Lymphedema symptoms and limb measurement changes in breast cancer survivors treated with neoadjuvant chemotherapy and axillary dissection: results of American College of Surgeons Oncology Group (ACOSOG) Z1071 (Alliance) substudy

Armer, Jane M.; Ballman, Karla V.; McCall, Linda; Armer, Nathan C.; Sun, Yidan; Udmuangpia, Tipparat; Hunt, Kelly K.; Mittendorf, Elizabeth A.; Byrd, David R.; Julian, Thomas B.; Boughey, Judy C.

doi:10.1007/s00520-018-4334-7

Cited by 56 publications

(54 citation statements)

References 21 publications

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“…Hormes et al found in his study of 295 women, arm swelling and lymphedema severity were less correlated with QOL than total number of arm symptoms and specific individual symptoms [15]. A study of breast cancer patients treated with neoadjuvant chemotherapy and axillary lymph node dissections showed slight agreement, with the kappa coefficient ranging from 0.05 to 0.09, when examining lymphedema symptoms of arm swelling and heaviness compared to volume or circumference measurements [57]. At our institution, we have seen some patients with minimal or low excess volumes measurements report a high degree of impairment in QOL [56].…”

Section: Discussionmentioning

confidence: 99%

Systematic Review of Patient-Reported Outcomes following Surgical Treatment of Lymphedema

Coriddi

Dayan

Sobti

et al. 2020

Cancers

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Introduction: Analysis of quality of life (QOL) outcomes is an important aspect of lymphedema treatment since this disease can substantially impact QOL in affected individuals. There are a growing number of studies reporting patient-reported outcomes (PROMs) for patients with lymphedema. The purpose of this study was to conduct a systematic review of outcomes and utilization of PROMs following surgical treatment of lymphedema. Methods: A literature search of four databases was performed up to and including March, 2019. Studies included reported on QOL outcomes after physiologic procedures, defined as either lymphovenous bypass (LVB) or vascularized lymph node transplant (VLNT), to treat upper and/or lower extremity primary or secondary lymphedema. Results: In total, 850 studies were screened—of which, 32 studies were included in this review. Lymphovenous bypass was the surgical intervention in 16 studies, VLNT in 11 studies, and both in 5 studies. Of the 32 total studies, 16 used validated survey tools. The most commonly used PROM was the lymph quality of life measure for limb lymphedema (LYMQOL) (12 studies). In the remaining four studies, the upper limb lymphedema 27 scale (ULL27), the short form 36 questionnaire (SF-36), the lymphedema functioning, disability and health questionnaire (Lymph-ICF), and lymphedema life impact scale (LLIS) were each used once. QOL improvement following surgical treatment was noted in all studies. Conclusions: Physiologic surgical treatment of lymphedema results in improved QOL outcomes in most patients. The use of validated PROM tools is increasing but there is no current consensus on use. Future research to evaluate the psychometric properties of PROMs in lymphedema is needed to guide the development and use of lymphedema-specific tools.

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Section: Discussionmentioning

confidence: 99%

Systematic Review of Patient-Reported Outcomes following Surgical Treatment of Lymphedema

Coriddi

Dayan

Sobti

et al. 2020

Cancers

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“…Survival improvement in breast cancer has been attained using surgical treatment, radiotherapy and targeted therapy, however, patients experience discomfort related to treatment related complications including breast cancer-related lymphedema (BCRL) (1). The first common consequence of trauma, infection, surgery or irradiation injury is BCRL, especially in lymphadenectomy, and this manifests as regionalized damage to the normal vasculature and an increase in limb volume by ≥10% (2). BCRL severely affects the quality of life of patients due to lifestyle and occupational alterations, changes in functional status, as well as changes in psychosocial and economic aspects (3)(4)(5)(6)(7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Lymphedema in survivors of breast cancer (Review)

et al. 2020

Oncol Lett

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The tremendous improvement of survival in patients with breast cancer can be attributed to several treatment strategies, but these strategies also lead to the occurrence of breast cancer-related lymphedema (BCRL). BRCL is regularly associated with factors such as axillary lymph node dissection and local lymph node radiotherapy and manifests as an increase of >10% in the volume of affected limbs. Being overweight or having obesity (body mass index ≥25 kg/m 2 ), an excessive number of positive lymph nodes (>8) and capsular invasion by a tumor are additional risk factors for lymphedema. It is worth assessing the risk before surgery as this can prevent the occurrence of BCRL at the initial stage of breast cancer management. The clinical utility of many diagnostic tools and lymphedema surveillance allows early stage and even subclinical BCRL to be diagnosed, and allows real-time monitoring of the disease. The early diagnosis of BRCL allows treatment at an early stage, which is beneficial to the reduction of excess limb volume and the improvement of quality of life. At present, the major therapeutic methods of BCRL include complex decongestive therapy, pneumatic compression devices, participating in exercise, microsurgery and liposuction, each of which alleviates lymphedema effectively. No medications for treatment of BRCL have yet been developed. However, the recent findings on the success of molecular therapy in animal models may remedy this deficiency. Furthermore, the volume reduction of swollen limbs without swelling rebound by transplanting autologous stem cells has been successfully reported in some pilot studies, which may provide a new technique for treating BCRL. This review aimed to discuss the pathogenesis, clinical manifestation, risk factors, advantages and disadvantages of diagnostic tools, lymphedema surveillance and the characteristics of traditional and newly emerging BCRL treatments.

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“…Circumferential measurement is a non-invasive, inexpensive and practical method of lymphedema measurement in the clinical setting (6,60) with established reliability (61). Self-report, on the other hand, is open to subjective variability between patients and is typically used in the clinic to assess the patient's view of improvement (6,60) and likely to report higher rates compared with the more objective lymphedema measurement methods like circumferential measurements (62). One study (37) reported on the use of bioimpedance spectroscopy in diagnosing lymphedema.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and incidence of cancer related lymphedema in low and middle-income countries: A systematic review and meta-analysis.

Torgbenu

Luckett

Buhagiar

et al. 2020

Preprint

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Abstract Background Little is known about the prevalence and incidence in low and middle-income countries (LMICs) of secondary lymphedema due to cancer. This study aims to estimate the prevalence and incidence in LMICs of secondary lymphedema related to cancer and/or its treatment(s) and identify risk factors. Method A systematic review and meta-analysis was conducted. Medline, EMBASE and CINAHL were searched in June 2019 for peer-reviewed articles that assessed prevalence and/or incidence of cancer-related lymphedema in LMICs. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. Estimates of pooled prevalence and incidence estimates were calculated with 95% confidence intervals (CI), with sub-group analyses grouping studies according to: country of origin, study design, risk of bias, setting, treatment, and lymphedema site and measurement. Heterogeneity was measured using X ² and I 2 , with interpretation guided by the Cochrane Handbook for Systematic Reviews. Results Of 8766 articles, 36 were included. Most reported on arm lymphedema secondary to breast cancer treatment (n=31), with the remainder reporting on leg lymphedema following gynecological cancer treatment (n=5). Arm lymphedema was mostly measured by arm circumference (n=16/31 studies), and leg lymphedema through self-report (n=3/5 studies). Eight studies used more than one lymphedema measurement. Only two studies that measured prevalence of leg lymphedema could be included in a meta-analysis (pooled prevalence =10.0%, 95%CI 7.0 – 13.0, I 2 =0%). The pooled prevalence of arm lymphedema was 27%, with considerable heterogeneity (95%CI 20.0 – 34.0, I 2 =94.69%, n =13 studies). The pooled incidence for arm lymphedema was 21%, also with considerable heterogeneity (95%CI 15.0 – 26.0, I 2 =95.29%, n =11 studies). There was evidence that higher BMI (>25) was associated with increased risk of arm lymphedema (OR: 1.98, 95%CI 1.45 – 2.70, I 2 =84.0%, P< 0.0001, n =4 studies). Conclusion Better understanding the factors that contribute to variability in cancer-related arm lymphedema in LMICs is an important first step to developing targeted interventions to improve quality of life. Standardising measurement of lymphedema globally and better reporting would enable comparison within the context of information about cancer treatments and lymphedema care.

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Lymphedema symptoms and limb measurement changes in breast cancer survivors treated with neoadjuvant chemotherapy and axillary dissection: results of American College of Surgeons Oncology Group (ACOSOG) Z1071 (Alliance) substudy

Abstract: NCT00881361.

Cited by 56 publications

References 21 publications

Systematic Review of Patient-Reported Outcomes following Surgical Treatment of Lymphedema

Systematic Review of Patient-Reported Outcomes following Surgical Treatment of Lymphedema

Lymphedema in survivors of breast cancer (Review)

Prevalence and incidence of cancer related lymphedema in low and middle-income countries: A systematic review and meta-analysis.

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