Lymphedema In Women Research Articles

New non-drug technologies for lymphedema associated with breast cancer: a review

INTRODUCTION. Breast Cancer-Related Lymphedema (BCRL) is the most common complication after radical treatment of breast cancer (BC). Currently, there are no molecular therapeutic targets whose pharmacologic action could prevent edema, making it necessary to study the efficacy of non-pharmacologic techniques. AIM. To study the effectiveness of non-medication technologies in BCRL to develop recommendations for practical application based on the analysis of systematic reviews and meta-analyses of randomized controlled trials (RCTs). MATERIALS AND METHODS. The search was conducted in the Physiotherapy Evidence-Based Database (PEDro, 2002–2024) using the keywords: “lymphedema”, “upper limbs”, “breast cancer”. A total of 203 sources were selected as of March 2024. RESULTS AND DISCUSSION. Numerous studies have found that the use of early postoperative physical exercise with a gradual expansion of the load in patients at risk of developing BCRL is a safe and effective method of rehabilitation. The effectiveness of early preventive use of manual lymphatic drainage (MLD) in 4 RCTs was studied in a Cochrane review. However, the clinical effectiveness of early prophylactic use of MLD to prevent BCRL remains insufficiently proven. In contrast, prophylactic use of compression sleeves has been shown to reduce and delay the onset of arm lymphedema in women at high risk of developing BCRL during the first year after breast cancer surgery. Studies have also confirmed the effectiveness of an early Prospective Surveillance Model using bioimpedance spectroscopy for early detection and immediate treatment of BCRL. It has been proven that in order to reduce the volume of a limb with BCRL, it is necessary to prescribe an intensive phase of complex decongestive therapy (CDT) for at least 3 weeks. Studies have also proven the effectiveness of using a standard or improved intermittent pneumatic compression device in the rehabilitation phases, including at home. CONCLUSION. To reduce the risk of development and progression of BCRL, modern exercise therapy techniques should be used to increase physical activity in order to control body weight, and educational techniques for self-massage and self-application of compression bandages should be actively used. The “golden” standard for conservative treatment of BCRL remains CDT, which is based on MLD. At the same time, the wider use and development of new methods of hardware lymphatic drainage that imitate MLD, which is a highly resourceful and costly method of treatment for BCRL, is justified. To confirm the clinical effectiveness of improved hardware pneumocompression, additional RCTs assessing long-term treatment results are required.

Assessment of proprioception, muscle strength and endurance during dynamic isokinetic test in patients with breast cancer-related lymphedema

BackgroundBreast cancer-related lymphedema is a common complication after breast cancer treatment.This study examined isokinetic proprioception, muscular strength, and endurance by comparing extremity with lymphedema and the extremity without lymphedema in women with breast cancer-related lymphedema. MethodsA total of 15 individuals aged between 35 and 70 years participated in this study. Cybex Humac NORM Isokinetic dynamometer (CSMi, Stoughton, MA) were used to assess upper extremity passive proprioception, active proprioception, kinesthesia, muscle strength, and muscle endurance. The upper extremity lymphedema was measured with the water displacement arm volumetry test using a volumeter. FindingsAll isokinetic measurements demonstrated a statistically significant difference between the extremity with lymphedema and the extremity without lymphedema, suggesting lower scores in the extremity with lymphedema (p < .05). There was a positive correlation between passive internal rotation in the extremity with lymphedema and the time after mastectomy (r= 0.628, p = .012) and a moderate positive relationship was found between the time after lymphedema and passive internal rotation (r = 0.577; p = .024), and active external rotation position sense (r = 0.540; p = .038) in the extremity with lymphedema. Also, a unidirectional positive moderate (r = 0.594; p = .020) relationship was found between the lymphedema stage and passive external rotation in the extremity with lymphedema. InterpretationThe difference in proprioception, muscle strength, and endurance between the extremity with lymphedema and the extremity without lymphedema in women with breast cancer-related lymphedema will provide valuable information in terms of prioritizing these parameters in treatment.

The benefits of compression sleeves to prevent clinically significant lymphedema in women with breast cancer.

The benefits of compression sleeves to prevent clinically significant lymphedema in women with breast cancer.

REHABILITATION AFTER LOWER LIMB LYMPHOEDEMA IN GYNAECOLOGICAL MALIGNANCIES – THE ROLE OF PHYSIOTHERAPY

Lower limb lymphoedema is one of the most invalidating long-term complications of treatments (such as surgery, chemo- and radiotherapy) for gynaecological malignancies, affecting approximately 15% of women treated for this condition. Lower limb lymphoedema occurrence is related to several risk factors, the most important being obesity and radiotherapy as well as the number of surgically removed lymph nodes. We conducted a retrospective study to assess the risk factors and efficiency of physiotherapy procedures in reducing lower limb lymphoedema in women who underwent an exhaustive treatment plan for gynaecological malignancies. The study enrolled 21 patients with lower limb lymphoedema, who were initially treated by a multidisciplinary team for gynaecological malignancies at the “Prof. Dr Alexandru Trestioreanu” Institute of Oncology in Bucharest. Early initiation of physiotherapy after surgical treatment and radiotherapy, along with patient education, is associated with a higher regression rate of lower limb lymphoedema compared to only patient education and awareness. The treatment response rate was better in patients benefitting from lymphatic drainage, compression bandage and an individual physiotherapy plan compared to patients who only received lymphatic drainage and compression bandage (Mann-Whitney U test, p = 0.05). Early detection and management of lower limb lymphoedema are important to prevent complications and improve quality of life for gynaecological cancer survivors.

Determinants of quality of life related to lower limb lymphedema in women with gynecological cancer surgery

ObjectiveThis study aimed to identify the predictors of quality of life (QoL) related to lower limb lymphedema among women who had undergone gynecological cancer surgery. Additionally, the association between fatigue and the QoL was examined. MethodsA cross-sectional design with a convenience sample was adopted. Participants included 200 women with lymphadenectomy following gynecological cancer surgery. Demographic data, QoL related to lower limb lymphedema, and fatigue symptoms were collected. ResultsOf the 200 participants, 60% (n ​= ​120) reported a mild to severe impact on QoL related to lower limb lymphedema, with the main impact on the function of mobility and physical symptoms. Age less than 55 years (β ​= ​0.706, OR ​= ​2.027, P ​= ​0.017), a diagnosis of ovarian cancer (β ​= ​0.804, OR ​= ​2.235, P ​= ​0.048), undergoing chemotherapy (β ​= ​0.616, OR ​= ​1.854, P ​= ​0.046), time after surgery (β ​= ​−0.833, OR ​= ​0.435, P ​= ​0.05), and fatigue (β ​= ​0.055, OR ​= ​1.06, P ​< ​0.001) were independently associated with QoL related to lower limb lymphedema. Hierarchical multiple regression demonstrated that fatigue was significantly associated with QoL related to lower limb lymphedema after controlling for age, types of cancer, time after surgery, and chemotherapy. Fatigue explained 11% of the variance in the QoL. ConclusionsMore than half of the women with gynecological cancer requiring lymphadenectomy experienced an impact on QoL related to lower limb lymphedema. Effective interventions are warranted to improve the QoL related to lower limb lymphedema among women with gynecological cancer, particularly those who present with fatigue.

Digital and Interactive Health Interventions Minimize the Physical and Psychological Impact of Breast Cancer, Increasing Women's Quality of Life: A Systematic Review and Meta-Analysis.

Simple SummaryThe development of digital and virtual devices for therapeutic purposes has been widely studied in recent years. There is a growing scientific interest in analyzing the effects of digital and interactive health interventions (DIHIs) in the management of different neurological and musculoskeletal pathologies, as well as breast cancer (BC). DIHIs include the use of a wide variety of virtual reality devices, as well as smartphone apps and games, to reduce the impact of BC signs and symptoms on women. In the present review, we assessed the effect of DIHIs, in comparison to conventional interventions or usual care, on improving the motor control and function of the upper extremities affected by lymphedema after BC surgery, including pain, anxiety, depression, and different dimensions of quality of life. In addition, we investigated which type of DIHI was more useful for women with BC: virtual reality devices or smartphone apps.Digital and interactive health interventions (DIHIs), such as virtual-reality-based therapy (VRBT) and smartphone-app-based therapy (SABT), may be useful for reducing the impact of the signs and symptoms of breast cancer (BC) in women. The aim of this meta-analysis was to explore the effect of DIHIs on improving pain, anxiety, depression, quality of life (QoL), and upper extremity (UE) disability-related lymphedema in women with BC. Methods: We searched PubMed Medline, Web of Science, Scopus, CINAHL, Physiotherapy Evidence Database, and SciELO for the period ending February 2022. We included studies that assessed the effect of DIHIs on UE motor disability, pain, anxiety, depression, and QoL in women with BC. The effect size was calculated using Cohen’s standardized mean difference (SMD) and its 95% confidence interval (95% CI). Results: Twenty studies providing data from 1613 women with BC were included. With respect to UE disability, DIHIs increased flexion (SMD, 1.92; 95%CI: −1.16, 2.68), abduction (SMD, 1.66; 95%CI: 0.91, 2.42), external rotation shoulder range of motion (SMD, 1.1; 95%CI: 0.36, 1.85), UE function (SMD, −0.72; 95%CI: −1.31, −0.13), and handgrip strength (SMD, 0.4; 95%CI: 0.21, 0.59). DIHIs reduced pain (SMD, −0.8; 95%CI: −1.31, −0.26), anxiety (SMD, −1.02; 95%CI: −1.71, −0.34), and depression (SMD, −1.57; 95%CI: −3.1, −0.08). Finally, DIHIs increased overall health (SMD, 0.6; 95%CI: 0.31, 0.89). Conclusions: Right at the end of therapy, DIHIs are effective at improving UE function, pain, anxiety, depression, and QoL in women with BC. VRBT has a greater effect than SABT for the assessed outcomes.

Early Blood Flow Abnormalities in Axillary and Brachial Arteries Precede the Onset of Persistent Lymphedema in Women Treated Surgically for Breast Cancer.

Background: surgery to treat breast cancer (BC) is associated with upper limb (UL) lymphedema, which in some cases may become permanent. It is uncertain whether lymphedema results from injury to either lymphatic or blood vessels, or to both. Methods and Results: a cohort of 200 BC patients was examined 1, 3, 6, 12, and 24 months after surgery. Axillary and brachial blood vessels were evaluated using Doppler Ultrasound, and patients had their UL examined for lymphedema at each visit. Patients who developed lymphedema 24 months after surgery presented with higher mean flow velocity (MFV) and end diastolic velocity (EDV) in both axillary (MFV = 13.57 vs. 10.7 cm/s, p = 0.02; EDV = 5.62 vs. 3.47 cm/s; p = 0.004) and brachial (MFV = 11.44 vs. 8.74 cm/s; p = 0.03; EDV = 5.08 vs. 3.04; p = 0.04) arteries as early as 1 month after surgery. Similar associations were found 3, 6, and 12 months after surgery. Early abnormalities of the resistive and pulsatility indexes were also significantly associated with persistent lymphedema. EDV measured 1 month after surgery had the best performance to detect patients who will later develop long-term lymphedema, (sensitivity = 73.7%; specificity = 71.2%; negative predictive value = 57.6%). Conclusion: vascular abnormalities precede and are possible causal factors for UL lymphedema in BC patients.

Efficacy of Complete Decongestive Therapy Versus Pneumatic Compression Against Faradism Underpressure in Patients with Lymphedema Secondary to Breast Cancer

Introduction: Lymphedema is the most common secondary complication that people with breast cancer face.Characterized by the appearance of new growth. The new growth usually takes the shape of a lump which isfrequently referred to as a neoplasm. Lymphedema in women who have had a mastectomy has the potential tobecome a chronic and progressive disorder. It is necessary to determine the impact of each strategy. The goal ofthis research was to investigate and evaluate the best treatment for lymphedema secondary to breast cancer.Method: This study included 30 women with lymphedema caused by breast cancer. They were assigned to oneof three groups. Group A (n=10) received complete decongestive therapy. Group B (n=10) received pneumaticcompression, while Group C (n=10) received faradism under pressure. Subjects from all three groups were askedto come to the department three times per week for two months. Patients girth and pain intensity were measuredpre and post treatment.Conclusion: As a result, the researchers concluded that in patients with mild lymphedema, comprehensivedecongestive therapy was more effective.

The role of physiotherapy treatment in arm lymphoedema associated with breast cancer

Ipsilateral arm lymphoedema is the most frequent long-term complication due to breast cancer surgery, chemo- and radiotherapy, affecting approximately 40% of women treated for this condition. We conducted a retrospective study to assess the efficiency of physiotherapy procedures in reducing arm lymphoedema in women who underwent an exhaustive treatment plan for breast cancer. The study included 32 patients out of the 641 with breast cancer, who were treated by the same multidisciplinary team at the “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology in Bucharest. They underwent unilateral modified radical mastectomy with axillary clearance between 1 January 2016 and 31 December 2019 due to developing ipsilateral arm lymphoedema, stage 2. Of the 18 patients who received individual counselling and education, manual lymph drainage and compressive bandage, 10 (55.5%) decreased arm lymphoedema from stage 2 to 1 after 3 months of treatment. Of the 14 patients who associated these procedures and also benefitted from additional individual physiotherapy including stretching exercises (for the levator scapulae, trapezius, pectoralis major and minor) and progressive active and action-assisted shoulder exercises, 11 (78.5%) reduced arm lymphoedema to stage 1 and regained upper arm mobility and sensitivity. Early initiation of physiotherapy after modified radical mastectomy with axillary lymph node dissection, along with patient education, is associated with a higher regression rate of arm lymphoedema compared to only patient education and awareness. The treatment response rate was 85.7% in patients benefitting from lymphatic drainage, compressive bandage and an individual physiotherapy plan compared to 55.5% in patients only benefitting from lymphatic drainage and compressive bandage.

SENTIREC – The sentinel node mapping in women with cervical cancer study – Patient-reported early lymphedema and its impact on quality of life

ObjectiveTo evaluate patient-reported incidence and severity of early lymphedema and its impact on quality of life (QoL) after sentinel lymph node (SLN) mapping only and after SLN and pelvic lymphadenectomy (PL) in women undergoing surgery for early-stage cervical cancer. MethodsIn a national prospective multicenter study, we included women with early-stage cervical cancer from March 2017–January 2021 to undergo radical surgery including SLN mapping. Women with tumors >20 mm underwent completion PL. The incidence and severity of early lymphedema and its influence on QoL were evaluated using validated patient-reported outcome measures before surgery and three months postoperative. We investigated changes over time using linear regression. ResultsTwo hundred of 245 (81.6%) included women completed questionnaires at baseline and three months postoperatively. The incidence of early lymphedema was 5.6% (95% CI 2.1–11.8%) and 32.3% (95% CI 22.9–42.7%) in women who underwent SLN mapping only and SLN + PL, respectively. Lymphedema symptoms in the legs, genitals, and groins increased in both groups postoperatively but three times more in women who underwent PL. Lymphedema symptoms after SLN + PL significantly impaired physical performance (p = 0.001) and appearance (p = 0.007). Reporting lymphedema was significantly associated with impaired body image, physical-, role-, and social functioning, and a high level of fatigue. ConclusionsSLN mapping alone carries a low risk of lymphedema in women undergoing surgery for early-stage cervical cancer. In contrast, completion PL is associated with a high incidence of early lymphedema. Reporting lymphedema is associated with significant impairment of several physical, psychological, and social aspects of QoL.

Breast cancer‐related lymphoedema: Risk factors and prediction model

To identify the risk factors for lymphoedema following axillary lymph node dissection (ALND) in a European sample and to propose a lymphoedema prediction model for this population. Predictive retrospective cohort study comparing women who developed lymphoedema in 2years of undergoing ALND with those who did not developed lymphoedema. We reviewed the clinical records of 504 women who, between January 2008 and May 2018, underwent surgery for breast cancer that involved ALND. Logistic regression was used to identify significant risk factors for lymphoedema. The prediction accuracy of the model was assessed by calculating the area under the receiver operating characteristic curve. Of the 504 women whose records were analysed, 156 developed lymphoedema. Significant predictors identified in the regression model were level of lymph node dissection, lymph node status, post-operative complications, body mass index (BMI) and number of lymph nodes extracted. The prediction model showed good sensitivity (80%) in the study population. The factor contributing most to the risk of lymphoedema was the level of lymph node dissection, and the only patient-related factor in the prediction model was BMI. The model offers good predictive capacity in this population and it is a simple tool that breast care units could use to assess the risk of lymphoedema following ALND. Nurses with specialist knowledge of lymphoedema have a key role to play in ensuring that women receive holistic and individualized care. What problem did the study address? Secondary lymphoedema is one of the main complications in the treatment of breast cancer. What were the main findings? The prediction model included five factors associated with the risk of lymphoedema following ALND. The strongest predictor was the level of lymph node dissection, and the only patient-related factor was BMI. Where and on whom will the research have an impact? The prediction model offers breast care units a tool for assessing the risk of lymphoedema in women undergoing surgery involving ALND. The results highlight the importance of weight reduction as a preventive measure and support a more conservative surgical approach.

ASO Visual Abstract: Longitudinal, Long-Term Comparison of Single-Versus Multi-Point Upper Limb Circumference Periodical Measurements as a Tool to Predict Persistent Lymphedema in Women Treated Surgically for Breast Cancer

ASO Visual Abstract: Longitudinal, Long-Term Comparison of Single-Versus Multi-Point Upper Limb Circumference Periodical Measurements as a Tool to Predict Persistent Lymphedema in Women Treated Surgically for Breast Cancer

Development and Psychometric Validation of a Patient-Reported Outcome Measure for Arm Lymphedema: The LYMPH-Q Upper Extremity Module

BackgroundA multiphased mixed-methods study was performed to develop and validate a comprehensive patient-reported outcome measure (PROM) for arm lymphedema in women with breast cancer (i.e., the LYMPH-Q Upper Extremity Module).MethodsQualitative interviews (January 2017 and June 2018) were performed with 15 women to elicit concepts specific to arm lymphedema after breast cancer treatment. Data were audio-recorded, transcribed, and coded. Scales were refined through cognitive interviews (October and Decemeber 2018) with 16 patients and input from 12 clinical experts. The scales were field-tested (October 2019 and January 2020) with an international sample of 3222 women in the United States and Denmark. Rasch measurement theory (RMT) analysis was used to examine reliability and validity.ResultsThe qualitative phase resulted in six independently functioning scales that measure arm symptoms, function, appearance, psychological function, and satisfaction with information and with arm sleeves. In the RMT analysis, all items in each scale had ordered thresholds and nonsignificant chi-square p values. For all the scales, the reliability statistics with and without extremes for the Person Separation Index were 0.80 or higher, Cronbach’s alpha was 0.89 or higher, and the Intraclass Correlation Coefficients were 0.92 or higher. Lower (worse) scores on the LYMPH-Q Upper Extremity scales were associated with reporting of more severe arm swelling, an arm problem caused by cancer and/or its treatment, and wearing of an arm sleeve in the past 12 months.ConclusionsThe LYMPH-Q Upper Extremity Module can be used to measure outcomes that matter to women with upper extremity lymphedema. This new PROM was designed using a modern psychometric approach and, as such, can be used in research and in clinical care.

Longitudinal, Long-Term Comparison of Single- versus Multipoint Upper Limb Circumference Periodical Measurements as a Tool to Predict Persistent Lymphedema in Women Treated Surgically for Breast Cancer: An Optimized Strategy to Early Diagnose Lymphedema and Avoid Permanent Sequelae in Breast Cancer Survivors.

We aim to evaluate whether upper limb (UL) circumference (ULC) and UL swelling sensation (ULSS) performed shortly after surgery or later on during follow-up can predict long-term/persistent forms of lymphedema in women who underwent surgery for breast cancer. Eighty-five women completed at least 24 months of follow-up. At each follow-up visit (1, 3, 6, 12, and 24 months after surgery), patients were tested for lymphedema using ULC and ULSS. Two different approaches to ULC were compared: (1) a "positive" lymphedema diagnosis if a difference ≥ 2 cm between the affected and contralateral UL was detected in at least two contiguous measurement points (MPs) and (2) a "positive" result if just one MP ≥ 2 cm. Patients were also questioned about their perception of weight, swelling, and/or tension (ULSS). The gold standard for long-term lymphedema was a water displacement difference between the UL ≥ 200 mL 24 months after surgery (ULWD). Twenty-four months after surgery, 19 (22.4%) women were diagnosed with long-term lymphedema. Using 24-month data, comparison of log-likelihoods denoted a clear superiority of the ULC approach 1 compared with 2 for the diagnosis of long-term lymphedema (p < 0.001). Using approach 1, the best prediction of a woman developing long-term lymphedema if she had a positive ULC in the follow-up was obtained at 6 months after surgery (posterior probability of 60%). Our study reveals that performing ULC 6 months after surgery, regarding as "positive" only women with a difference ≥ 2 cm at two contiguous MPs, is the best strategy to identify women at increased risk of later developing permanent forms of lymphedema.

Paclitaxel versus docetaxel-based neoadjuvant chemotherapy and risk of lymphedema in breast cancer patients.

e12620 Background: Neoadjuvant chemotherapy (NAC) is commonly utilized in women with locally advanced breast cancer, usually followed by surgery and radiation therapy (RT). Many studies aimed to address the risk factors contributing to a higher incidence of lymphedema in patients with breast cancer. Our group previously reported the extent of surgery increases the risk of lymphedema. Adjuvant chemotherapy with taxane-based regimens are associated with an increased risk of lymphedema likely due an increase in interstitial extracellular fluid volume therefore resulting in fluid retention. This study aims to directly compare and characterize the risk of lymphedema in patients receiving paclitaxel versus docetaxel-based NAC. Methods: This is a retrospective study approved by our institutional review board. The study included women with breast cancer treated consecutively at our institution with taxane-based NAC followed by surgery and RT from 2006 to 2018. Patients and tumor characteristics including age, race, body mass index (BMI), clinical stage, hormone receptor, HER2 status, type of surgery, RT techniques, and type of NAC (Paclitaxel versus Docetaxel), and its association to risk of lymphedema were analyzed using univariable and multivariable binary logic regression tests. Lymphedema was assessed before RT and at follow up visits, and was identified by &gt;2.0-cm increase in arm circumference, or &gt;10% increase in limb volume, or new self-reported lymphedema symptoms. Results: A total of 263 patients treated with either paclitaxel or docetaxel-based NAC were identified and analyzed. At a median follow up of 28.4 months (range 3.5-158.7 months). 26.2% (69/263) of patients developed lymphedema. On a multivariable analysis, patients who underwent axillary lymph node dissection (ALND) had a significantly higher rate of lymphedema (42.6%) compared to those who had only a sentinel lymph node biopsy (SLNB, 10.5%, p&lt;0.05). Regardless of the type of surgery, there was no significant difference in rates of lymphedema between patients who received paclitaxel versus docetaxel-based NAC (28.7% vs 21.3%). However, among high-risk patients who underwent mastectomy with ALND, NAC with Paclitaxel was associated with a significantly higher rate of lymphedema compared to docetaxel (56.8% vs 22.7%, RR 2.50, p&lt;0.05). Conclusions: This represents one of the largest studies examining the impact of taxane-based NAC on the risk of lymphedema in women with breast cancer. In this study, paclitaxel-based NAC was associated with a significantly higher risk of lymphedema in women who underwent mastectomy and ALND compared to docetaxel based chemotherapy. A larger, balanced, prospective study is warranted to verify this previously unidentified lymphedema risk from paclitaxel and guide individualized NAC decision.

Abstract PS1-12: Factors associated with chronic breast lymphedema after adjuvant radiation in women undergoing breast conservation therapy

Abstract Purpose/Objective(s):Unlike temporary breast edema caused by post-lumpectomy radiation therapy (RT), the edema that persists beyond one year is not well defined and difficult to treat. The aim of this study is to define the incidence and risk factors for the development of chronic breast lymphedema in women undergoing lumpectomy with RT at a large metropolitan cancer center. Materials/Methods:A retrospective chart review was performed on all patients who underwent lumpectomy from 2014 to 2018. Women who did not undergo RT at our institution and those with stage IV disease were excluded from the analysis. Patient demographics, comorbidities, operative data, RT data and postoperative complications were obtained. Chronic breast lymphedema (CBL) was defined as edema that persisted beyond one year post completion of radiation therapy. Breast volumes were determined by contoured breast volumes or, if unavailable, estimated by the 95% isodose volumes from the RT treatment planning system. Using a density curve, the distribution of breast volumes was plotted for patients with and patients without CBL. Univariate analysis was used to evaluate factors associated with CBL. Multivariate regression analysis was used to evaluate factors associated with the risk of CBL while accounting for potential confounding variables as defined by the univariate analysis. Results:A total of 1173 patients were included for analysis. Seventy-four (6.3%) patients developed breast lymphedema beyond one year. For the entire cohort, mean age was 63 years old (SD=11.17), mean BMI was 31.15 kg/m2 (SD=7.17), mean breast volume was 1198.54 cm3 (SD=645.82 cm3), mean total radiation was 59.18 Gy (SD=16.76), and 139 (11.8%) patients underwent ALND. Compared to the cohort that did not develop CBL (n=1099), the CBL cohort (n=74) had a higher median BMI (33.23 kg/m2 vs. 29.81 kg/m2, P&amp;lt;0.001), higher percentage of African Americans (56.8% vs. 37.9%, P=0.004), larger median breast volume (1502.33 cm3 vs. 1083.59 cm3, P&amp;lt;0.001), higher percentage that underwent ALND (23% vs. 11.1%, P=0.005), and larger median size of lumpectomy specimen (128.00 cm3 vs. 94.57 cm3, P=0.002). When accounting for potential confounding variables, multivariate regression analysis revealed when breast volume was evaluated as a continuous variable, for every 1 cm3 increase in breast volume, the risk of breast lymphedema increases by 0.1% (OR=1.001, P&amp;lt;0.001). When breast volume was analyzed as a categorical variable using 1300 cm3 as the optimal cutoff (based on density curve evaluations), patients whose breast volume was greater than 1300 cm3 had nearly 3 times the risk of developing CBL (OR=2.976, P&amp;lt;0.001) compared to those with less than 1300 cm3 breast volume. The multivariate regression also demonstrated that CBL was associated with total radiation dose (OR=1.02, P=0.015) and African American race (OR=1.705, P=0.037). Conclusion:Chronic breast lymphedema presents a clinical concern for women undergoing lumpectomy with postoperative radiation, particularly in women with larger breasts. Further studies should focus on preventative strategies, as well as the psychosocial and economic impact of this morbidity. Citation Format: Sanjay Rama, Cara Canella, Jenna Luker, Kelley Park, Renee Barry, Saheli Ghosh, Simeng Zhu, Yalei Chen, Jessica Bensenhaver, Eleanor Walker, Kenneth Levin, Dunya Atisha, Maristella Evangelista. Factors associated with chronic breast lymphedema after adjuvant radiation in women undergoing breast conservation therapy [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 PS1-12.

Efficacy and efficiency of a new therapeutic approach based on activity-oriented proprioceptive antiedema therapy (TAPA) for edema reduction and improved occupational performance in the rehabilitation of breast cancer-related arm lymphedema in women: a controlled, randomized clinical trial

BackgroundBreast cancer (BC) is a major public health issue. More than one out of five women treated for breast cancer will develop lymphedema in an upper extremity. Current evidence advocates transdisciplinary oncological rehabilitation. Therefore, research in this area is necessary since limited consensus having been reached with regard to the basic essential components of this rehabilitation.Consensus has, however, been reached on the use of decongestive lymphedema therapy (DLT), but due to a lack of tests, the necessary dosages are unknown and its level is moderately strong.This study attempts to verify both the efficacy of activity-oriented proprioceptive antiedema therapy (TAPA), as compared to conventional treatments such as DLT or Complex Physical Therapy (CPT), as well as its efficiency in terms of cost-effectiveness, for patients affected by breast cancer-related arm lymphedema.MethodsControlled, randomized clinical trial with dual stratification, two parallel arms, longitudinal and single blind. 64 women with breast cancer-related arm lymphedema will take part in the study. The experimental group intervention will be the same for stage I and II, and will consist of neuro-dynamic exercises oriented to the activity, proprioceptive neuromuscular facilitation activities and proprioceptive anti-edema bandaging. The control group intervention, depending on the stage, will consist of preventive measures, skin care and exercise-prescribed training in the lymphedema workshop as well as compression garments (Stage I) or conservative Complex Decongestive Therapy treatment (skin care, multi-layer bandaging, manual lymphatic drainage and massage therapy) (Stage II).ResultsSociodemographic and clinical variables will be collected for the measurement of edema volume and ADL performance. Statistical analysis will be performed on intent to treat.DiscussionIt has been recommended that patient training be added to DLT, as well as a re-designing of patient lifestyles and the promotion of health-related aspects. In addition, clinical trials should be undertaken to assess neural mobilization techniques and proprioceptive neuromuscular facilitation should be included in the therapy. Cohesive bandaging will also be performed as an early form of pressotherapy. The proposed study combines all of these aspects in order to increased comfort and promote the participation of individuals with lymphedema in everyday situations.LimitationsThe authors have proposed the assessment of the experimental treatment for stages I and II. One possible limitation is the lack of awareness of whether or not this treatment would be effective for other stages as well as the concern for proper hand cleansing during use of bandages, given the current COVID-19 pandemic situation.Trial registrationThis trial was registered in ClinicalTrials.gov (NCT03762044). Date of registration: 23 November 2018. Prospectively Registered.

P136: Role of delfin lymphscanner in assessing breast lymphoedema in women treated for breast cancer

Introduction: The assessment of breast lymphoedema is complex and the wide range of incidence (0-94%) is largely due to subjective characterization, lack of standardized definitions and objective tools for diagnosis. Measuring the percentage water content (PWC) of the tissue is useful in early detection of lymphedema. The Delfin lymph scanner is a mobile non-invasive method using tissue dielectric constant (TDC) for measuring subcutaneous tissue water. However the data on the use of this tool is limited. We aim to assess the utility of this tool in the outpatient setting.

Tissue Dielectric Constant Measures in Women With and Without Clinical Trunk Lymphedema Following Breast Cancer Surgery: A 78-Week Longitudinal Study.

Following breast cancer surgery with lymph node removal, women are at risk of developing lymphedema in the upper extremity or trunk. Currently, trunk lymphedema diagnosis relies on a clinical assessment because no quantifiable standard method exists. Tissue dielectric constant (TDC) values are quantifiable measures of localized skin tissue water and may be able to detect trunk lymphedema. The goal of this study was to (1) compare parameters derived from TDC measurements with those derived from clinically accepted criteria for trunk lymphedema in women following breast cancer surgery and (2) explore the potential utility of TDC to detect trunk lymphedema early in its progression. This prospective longitudinal study, a secondary analysis from a larger study, observed women with and without clinically determined truncal lymphedema following breast cancer surgery. TDC was measured on the lateral trunk wall at post-surgery weeks 2, 4, 12, and 78 in women who had surgical breast cancer treatment with lymph node removal. Clinical assessment for trunk lymphedema was determined at 78weeks by a lymphedema expert. Comparison of TDC measurements in women with and without clinical trunk lymphedema was analyzed. Clinical assessment identified trunk lymphedema in 15 out of 32 women at 78weeks. These women had TDC ratios statistically higher than women without truncal lymphedema. The overall findings indicate that TDC has the ability to quantify trunk lymphedema and might be valuable in early detection. TDC may be a beneficial tool in the early detection of breast cancer-related trunk lymphedema, which could trigger intervention. A new device may help recognize trunk lymphedema in patients with breast cancer so they could receive appropriate treatment.

Effect of CDT and IPC in Secondary Upper Extremity Lymphedema in Women Post Breast Cancer Surgery on Anxiety, Depression and Quality of Life

Objective: To study the effect of complex decongestive therapy and intermittent pneumatic compressionon the secondary upper extremity lymphedema in women post breast cancer surgery on anxiety, depression,and quality of life.Methodology: 15 women with unilateral lymphedema post breast cancer surgery with the age of 18 yearswere included in the study. Women have observed pre-intervention and measured for lymphedema, theywere provided with the CDT and IPC as the intervention which was followed on the 1st, 7th ,and 14th day ofintervention and measured post-intervention on the basis of questionnaires for quality of life, anxiety ,anddepression. The subjects were excluded with bilateral lymphedema, men with breast cancer ,and no lowerextremity lymphedema. The improvement was calculated with measurement of arm, LYQLI ,and HADSquestionnaire.Results: There was a significant improvement that was seen in from pre-intervention and the 14th day ofintervention followed with CDT and IPC. The LYQLI was measured in the physical, psychological andpractical concerns where the significant improvement was seen on the 14th day and no difference on 1st daywhereas the HADS having parameters of anxiety and depression shows improvement on the 7th and 14th dayof intervention and no difference on 1st day.Conclusion: The statistical analysis software was used for all the analyses and result s were found for all theanalysis and results were found to be significant at 5% level The result came to be significant in the case anduseful on the 14th day of the intervention