Bioelectrical Impedance Self-Measurement Protocol Development and Daily Variation Between Healthy Volunteers and Breast Cancer Survivors with Lymphedema

Abstract

Background: A significant percentage of breast cancer survivors are at risk for lymphedema for which lifelong self-care is required. Previous studies suggest that less than 50% of breast cancer survivors with lymphedema (BCS-LE) perform prescribed self-care tasks and that even wearing a compression sleeve, the most commonly reported self-care activity, is done irregularly. Reasons for poor self-care adherence include perceived lack of results from self-care (no available arm volume data) and perceived inability to manage the condition. Methods and Results: A two-part pilot study was conducted to: 1) develop and determine the feasibility of a selfmeasurement protocol using a single frequency bioelectrical impedance device; and 2) examine daily variation in extracellular volume in healthy and lymphedematous limbs. Healthy and BCS-LE volunteers were recruited to refine and test a self-measurement protocol. Volunteers were trained in the use of the device and measured for 5 consecutive days in a laboratory setting. They were then given the device to use at home for an additional 5 consecutive days of self-measurement. All volunteers completed each scheduled home measurement. Daily variability in both groups was noted. Conclusions: Home self-measurement using bioelectrical impedance is feasible, acceptable, and captures change. This has implications for both self-care support and for the possibility of incorporating self-measurement using bioelectrical impedance in future clinical trials examining effectiveness of lymphedema treatment.

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

“…BIS was administered to measure the impedance of each arm, which scales with the extracellular fluid content of the arm. 12 The L-Dex ratio is reported as a standardized measure of the ratio of the impedance of extracellular water in the affected limb compared to the unaffected limb. 13 Qualitative and quantitative MRI measures of tissue structure MRI measurements were performed at 3 Tesla (Philips Medical Systems, Best, The Netherlands) using dual-channel body coil radiofrequency transmission and a 16-channel torso coil for reception.…”

Bridging the divide between pathogenesis and detection in lymphedema

“…Newman and colleagues demonstrated that bioimpedance spectroscopy has sufficient sensitivity to assess not only extracellular fluid volume, but also lean mass and fat mass between affected and unaffected extremities of Stage II unilateral breast cancer-related lymphedema patients, which could provide additional diagnostically-relevant metrics to monitor the progression of later-stage lymphedema (104). Most recently, and arguably most excitingly, Ridner et al recently developed and reported the first self-measurement protocol for bioimpedance testing, which may pave the way for a home-use diagnostic in the future (105). …”

A Pilot Randomized Trial Evaluating Lymphedema Self-Measurement with Bioelectrical Impedance, Self-Care Adherence, and Health Outcomes

“…19 After completion of baseline assessments, participants were randomized (1:1 allocation) into either a BIS self-measurement intervention or standard care control group using a computer-generated, permuted block randomization scheme developed prior to implementation of the study. (Fig.…”

“…19 The Food and Drug Administration (FDA) has approved a BIS device to measure changes in extracellular fluid associated with lymphedema. 20 This device is small, portable, and gives numerical output (L-Dex readings) informing the patient if extracellular fluid is above normal ranges.…”