Lymphedema In Breast Cancer Survivors Research Articles

Sleep quality and lymphedema in breast cancer survivors: a mixed method analysis.

The purpose of this convergent mixed methods study was to assess the perceptions and characteristics of sleep in breast cancer survivors (BCSs) and elucidate perceptions of sleep among BCS with lymphedema. Participants were BCS with and without lymphedema. Both groups completed the Pittsburgh Sleep Quality Index (PSQI), PROMIS® Sleep Disturbance (8a short form), and wore an actigraph on their wrist to capture sleep/wake cycles for 7 days/nights while logging their sleep using a sleep diary. The coefficient of variation of sleep efficiency was calculated from the sleep diary to assess intraindividual variability. In addition, a subsample of BCS with lymphedema participated in a semi-structured qualitative interview. The qualitative data was analyzed separately, and the themes were applied to provide a more nuanced explanation of the quantitative outcomes. The BCS with lymphedema (n=23) had a significant difference in PSQI (p=0.002), PROMIS® Sleep Disturbance (p=0.084), and sleep efficiency coefficient of variation (p=0.014) compared to BCS without lymphedema (n=23). There were no statistically significant differences between groups in the actigraphy results. BCS with lymphedema perceived that lymphedema management contributed to their sleep disturbance, further exacerbating their mind/body fatigue. This study provides the foundation for future research to investigate the integration of sleep interventions with lymphedema management for holistic survivorship care for BCS with lymphedema. An innovative sleep health intervention designed to consider the unique factors contributing to sleep disturbance in BCS with lymphedema will fill a gap in their post-cancer treatment quality of life.

Examining the efficacy of treatments for arm lymphedema in breast cancer survivors: an overview of systematic reviews with meta-analyses

Lymphedema affects one in six breast cancer survivors making it a global healthcare challenge. There is considerable debate about the efficacy of different treatments for lymphedema. We aimed to summarize the current evidence for treatments for lymphedema in breast cancer survivors. In this overview of systematic reviews with meta-analyses (SRMAs), five databases were searched for SRMAs of randomised controlled trials (RCTs) reporting effects of medications, surgery, exercise, laser therapy, acupuncture, kinesio taping, or complex decongestive physiotherapy (CDP) for breast cancer-related lymphedema published from database inception up to March 7, 2023. Data extraction was performed for the SRMAs and RCTs, and SRMAs were appraised with AMSTAR2. Random effects meta-analyses of the RCTs provided estimates of the pooled effects sizes (Hedges' g) for each treatment modality. This study is registered with PROSPERO, CRD42020184813. 1569 studies were identified by the search and eighteen SRMAs with 51 RCTs were included, investigating manual lymphatic drainage (MLD), compression pump, exercise, kinesio taping, laser, and acupuncture. Overall, the methodological quality of the SRMAs was low. SRMAs reached different conclusions for all treatment modalities, except for kinesio taping where the two SRMAs found no effect. The analysis of 40 RCTs with 1970 participants revealed a small effect across all interventions compared to any control (g=0.20, p=0.047, I2=0.79), corresponding to volume reductions of 119.7ml (95% CI 135-104) and 88.0ml (95% CI 99-77) in the intervention and control groups, respectively, and a small effect of exercise (g=0.26, p=0.022, I2=0.44). The between-group differences in volume reduction were small and did not reach statistical significance for any one treatment modality. Based on the available data, there is no evidence of superiority of any one treatment on volume reduction nor any solid research refuting these treatments. Thus, definitive conclusions to inform clinical practice about the efficacy of these treatments cannot be drawn. Due to poor-quality evidence, more research is needed to untangle the efficacy of each treatment component for different stages of lymphedema. Danish Cancer Society.

Effect of Complex Decongestive Therapy (CDT) and Manual Lymphatic Drainage (MLD) on Lymphedema Control after Surgery in Breast Cancer Patients -A Literature Review

Background: Breast cancer considerably affects both developed and developing nations globally, it has been the focus of several studies. Lymphedema in breast cancer survivors is a more prevalent condition that healthcare providers often fail to completely comprehend. About five in one women who have undergone breast cancer surgery acquires Breast Cancer Related Lymphedema (BCRL). Lymphedema is a chronic and debilitating disease that that can develop as a consequence of breast cancer treatment. It can have disastrous impacts on a patient's quality of life associated with lymphedema. In general, it is underreported and undertreated. The aim of this reviews study is to determine the effectiveness of CDT on reducing the occurrence of lymphedema in breast cancer patients. Methodology: For these studies literature review, databases PubMed, Google Scholar and science direct were employed. Articles published from 2019-2023, and with the full English text met the inclusion criteria. Articles published prior to 2019 and articles having an incorrect abstract were excluded. Results: CDT has been shown to be useful in reducing the symptoms associated with BCRL. It proved that exercise is safe, in addition to it is important to continue exercise in daily life. The functional status of the patients also showed a noticeable improvement. Conclusion: In patients with BCRL, CDT improves upper extremity functioning and quality of life. Contributing factors include the decrease in volume of lymphedema, aching and heaviness, and an increase in shoulder movement. CDT is a promising therapeutic modality for the lymphedema.

Recent Advances in Therapeutic Modalities Against Breast Cancer-Related Lymphedema: Future Epigenetic Landscape.

Background: Lymphedema is a significant postsurgical complication observed in the majority of breast cancer patients. These multifactorial etiopathogenesis have a significant role in the development of novel diagnostic/prognostic biomarkers and the development of novel therapies. This review aims to ascertain the epigenetic alterations that lead to breast cancer-related lymphedema (BCRL), multiple pathobiological events, and the underlying genetic predisposing factors, signaling cascades pertinent to the lapses in effective prognosis/diagnosis, and finally to develop a suitable therapeutic regimen. Methods and Results: We have performed a literature search in public databases such as PubMed, Medline, Google Scholar, National Library of Medicine and screened several published reports. Search words such as epigenetics to induce BCRL, prognosis/diagnosis, primary lymphedema, secondary lymphedema, genetic predisposing factors for BRCL, conventional therapies, and surgery were used in these databases. This review described several epigenetic-based predisposing factors and the pathophysiological consequences of BCRL, which affect the overall quality of life, and the interplay of these events could foster the progression of lymphedema in breast cancer survivors. Prognosis/diagnostic and therapy lapses for treating BCRL are highly challenging due to genetic and anatomical variations, alteration in the lymphatic vessel contractions, and variable expression of several factors such as vascular endothelial growth factor (VEGF)-E and vascular endothelial growth factor receptor (VEGFR) in breast cancer survivors. Conclusion: We compared the efficacy of various conventional therapies for treating BCRL as a multidisciplinary approach. Further substantial research is required to decipher underlying signaling epigenetic pathways to develop chromatin-modifying therapies pertinent to the multiple etiopathogenesis to explore the correlation between the disease pathophysiology and novel therapeutic modalities to treat BCRL.

Estimation of Neural Tissue Mobility in Breast Cancer Survivors with Lymphedema.

Lymphedema in breast cancer survivors is a very common condition which progressively may lead to entrapment neuropathy. In lymphedema there is accumulation of fluid due to removal of lymph nodes which causes stretching of nerve fibres within the skin, compression on top of the nerve bundle leading to nerve entrapment. This will increase the neural mechanosensitivity and functional impairment of shoulder as a protective neural response to movement or traction. This study was carried out by assessing the total 72 breast cancer survivor women, with lymphedema. Out of 72, 28 of women underwent lumpectomy, 12 underwent quadrantectomy and 32 underwent unilateral mastectomy. These subjects were assessed for neural tissue mobility by taking pain assessment using visual analogue scale (VAS), range of motion (ROM) using goniometer, lymphedema measurement using an inch tape. The neural tissue mobility for median nerve, ulnar nerve and radial nerve was measured using limb tension test. The result obtained from this study showed that neural tissue mobility was significantly impaired in breast cancer survivors with lymphedema. The result of the upper limb tension tests showed 32 women with mild lymphedema had median nerve affected on the involved side 54.1%, about 21 women had moderate lymphedema with 75% of women had median and 25% ulnar nerve affected with median nerve affected in majority of women. Only 19 women with severe lymphedema had all the three nerves affected. This study of women who have undergone surgical intervention for breast cancer concludes that there was significant amount of neural tissue impairment noted to mechanical provocation test post operatively after 6 months of surgery. The study suggests that severity of lymphedema was directly related to the nerves affected due to neural tissue impairment.

Correlation between Postural Impairment and Lymphedema in Breast Cancer Survivors

The major complication of breast cancer is secondary lymphedema seen within few days to months after the surgery. Lymphedema has a debilitating effect on posture. The significance of this study is to show the effect of lymphedema on posture. These all have a huge impact on the quality of life of patients, within her family as well as working places. This study provides a platform to assess the spinal posture which may be at risk due to lymphedema in breast cancer survivors. Hence, the study is to find out correlation between spinal postural impairment and lymphedema in breast cancer survivors and to assess the correlation between demographic variables and lymphedema in breast cancer survivors. The aim of the study was to study and find out the correlation between postural impairment and lymphedema in breast cancer survivors. This was an observational study with the total of 116 breast cancer survivor women’s who had undergone radiotherapy and surgery were selected from Krishna Institute of Medical Sciences, Karad. Their age ranged from 35 to 60 years old. The outcome measures which were included are postural examination chart in the anterior, posterior, lateral views by plumb line, muscle length test, muscle strength test, pain assessment using visual analog scale, and lymphedema measurement using inch tape. The obtained results showed statistically high significant increase in the forward head posture, rounded shoulders, thoracic kyphosis and scoliosis, scapular dyskinesis, and increased volume of affected arm. There were high significant correlation between spinal postural impairments and lymphedema in breast cancer survivors and also correlation between demographic variables and lymphedema in breast cancer survivors.

Abstract P4-11-21: Plasma cytokine levels in breast cancer-related lymphedema patients

Abstract Background: Breast cancer-related lymphedema (BCRL) is encountered by approximately 40% of breast cancer survivors. BCRL drastically affects quality of life, as the arm, breast, and trunk swelling, together with pain, depression, and cellulitis risk can make everyday functions difficult or impossible. Objective: To identify plasma biomarkers that can suggest targeted pharmacological treatments for breast cancer survivors who develop lymphedema (LE). Methods: In a prospective, ongoing, longitudinal clinical study (NCT02949726), peripheral blood, perometric arm volumes, and near-infrared fluorescence lymphatic images/videos (NIRF-LI) for the first 33 enrolled advanced breast cancer patients were collected pre-mastectomy/breast-conserving surgery with ALND, four weeks postoperatively, at the end of radiation therapy (RT), and at 6 months post-RT. 29 cytokines were measured at each time point using a MILLIPLEX MAP human cytokine/chemokine magnetic bead panel from isolated blood plasma. Cytokine levels in subjects with >5% perometric arm swelling at 6 months post-regional nodal RT were analyzed and compared to those with <5% perometric arm swelling at 6 months post-regional nodal RT. Additionally, subjects who exhibited LE-associated dermal backflow, identified by cloudy fluid masses, instead of linear vessels, with NIRF-LI, at 6 months post-regional nodal RT were compared to those without backflow at 6 months post-regional nodal RT. GraphPad/Prism 9 non-parametric Mann-Whitney t-test was used to compute the p-values of each cytokine. P-values less than 0.05 were deemed significant. Results: Out of the 33 subjects, 7 developed >5% perometric arm swelling 6 months post-regional nodal RT and 15 developed dermal backflow 6 months post-regional nodal RT. Of the 15 subjects that developed backflow, 7 also had >5% perometric arm swelling. G-CSF, GM-CSF, IL-10, IL-12p40, and IL-1R-alpha were found to be significantly higher in subjects with >5% perometric arm swelling at 6 months post-RT than in subjects with <5% perometric arm swelling while IL-1beta was identified to be significantly lower in subjects with backflow at 6 months post-regional nodal RT than those without backflow at 6 months post-regional nodal RT. Conclusions: G-CSF, GM-CSF, IL-10, IL-12p40, IL-1Ralpha, and IL-1beta are candidate biomarkers for detecting and directing pharmacological treatment for lymphedema in breast cancer survivors. Citation Format: Anna R Vang, Simona F Shaitelman, Eva M Sevick-Muraca, Chan Wen-yaw, John C Rasmussen, Sarah D DeSnyder, Melissa B Aldrich. Plasma cytokine levels in breast cancer-related lymphedema patients [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-11-21.

Feasibility and Efficacy Exercises in Women With Lymphedema Post Breast Cancer – A Pilot Study

Research Objectives was to examine the feasibility and efficacy of exercises in women with lymphedema post breast cancer. Breast cancer treatment often results in the development of upper extremity lymphedema. Evidence is lacking on the effects exercise has on lymphedema in breast cancer survivors. This analysis looks to see the impact of exercise programs on lymphedema in breast cancer survivors. Design Retrospective data analysis. Setting The data in this study came from an original research project, Project IMPACT (Improving Mental and Physical ACTivity), that took place in San Antonio, Texas. Participants This analysis included data from a sub-group of 9 participants with lymphedema in at least one of their arms. The original study had 94 participants who were breast cancer survivors. Interventions Project Impact looked at the effects six month exercise interventions on breast cancer survivors: yoga-based exercise, a comprehensive individualized designed program (including aerobic, resistance and flexibility exercises), and exercise of the participant's own choice. Main Outcome Measures Affected side volume, passive range of motion (PROM), and self-reported effects of Lymphedema on daily life measured by the Norman Lymphedema Self-Report Survey (NLSS). All outcomes were measured at the beginning and end of the exercise program. Results All participants completed the exercise program with no adverse events. A significant difference (p < 0.05) was found in four subscales pertaining to the affected upper extremity's forearm and hand in the NLSS. No other significant changes were found. Conclusions The results of this pilot study suggest that it is safe for breast cancer survivors with lymphedema to exercise. Performing exercises can positively reduce some symptoms related to lymphedema. Future studies with bigger sample sizes can help confirm these findings. Author(s) Disclosures The authors also gratefully acknowledge the support of Dr. Amy Lang, the ThriveWell Cancer Foundation, and the START Center for Cancer Care. There are no other disclosures from any of the authors. was to examine the feasibility and efficacy of exercises in women with lymphedema post breast cancer. Breast cancer treatment often results in the development of upper extremity lymphedema. Evidence is lacking on the effects exercise has on lymphedema in breast cancer survivors. This analysis looks to see the impact of exercise programs on lymphedema in breast cancer survivors. Retrospective data analysis. The data in this study came from an original research project, Project IMPACT (Improving Mental and Physical ACTivity), that took place in San Antonio, Texas. This analysis included data from a sub-group of 9 participants with lymphedema in at least one of their arms. The original study had 94 participants who were breast cancer survivors. Project Impact looked at the effects six month exercise interventions on breast cancer survivors: yoga-based exercise, a comprehensive individualized designed program (including aerobic, resistance and flexibility exercises), and exercise of the participant's own choice. Affected side volume, passive range of motion (PROM), and self-reported effects of Lymphedema on daily life measured by the Norman Lymphedema Self-Report Survey (NLSS). All outcomes were measured at the beginning and end of the exercise program. All participants completed the exercise program with no adverse events. A significant difference (p < 0.05) was found in four subscales pertaining to the affected upper extremity's forearm and hand in the NLSS. No other significant changes were found. The results of this pilot study suggest that it is safe for breast cancer survivors with lymphedema to exercise. Performing exercises can positively reduce some symptoms related to lymphedema. Future studies with bigger sample sizes can help confirm these findings.

Analysis of Spinal Dysfunction in Breast Cancer Survivors with Lymphedema.

Background:To study and analyse the spinal dysfunction in breast cancer survivors with lymphedema. Methods:This study was carried out by analysing total 116 breast cancer survivor women, who were having lymphedema. Out of 116 subjects, 39 undergone radical mastectomy (RM), 39 undergone modified radical mastectomy (MRM) and 38 undergone breast conserving surgery (BCS). Thesesubjects were assessed for spinal function bytaking range of motionusing goniometer, lymphedema measurement usinginch tape, spinal stability test and functional rating index. Results:The spinal range of motion wassignificantly reduced in patients suffering from lymphedema in breast cancer survivors. The strength and endurance were significantly reduced in abdominals, extensors and lateral muscles of spine. There wasmarked effect seen on quality of life of patients assessed by using functional rating index due to spinal dysfunction in lymphedema patients. Conclusion:This study showed that there is statistically significant spinal dysfunction caused due to lymphedema in breast cancer survivors.

Periclavicular Lymph Node Activation Maintains the Lymphatic Circulation of Upper Extremity Following Breast Cancer Surgery with Axillary Lymph Node Dissection

Backgrounds: Axillary lymph node dissection (ALND) can cause breast cancer-related lymphedema (BCRL). However, ALND does not always produce lymphedema to the breast cancer survivors. Therefore, we aimed to investigate the correlation between the finding of lymphoscintigraphy and lymphedema in patients undergoing breast cancer surgery with ALND. Methods and Results: Patients with BCRL (n = 73, mean age: 53.92 ± 11.13 years) after full ALND (levels I, II, and III) were retrospectively included in this study. All patients underwent lymphoscintigraphy and according to the findings of the imaging, patients were divided into three groups: negative group, periclavicular lymph nodes (P-LN) activation, and axillary lymph nodes (A-LN) activation. According to the extent of radiation therapy, groups were classified as the following: no radiation group (None), breast radiation group (BI), and breast irradiation in addition to P-LN (BI+PC). The percentage difference in the upper extremities was used as the marker of severity of lymphedema. The subjects in the negative group, P-LN, and A-LN were 34 (46.6%), 33 (45.2%), and 6 (8.2%) patients, respectively. The findings of lymphangiography showed statistically significant relationship with the severity of lymphedema. The extent of radiation therapy did not have statistically significant relationship. Despite ALND, 53.4% patients had active L/N capable of removing the upper limb lymphatic fluids and 45.2% patients showed activation of collateral formation of lymphatic circulation after ALND. Conclusion: The collateral lymphatic formation was provoked after breast cancer operation with ALND, which decreased the severity of lymphedema in breast cancer survivors.

Development and validation of a nomogram to predict the risk of breast cancer-related lymphedema among Chinese breast cancer survivors.

Breast cancer-related lymphedema (BCRL) is a major long-term complication for post-surgery breast cancer survivors. Although several risk factors have been identified, lifestyle characteristics have been neglected in previous studies. The aim of this study was to develop and validate a nomogram for estimating this population's risk of developing lymphedema, taking into consideration their demographic, clinical, and personal lifestyle behaviors. In a cross-sectional study, we collected data from 775 post-operative breast cancer survivors who had attended a follow-up session in the recent 10 years (primary cohort). Lymphedema was assessed using the Norman telephone questionnaire, self-reported by patients. Multiple logistic regression was used to identify risk factors for lymphedema, including demographic, clinical, and lifestyle-related factors. A nomogram was constructed based on those factors and was validated using a separate group of 314 breast cancer patients (validation cohort). The factors independently associated with lymphedema were higher body mass index (BMI), modified radical mastectomy (MRM), postsurgical infection, chemotherapy, radiotherapy, exercise of the affected arm, and the active participation in physical activity (P<0.05). The area under the curve (AUC) values of the primary and the validation cohorts were 0.721 (95% confidence interval: 0.685-0.756) and 0.702 (95% confidence interval: 0.646-0.759), respectively. BCRL risk factors include MRM, radiotherapy, chemotherapy, and higher BMI, while the active physical activity behavior of patients appears to be a factor against lymphedema. The nomogram incorporating the patients' clinical and lifestyle factors might be useful for predicting lymphedema in breast cancer survivors.

Conserving the lymphatics from the arm using fluorescence imaging in patients with breast cancer at high risk of postoperative lymphedema: a pilot study.

Postoperative lymphedema in breast cancer survivors is a serious complication that develops from axillary lymph node dissection (ALND), chemotherapy, and radiation therapy. Axillary reverse mapping (ARM) was recently introduced to reduce lymphedema. This pilot study aimed to investigate the feasibility of preserving the ARM node using fluorescence imaging for patients at high risk of lymphedema. We prospectively screened patients with breast cancer who had pathologic node-positive disease at diagnosis and were scheduled for neoadjuvant chemotherapy (NCT). The sentinel lymph node (SLN) was identified using blue dye and radioisotope, while the ARM node was traced using indocyanine green (ICG). In cases in which SLN was negative on the intraoperative frozen section examination, the ARM node and lymphatics were preserved. Of the 20 screened patients, six whose metastatic axillary lymph node (ALN) was converted to clinically node-negative disease after NCT were enrolled. No patients experienced recurrence at 24 months postoperative. Four patients who had a preserved ARM node did not develop lymphedema. One patient whose ARM node was not preserved due to SLN identification failure did not develop postoperative lymphedema. One patient who underwent ALND without ARM node conservation because of metastatic SLN on frozen section examination developed postoperative lymphedema. ARM is oncologically safe, decreases the incidence of postoperative lymphedema, and allows for the early detection of postoperative lymphedema in patients who underwent ALND. Ultimately, ARM may help improve the quality of life of patients with pathologic node-positive breast cancer.

Utilization of bioelectrical impedance analysis for detection of lymphedema in breast Cancer survivors: a prospective cross sectional study

BackgroundBreast cancer survivors are at risk of developing breast cancer-related lymphedema (BCRL) after surgical treatment, which may have a negative effect on quality of life. The purpose of this study was to investigate the clinical role of bioelectrical impedance analysis (BIA) and the relationship between the development of BCRL in breast cancer survivors who have undergone axillary surgery.MethodsA total of 228 patients with breast cancer were enrolled in the study between May 2016 and January 2017. BCRL was assessed by measuring the circumference of both arms at 15 cm below the acromion process and the olecranon process. Patients were classified as BCRL (n = 22) and non-BCRL (n = 206) based on the difference of the arm circumference of 2 cm. Data including lymphedema, anthropometry, BIA measurements, food frequency questionnaire, type of surgery, total number of dissected lymph nodes, and post-operative treatment were collected.ResultsOf the breast cancer survivors, 10.4% had BCRL by the definition. The BCRL group contained 22 patients, while the non-BCRL group contained 206 patients. Compared to the non-BCRL group, the BCRL group had a higher body mass index, a larger percentage of ideal body weight, more dissected lymph nodes, and higher single frequency BIA (SFBIA) ratio (P = 0.027, P = 0.031, P < 0.001, and P < 0.001, respectively). The SFBIA ratio provided 63.64% sensitivity and 95.15% specificity in estimating the risk of BCRL.ConclusionOur data provides evidence to support that the use of SFBIA ratio can serve as an alternative method to monitor and/or diagnose BCRL.Trial registrationThis trial was retrospectively registered at Clinicaltrials.gov identifier (NCT03391206) on the 5 January 2018.

Effects of Exercise on Breast Cancer-related Upper Extremity Lymphedema in Breast Cancer Survivors: A Systematic Review and Meta-analysis

Effects of Exercise on Breast Cancer-related Upper Extremity Lymphedema in Breast Cancer Survivors: A Systematic Review and Meta-analysis

Early Detection and Treatment of Subclinical Lymphedema in Patients with Breast Cancer.

Background: Early identification and treatment of subclinical lymphedema may prevent development of advanced stages and its related complications. We aimed to detect subclinical lymphedema and to evaluate the effects of early treatment program on the development of clinical lymphedema, upper extremity functions, and quality of life in patients with subclinical lymphedema. Methods and Results: Twenty-five women who were diagnosed having subclinical lymphedema were enrolled in the study. The patients were informed about lymphedema and its risk factors, and skin care and exercises to prevent the development of lymphedema. Self-reported symptoms, arm volumes, upper extremity functions, quality of life were evaluated before and after treatment. Tightness and numbness were found to have a good correlation with affected arm volume. Volume of the affected arm, percentage volume difference between the arms, upper extremity functions, and quality-of-life scores improved significantly at the end of the treatment. Conclusions: It is crucial to have early detection and treatment of subclinical lymphedema to prevent the development of established lymphedema in breast cancer survivors. Information about lymphedema and its risk factors, skin care, and home-based specific exercise program improves self-reported symptoms, volume measurements, functioning, and quality of life in patients with subclinical lymphedema.

Exercise Training and Breast Cancer-Related Lymphedema: A Systematic Review

Abstract Context: Despite the improvements thathavebeenmade intreatment of breast cancer, upper-limblymphedema is still anunsolved problemin the treatment of womenwith breast cancer. Upper extremity lymphedemamay accompanywith decreased in shoulder range of motion and strength, and also pain. Nowadays, exercise training acts as a treatment method to control lymphedema in breast cancer survivors. Therefore, this study reviews the resultsof the appliedstudies inthisfieldtosurvey the influencesof exercise training on lymphedema and to determine its related symptoms in women with breast cancer. Data Sources: Literature investigation was conducted on August 1st, 2016 using PUBMED, MEDLINE, CINAHL, and Google Scholar databases. StudySelection: RandomizedandnonrandomizedcontrolledtrialspublishedinEnglishwere included. Twelve trailsmet inclusion criteria. Data Extraction: Datawere extractedina standardizedmanner into thepredefinedtable. Then, quality of the studieswas evaluated using the guide to community preventive services tool. Conclusions: It can be seen that a few studies have examined the effect of exercise training on lymphedema to conduct a review study. So, lymphedema continues to be a problem for breast cancer survivors. According to most studies, aerobic, resistance and stretching training programs had no influence on the volume and circumference of armin lymphedema cancer patients, but the training had a noticeable influence on quality of life

The incidence and risk factors of related lymphedema for breast cancer survivors post-operation: a 2-year follow-up prospective cohort study.

To investigate the incidence rate, severity and risk factors of related lymphedema in breast cancer survivors. A 2-year follow-up prospective study of 387 women who had operation from four hospitals from January 1, to December 31, 2014 was conducted. Limb volume was measured by circumference and symptoms were measured using questionnaires pre-treatment and 1, 3, 6, 12, 18, 24months after surgery separately. The incidence rates and the severity of lymphedema were evaluated, respectively. Risk factors for the development of breast cancer-related lymphedema (BCRL) were analyzed using log-rank test and Cox regression. The incidences of BCRL were 4.4, 10.1, 15.2, 28.6, 31.2 and 32.5% at 1, 3, 6, 12, 18, 24months after surgery, respectively, measured by Norman questionnaire. The rates measured by arm circumference were 2.5, 6.7, 13.4, 21.4, 26.3 and 29.4%, respectively. About 114 (29.4% of 387) women were diagnosed with BCRL, and 78 of them got mild lymphedema. Axillary lymph node dissection (ALND) (HR=5.2, 95% CI 1.6-17.3), radiotherapy (HR=3.9, 95% CI 2.0-7.5), modified radical mastectomy (MRM) (HR=2.1, 95% CI 1.3-3.4), the number of positive lymph nodes (HR=1.1, 95% CI 1.0-1.2) and body mass index (BMI) (HR=1.1, 95% CI 1.0-1.1) were independent risk factors for BCRL. BCRL is a common complication for breast cancer patients after surgery. It can be fairly diagnosed only 1month post-operation and the cumulative incidence of BCRL seems to be increasing over time, especially in the first year after surgery. ALND, radiotherapy, MRM, the number of positive axillary lymph nodes and BMI were found to be independent risk factors in the development of BCRL in this study.

Effects of a specific adapted upper limb exercise on lymphedema in breast cancer survivors: a pilot study

Effects of a specific adapted upper limb exercise on lymphedema in breast cancer survivors: a pilot study

Bioelectrical Impedance Utilization and Dietary Intake Relation in the Analysis of Risk of Lymphedema in Breast Cancer Survivors

Breast cancer survivors are at risk of complications of breast cancer‐related lymphedema (BCRL) after surgery, which may negatively impact the quality of life of breast cancer survivors. The purpose of this study was to investigate bioelectrical impedance analysis (BIA) values from the BIA and the relationship between the occurrence of BCRL and dietary factors. All subjects had a unilateral breast cancer (n =227, 53.16 ± 9.71yr) and underwent surgery at least six month ago. 147 patients had axillary lymph node dissection (ALND) and 80 received sentinel lymph node biopsy (SLNB). BCRL was evaluated based on values from the circumference measurement which was taken at 15cm below the acromion process and 15cm below the olecranon in both arms. BIA, food frequency questionnaire, type of surgery, total number of dissected lymph nodes, and post‐operative treatment were collected. There were approximately 10.7% of breast cancer‐associated lymphedema among the breast cancer survivors. 22 were patients with BCRL and 205 were not (Non‐BCRL). Compared to the Non‐BCRL, the BCRL had higher body mass index (BMI, 25.73 ± 3.59 kg/m2 and 23.70 ± 4.12 kg/m2, p = 0.028), the percent of ideal body weight (PIBW, 121.73 ± 17.34 and 112.21 ± 19.67, p = 0.030), the number of dissected lymph nodes (15.68 ± 9.21 and 7.72 ± 7.01, p = 0.000) and single frequency BIA (SFBIA) ratio (1.145 ± 0.234 and 0.998 ± 0.032, p=0.000). In addition, dietary intake of animal fat and protein intake was found to be greater in the BCRL compared to the Non‐BCRL (p=0.000, p=0.002). Univariate analysis and linear regression analysis demonstrated that BMI, PIBW, the number of dissected lymph nodes, SFBIA ratio and dietary animal fat intake were significant contributors to the occurrence of BCRL. In addition, SFBIA ratio showed 59.09% of sensitivity and 99.09% of specificity to estimate BCRL. In conclusion, our data provide strong evidence to support that obesity‐associated anthropometric and dietary factors are risk factors for the occurrence of BCRL and the use of SFBIA ratio as an alternative method to monitor and/or diagnose BCRL.

Risk assessment for lymphedema in breast cancer survivors.

141 Background: Breast cancer patients are receiving survivorship care plans that describe potential late effects of treatment. The potential for lymphedema ranges from 5% to 53% and is a serious long term problem. In the past, water displacement was the “gold standard” for measuring lymphedema; this involves placing the arm into a large graduated cylinder filled with water to measure displacement compared with the opposite arm. This method is inconvenient for both patient and practitioner and can cause significant anxiety. Methods: In 2010 we began assessing women undergoing unilateral axillary surgery for preclinical and clinical lymphedema using a method that measures bioimpedance, using the L-Dex U400 analyzer. L-Dex uses a mild electrical current to assess fluid levels in the extracellular compartment, earlier than a patient might feel a change in size or weight. One hundred thirty -seven patients were assessed using both volume displacement and L-Dex preoperatively, as a baseline and repeating at 3 to 6 month intervals for three years. Results: Of the patients followed, 83% had sentinel node excision only and 17% had completion axillary dissection. Our study identified an overall lymphedema rate of 7%. Of the patients with full axillary dissection the lymphedema rate was 9% and those with sentinel node excision were found to have no clinical lymphedema (0%). In every case where the patients developed lymphedema the L-Dex bioimpedance measurement identified a change 100% of the time before fluid volume displacement became out of range. Conclusions: Based on our results and the ease of use of the bioimpedance analysis, we have added lymphedema assessment using the L-Dex analyzer to our survivorship process. Patients with invasive cancer undergoing unilateral axillary node surgery are assessed at the same time they receive their sentinel node tracer injection. If there is a sentinel node excision only they are checked once or with any symptom. Patients who have a complete axillary dissection are to be followed for three years. This modest intervention should reduce anxiety surrounding one of the most serious late effects of breast cancer.