ray absorptiometry (DXA), are relatively easy to use, reproducible, and fast to perform. However, the disadvantages of these techniques include lower sensitivity and specificity compared with CT and MRI. Of note, direct imaging techniques are highly effective for the diagnosis of lymphedema because they utilize dyes or radiotracers in order to directly visualize lymphatic vessels. Fluorescent microlymphography (FMLG) and near-infrared imaging (NIR) involve injection of fluorescent dyes that can be excited with light. Lymphoscintigraphy has effectively replaced lymphangiography as the method of choice for the diagnosis of lymphedema because it is safer, less invasive, and has no risk of causing an allergic reaction in patients. Novel approaches that are currently in development include bioimpedance spectroscopy, ultra-high-frequency ultrasound systems (UHFUS), and magnetic resonance lymphography (MRL). The wide range of diagnostic methods for BCRL exhibit the tradeoff between simplicity and sensitivity; some techniques provide high resolution but are expensive and time consuming. On the other hand, other modalities are easy to use, reliable, and relatively fast in execution yet lack the ability to precisely visualize the lymphatic system. In review of these various techniques, lymphoscintigraphy serves as a clear gold standard for diagnosing secondary lymphedema while more advanced and promising techniques continue to emerge as newer alternatives in clinical practice.

A study of the effect of case management on postoperative lymphedema in breast cancer patients

Objective To explore the effect of case management on postoperative affected limb lymphedema in breast cancer patients. Methods This study is a non-concurrent control trial. A total of 157 cases of breast cancer patients who met the inclusion/exclusion criteria were selected from the Sun yet-sen University Cancer Center from June 2016 to July 2017 and from June 2016 to July 2017 by the convenient sampling method. Among them, 80 patients from June to July 2016 were listed as the control group, and 77 patients from June to July 2017 were listed as the intervention group. The control group implemented the routine nursing mode of breast cancer. The intervention group implemented case management on the basis of routine nursing. Lymphedema of the affected limb were compared between the two groups before intervention, 3 months after surgery, 6 months after surgery and 1 year after surgery. Results The incidence of postoperative lymphedema (OR=2.467, 95%CI1.177-5.169, P 0.05). There was a statistically significant difference between the two groups 6 months after operation (χ2=5.835, P<0.05) and 1 year after operation (P=0.003). The incidence of lymphedema in the affected limbs in the experimental group was lower than that in the control group. There was an increased incidence of lymphedema in the control group, the incidence of side pain, but an incidence of lymphedema in the intervention group was in a downward trend. Conclusion Case management mode can effectively prevent and improve the occurrence of postoperative lymphedema in patients with breast cancer. Key words: Breast carcinoma; Case management; Lymphedema

Calcium Channel Blockers and Risk of Lymphedema among Breast Cancer Patients: Nested Case-Control Study.

To assess the risk of lymphedema associated with the use of calcium channel blockers (CCB) among breast cancer patients. A nested case-control study of adult female breast cancer patients receiving an antihypertensive agent was conducted using administrative claims data between 2007 and 2015. Cases were patients with lymphedema who were matched to 5 controls based on nest entry date (±180 days), age (±5 years), number of hypertensive drug classes, Charlson Comorbidity Index (CCI), thiazide exposure, and insurance type. Exposure to CCBs and covariates was identified in the 180-day period prior to event date. Conditional logistic regression was used to assess the impact of exposure among cases and controls. A total of 717 cases and 1,681 matched controls were identified. After matching on baseline characteristics, mastectomy (7.8% vs. 4.8%; P = 0.0039), exposure to radiotherapy (27.1% vs. 21.7%; P = 0.0046), taxane-based chemotherapy (11.7% vs. 7.4%; P = 0.0007), anthracycline-based chemotherapy (6.0% vs. 3.6%; P = 0.0073), CCB use (28.3% vs. 23.3%; P = 0.0087), and CCI (19.8% vs. 12.7%; P < 0.0001; score of 4 or above) were all higher in cases during the 180 days prior to the event date. In the adjusted analysis, CCB exposure was significantly associated with increased risk of lymphedema (OR = 1.320; 95% confidence interval, 1.003-1.737). CCB use was significantly associated with the development of lymphedema in breast cancer patients. CCBs should be avoided or used with caution in breast cancer patients to reduce the risk for developing lymphedema.

The Effect of Traditional Medicine for Lymphedema in Breast Cancer Patients: A Systematic Review

The Effect of Traditional Medicine for Lymphedema in Breast Cancer Patients: A Systematic Review

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.

Lymphoedema After Breast Cancer Treatment is Associated With Higher Body Mass Index: A Systematic Review and Meta-Analysis.

Background:Excess body weight has been identified as an important risk factor for lymphoedema following breast cancer treatment, however it remains unclear how much risk increases as weight increases. We conducted a meta-analysis to assess the relationship between body mass index (BMI) and risk of lymphoedema in breast cancer patients, and to estimate the level of risk by BMI category.Methods:We conducted a systematic search of all articles published through May 2018 in PubMed and the Cochrane library. Studies that included data on BMI and lymphoedema in breast cancer patients were included in the meta-analysis. We compared risk of lymphoedema in BMI groups as: BMI<25 versus BMI≥25, BMI<25 versus BMI≥30, BMI≥25 to <30 versus BMI≥30, BMI<30 versus BMI≥30, BMI<25 versus BMI≥25 to BMI<30.Results:After exclusion of ineligible studies, 57 studies were included in the meta-analysis. The mean difference in BMI between patients with lymphoedema compared to those without lymphoedema was 1.7 (95% CI, 1.3–2.2). Compared to patients with a BMI<25, risk of lymphoedema was higher in those with a BMI >25 to <30 (odds ratio [OR] 1.3; 95% CI, 1.2 to 1.5), a BMI≥25 (OR 1.7; 95% CI, 1.5 to 1.9), or a BMI≥30 (OR 1.9; 95% CI, 1.6 to 2.4). Compared to patients with a BMI of >25 to <30, risk of lymphoedema was higher in patients with a BMI>30 (OR 1.5; 95% CI,1.4 to 1.8).Conclusion:Excess body weight is a risk factor for lymphoedema following treatment of breast cancer, with the magnitude of risk increasing across higher categories of BMI.

Risk factors for postoperative lymphedema in breast cancer patients

Objective To investigate the risk factors of lymphedema in patients with breast cancer after operation. Methods From January 2012 to May 2016, the clinical data of 350 patients with breast cancer who underwent surgical treatment in First People′s Hospital of Foshan were collected. According to the occurrence of postoperative lymphedema, the patients were divided into lymphedema group (87 cases) and non lymphedema group (263 cases). The possible risk factors were evaluated from general demographic indicators, pathological data of breast cancer, perioperative related data and preventive action implementation. Results General demographic data: there was no correlation between the incidence of lymphedema and age, preoperative body mass index (BMI), postoperative BMI, educational level, marital status, residence, family income, menopause, hypertension history (P>0.05). Pathological data of breast cancer: the occurrence of lymphe-dema was related with tumor quadrant (χ2=20.039, P 0.05). Comparison of preventive behaviors: avoiding injuries such as cuts and bites (χ2=15.754, P 0.05). Lymphedema as the dependent variable, multivariate logistic regression analysis results showed that tumor located in the upper outer quadrant (OR=3.943, P<0.001), surgical incision for longitudinal incision (OR=3.767, P<0.001) or oblique incision (OR=2.492, P<0.001), Ⅱ (OR=1.707, P=0.003) or Ⅲ (OR=4.211, P<0.001) axillary lymph node dissection, breast/chest wall radiotherapy (OR=2.869, P<0.001) or lymph node radiotherapy (OR=4.829, P<0.001), grabing heavy objects or not (OR=3.264, P<0.001), avoiding injuries such as cuts and bites (OR=2.602, P<0.001) were independent risk in-fluence factors of postoperative lymphedema. Conclusion A variety of factors affect the occurrence of posto-perative lymphedema in breast cancer patients. Tumors located in the upper outer quadrant, longitudinal or oblique incision, high level of axillary lymph node dissection, radiotherapy, having injuries such as cuts and bites, grabing heavy objects are independent risk influence factors of postoperative lymphedema in breast cancer patients. More attention should be paid to the high risk of lymphedema, and the preventive measures should be taken actively. Key words: Breast neoplasms; Lymphedema; Risk factors

Prospective study of shoulder strength, shoulder range of motion, and lymphedema in breast cancer patients from pre-surgery to 5years after ALND or SLNB.

Determine the changes in shoulder strength, shoulder range of motion, and arm volume in breast cancer patients treated with sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) METHOD: Sixty-eight SLNB and 44 ALND patients were followed up from pre-surgery to 5years after surgery. Primary outcomes were the differences between affected and non-affected sides for the following: shoulder strength measured by dynamometry, shoulder range of motion measured by goniometry, and lymphedema measured by volume. As a secondary outcome, health-related quality of life (HRQL) was assessed by the Short Form-36 Health Survey (SF-36) and the Functional Assessment of Cancer Therapy for breast cancer (FACT-B+4) questionnaires. Changes over time were tested for SLNB and ALND using univariate repeated measures analysis of variance. Generalized estimating equation models were constructed to assess the effect of SLNB and ALND over time. After 5years, the ALND group had significant loss of strength for internal rotators (1.39kg, p = 0.001) and significant arm volume increase (132.45mL, p = 0.031). The ALND group had a greater number of patients with clinically relevant internal rotator strength loss (38.7 vs. 13.6%, p = 0.012) and a greater number of lymphedema requiring treatment (33.3 vs. 3.4%, p < 0.001) than the SLNB group. A loss of strength for shoulder external rotators, shoulder range of motion, and HRQL in physical and arm domains persisted at 5years in both SLNB and ALND groups. These results could help understand and plan the prevention, needs, and long-term care of breast cancer patients.

Predicting the Risk of Lymphedema in Breast Cancer Patients by Using Data Mining Techniques

Predicting the Risk of Lymphedema in Breast Cancer Patients by Using Data Mining Techniques

Upper limb lymphedema in breast cancer patients in the era of Z0011, sentinel lymph node biopsy and breast conservation.

Surgical techniques in breast cancer (BCa) have seen a dramatic change recently with breast-conserving surgery (BCS) and sentinel lymph node biopsy (SLNB). The ACOSOG-Z0011 trial reported equivalence in outcomes for certain patients with SLN metastases treated with axillary lymph node dissection (ALND) or SLNB alone. Our aim was to investigate changes in lymphedema referral patterns in BCa patients over the last 3years in a specialist unit and to elucidate effects of SLNB, BCS, and Z0011 trial publication on such patterns. A retrospective study was performed over a 3-year period (May 2012-May 2015). Patients were identified using a prospectively maintained lymphedema database and newly referred BCa patients with data availability were included. Overall lymphedema incidence was 11% (19.2% in ALND and 5.1% in SLNB cohort). There was a statistically significant difference in lymphedema referral patterns after Z0011, new referrals reduced by 20% (chi-sq; p=0.001). Volume of referrals post ALND was reduced by 40% with concomitant 31% rise in those post SLNB alone, reflecting changing surgical patterns. There was a significant change in extent of lymphnode dissection during ALND (p=0.003). The Z0011 trial in association with wider implementation of SLNB has led to significant changes in the lymphedema referral patterns and extent of ALND.

Abstract PD4-03: Chemotherapy-related risk factors associated with lymphedema in breast cancer patients: Should repeated ipsilateral arm infusions be avoided?

Abstract Background: Breast Cancer-Related Lymphedema (BCRL) is a chronic, iatrogenic condition that can occur after damage to the lymphatic system during surgery (sx) or radiation, precipitating edema of the arm, breast, or trunk. BCRL risk-reduction education is an essential component of clinical care, and practitioners often advise patients (pts) to avoid needle punctures on the treated arm when possible. There is, however, a lack of substantial scientific evidence to lessen patient distress. Considering the common use of chemotherapy (CT) agents in this population, we assessed whether repeated skin punctures on the ipsilateral arm for CT infusions increased the risk of BCRL compared to CT via central lines in a large, prospective cohort of breast cancer (BC) pts. Methods: We prospectively screened 630 pts with unilateral (487) or bilateral (143) BC sx receiving neoadjuvant (NAC) and/or adjuvant CT (AdjCT) for arm lymphedema (defined as volume change ≥10%) at our hospital from 2005–16. Pts were measured with a perometer pre-operatively and at 3–7 month follow-up intervals. Clinicopathologic and treatment (tx)-related characteristics, including details on CT regimen and the method of intravenous (IV) CT administration [peripheral IV catheters (PIVCs), central venous access devices (CVADs), peripherally inserted central catheters (PICCs)] were obtained by chart review. Cox proportional hazard analyses were applied to ascertain the risk of BCRL associated with these factors. Results: The median post-op follow-up was 44 months. Of the 630 pts, 40% underwent axillary lymph node dissection (ALND), 60% underwent sentinel lymph node biopsy (SLNB) or no nodal sx, 16% and 89% received NAC or AdjCT, respectively. CT was administered via PIVCs inserted in the hand/arm for 59%, via CVADs or PICCs for 26%, and via both PIVCs at least once and CVADs/PICCs for 15%. The 2-yr cumulative incidence of BCRL was 12% (95% CI 9.9-15.2%). Multivariable regression results indicated that pts with both peripheral IV infusions on the arm and implanted CVADs did not have a higher risk of BCRL (HR(95% CI)=1.4(0.6-3.6)) than pts who received CT via CVADs only (1.7(0.7-3.8)). The overall number of NAC (p=0.24;0.9(95% CI 0.8-1.1)) or AdjCT cycles (p=0.78;1.0(0.9-1.1)) was not associated with BCRL, nor was the number of peripheral IV infusions (p=0.17;1.0(1.0-1.1)). BMI &amp;gt;30 (p&amp;lt;0.0001;3.4(1.9-6.0)) and number of positive lymph nodes (p=0.02;3.2(1.3-8.1)) were significantly associated with BCRL. Among those with PIVCs, pts with bilateral SLNB/ALND were more likely to develop BCRL than pts with unilateral sx (p&amp;lt;0.01;5.0(1.9-13.4)). Only 38% of the 32 bilateral pts with BCRL received at least one peripheral IV infusion on their ipsilateral arm. Conclusion: Results suggest that repeated skin punctures on the ipsilateral arm for CT infusions do not significantly increase the risk for BCRL compared to implanted CVADs, nor does the overall number of CT cycles. As survivors may be concerned about the risk of developing BCRL following sx and tx, healthcare practitioners should strive to mitigate pt worry during and well beyond the course of tx, educating pts about the lifestyle risk exposures for BCRL and precautionary guidelines not being definitive. Citation Format: Asdourian MS, Rao SR, Skolny MN, Salama L, Brunelle C, Seward C, Taghian AG. Chemotherapy-related risk factors associated with lymphedema in breast cancer patients: Should repeated ipsilateral arm infusions be avoided? [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr PD4-03.

Effectiveness of compression therapy along with exercise to reduce upper limb lymphedema in breast cancer patients

Objectives: Lymphedema is a communal issue in breast cancer patients. This study was designed to evaluate the effectiveness of compression therapy and exercise in the treatment of lymphedema in breast cancer patients. Materials and Methods: Thirty patients were randomly assessed in a randomized controlled study trial at the Department of Oncology, Mayo Hospital Lahore. Patients were divided into two groups. Fifteen patients were selected in Group 1 (compression therapy), and 15 patients were selected in Group 2 (compression therapy along with exercise). Both groups received eight sessions for 4 weeks followed by one session in each week. Limb circumferential measurements were used to assess the limb volume reduction and pain numeric rating scale for pain and shoulder pain and disability index scale for the pain and disability. Data were collected at baseline and after 4 weeks. Results: Statistically significant improvement was found in both groups (P > 0.05). However, no group difference was insignificant. However, clinically, the compression bandage along with exercise and skin care is more effective in reducing lymphedema in breast cancer patients. Conclusion: This study concluded that both the treatment techniques, compression bandage and compression bandage along with exercise are effective in reducing lymphedema and pain; but, clinically, compression bandage along with exercise is more effective.