Nomograms for Predicting the Risk of Arm Lymphedema after Axillary Dissection in Breast Cancer

Bevilacqua, José Luiz Barbosa; Kattan, Michael W.; Yu, Changhong; Koifman, Sérgio; Mattos, Inês Echenique; Koifman, Rosalina Jorge; Bergmann, Anke

doi:10.1245/s10434-012-2290-x

Cited by 122 publications

(114 citation statements)

References 52 publications

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“…Ten of the remaining twelve studies were internally validated, using split sample, cross-validation, or bootstrap techniques to correct for optimism. (8, 11–14, 17–21) One study was a metaanalysis of multiple studies of erectile dysfunction, which was limited by poor study design (failure to account for between-study variability). (10)…”

Section: Resultsmentioning

confidence: 99%

“…(8, 11, 14, 16, 19, 21) The studies by Bevilacqua et al (on lymphedema) and Gallina et al (on erectile function) discussed using models to identify patients at highest risk in order to target therapies for late effects. (14, 21) Kovalchik et al and Ezaz et al predicted occurrence of a late effect (second primary thyroid cancer and cardiomyopathy, respectively) with the goal of stratifying monitoring efforts in the survivorship period. (16, 19) Ganz et al developed a model of psychosocial morbidity after breast cancer treatment.…”

Section: Resultsmentioning

confidence: 99%

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Are we ready to predict late effects? A systematic review of clinically useful prediction models

Salz

Baxi

Raghunathan

et al. 2015

European Journal of Cancer

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Background After completing treatment for cancer, survivors may experience late effects: consequences of treatment that persist or arise after a latent period. Purpose To identify and describe all models that predict the risk of late effects and could be used in clinical practice. Data sources We searched Medline through April 2014. Study selection Studies describing models that 1) predicted the absolute risk of a late effect present at least one year post-treatment, and 2) could be used in a clinical setting. Data extraction Three authors independently extracted data pertaining to patient characteristics, late effects, the prediction model, and model evaluation. Data synthesis Across fourteen studies identified for review, nine late effects were predicted: erectile dysfunction and urinary incontinence after prostate cancer; arm lymphedema, psychological morbidity, cardiomyopathy or heart failure, and cardiac event after breast cancer; swallowing dysfunction after head and neck cancer; breast cancer after Hodgkin lymphoma; and thyroid cancer after childhood cancer. Of these, four late effects are persistent effects of treatment and five appear after a latent period. Two studies were externally validated. Six studies were designed to inform decisions about treatment rather than survivorship care. Nomograms were the most common clinical output. Conclusion Despite the call among survivorship experts for risk stratification, few published models are useful for risk-stratifying prevention, early detection, or management of late effects. Few models address serious, modifiable late effects, limiting their utility. Cancer survivors would benefit from models focused on long-term, modifiable, serious late effects to inform the management of survivorship care.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Are we ready to predict late effects? A systematic review of clinically useful prediction models

Salz

Baxi

Raghunathan

et al. 2015

European Journal of Cancer

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“…Por meio desse achado, pode-se observar a necessidade de adequação no atendimento a pacientes em fase pós-operatória, questão observada em muitos serviços do SUS 19 . Como proposta, sugere-se a distribuição de cartilhas de orientação e palestras informativas quanto aos cuidados pré e pós-operatórios, bem como o de encaminhamento médi-co mais precoce à fisioterapia, e deve-se considerar que é comum o desenvolvimento de sequelas como o linfedema mais tardiamente, levando o paciente a procurar a fisioterapia somente após sua instalação 20 . As técnicas cirúrgicas para o tratamento do câncer de mama evoluíram com o tempo e estão cada vez menos invasivas.…”

Section: Discussionunclassified

“…Com isso, o tratamento cirúrgico tem sido mais indicado para a remoção do nódulo mamário, sem um tempo longo de cirurgia 21 , como observado em nossos resultados, que apontaram o tratamento cirúrgico como o mais realizado (n = 89, 94,7%). Apesar dos avanços no tratamento cirúrgico do câncer de mama, Perfil clínico dos pacientes atendidos em um ambulatório de fisioterapia em oncologia do município de São Paulo observam-se ainda diversas complicações no pós-operatório: episódios de infecção do braço, seroma, necrose tecidual, sintomas sensoriais do nervo intercostobraquial, escápula alada e redução da amplitude de movimento do ombro 20 . A alta taxa de procedimento cirúrgico realizado na amostra deste estudo pode estar associada ao diagnóstico fisioterapêutico mais frequente, que foi de alterações vasculares e linfáticas, tendo destaque o linfedema de membros superiores (n = 42, 51%, p < 0,001).…”

Section: Discussionunclassified

Perfil clínico dos pacientes atendidos em um ambulatório de fisioterapia em oncologia do município de São Paulo

et al. 2014

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ResumoOs avanços no tratamento das neoplasias têm favorecido maiores taxas de sobrevida, aumentando a demanda da reabilitação dos pacientes com câncer, sendo a fisioterapia uma das áreas em amplo crescimento. Porém, essa população possui perfil, demanda e realidade bem diferentes, sendo necessário o conhecimento de suas características para melhor elaborar estratégias de atuação e condutas dentro da área de fisioterapia em oncologia. O objetivo deste estudo foi identificar o perfil clínico dos pacientes atendidos em um ambulatório de fisioterapia em oncologia. Foram analisados 105 prontuários para a coleta dos dados sociodemográficos e clínicos de um ambulatório de fisioterapia em oncologia do município de São Paulo, de agosto de 2008 a julho de 2010, sendo 11 (10,5%) excluídos. Para a análise estatística foi utilizado o teste de igualdade de duas proporções para avaliar a distribuição relativa das variáveis e Mann-Whitney para comparação destas. Dos 94 prontuários analisados, 63,8% (n = 60) eram do gênero feminino (p < 0,001), com faixa etária média de 56,3 ± 13,3 anos e IMC de 27,09 ± 5,88 kg/m 2 . O diagnóstico médico mais frequente foi o câncer de mama em 44,4% (n = 44; p < 0,05). A maioria estava entre o segundo e quinto ano (33%; n = 31) de evolução da doença. O tratamento cirúrgico foi o mais realizado (94,7%; n = 89; p < 0,001). O diagnóstico fisioterapêutico mais encontrado foi de alterações vasculares e linfáticas (87,2%; n = 82; p < 0,001). A queixa principal dos pacientes foi de dor (55,3%; n = 52) e edema (51,1%; n = 48; p = 0,559). Pode-se concluir que o perfil clínico dos pacientes se caracterizou por mulheres acima de 50 anos, com sobrepeso, em pós-operatório tardio de câncer de mama, apresentando dor e linfedema nos membros. Palavras-chave:Neoplasias. Perfil de Saúde. Fisioterapia. AbstractAdvances in cancer treatment has been favoring higher survival rates, increasing demand of rehabilitation of cancer patients, being physical therapy one of the areas in a higher growth. However, this population has very different profiles, demands and realities, requiring the knowledge of its features to better develop action strategies and conducts in the area of physical therapy in oncology. The objective of this study was to identify the clinical profile of patients assisted in a physical therapy outpatient in Oncology. One hundred five medical records were analyzed for demographic and clinical data collection in a outpatient physiotherapy service of Sao Paulo city, from August 2008 to July 2010, being 11(10.5%) excluded. Statistical analysis was performed using the test for equality of two proportions to evaluate the relative distribution of variables, which were compared using the Mann-Whitney test. Among those 94 medical records, 63.8% (n = 60) were female (p < 0.001), with a mean age of 56.3 ± 13.3 years and they had a BMI of 27.09 ± 5.88 kg/m². The most prevalent medical diagnosis was breast cancer in 44.4% (n = 44; p < 0.05). Most patients were between the second and the fifth year (33%; n = 31) of di...

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“…Apart from treatment-related risk factors, high BMI at diagnosis (≥30 kg/m 2 ) is a frequently published risk factor for lymphedema development [4, 18–23, 25, 26, 65]. Jammallo et al reported on a cohort of 787 patients who were prospectively screened for BCRL via perometry.…”

Section: Risk Factorsmentioning

confidence: 99%

Diagnostic Methods, Risk Factors, Prevention, and Management of Breast Cancer-Related Lymphedema: Past, Present, and Future Directions

Sayegh

Asdourian

Swaroop

et al. 2017

Curr Breast Cancer Rep

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Purpose of Review Breast cancer-related lymphedema (BCRL) is a chronic, adverse, and much feared complication of breast cancer treatment, which affects approximately 20% of patients following breast cancer treatment. BCRL has a tremendous impact on breast cancer survivors, including physical impairments and significant psychological consequences. The intent of this review is to discuss recent studies and analyses regarding the risk factors, diagnosis, prevention through early screening and intervention, and management of BCRL. Recent Findings Highly-evidenced risk factors for BCRL include axillary lymph node dissection, lack of reconstruction, radiation to the lymph nodes, high BMI at diagnosis, weight fluctuations during and after treatment, subclinical edema within and beyond 3 months after surgery, and cellulitis in the at-risk arm. Avoidance of potential risk factors can serve as a method of prevention. Through establishing a screening program by which breast cancer patients are measured pre-operatively and at follow-ups, are objectively assessed through a weight-adjusted analysis, and are clinically assessed for signs and symptoms, BCRL can be tracked accurately and treated effectively. Management of BCRL is done by a trained professional, with research mounting towards the use of compression bandaging as a first line intervention against BCRL. Finally, exercise is safe for breast cancer patients with and without BCRL and does not incite or exacerbate symptoms of BCRL. Summary Recent research has shed light on BCRL risk factors, diagnosis, prevention, and management. We hope that education on these aspects of BCRL will promote an informed, consistent approach and encourage additional research in this field to improve patient outcomes and quality of life in breast cancer survivors.

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Nomograms for Predicting the Risk of Arm Lymphedema after Axillary Dissection in Breast Cancer

Abstract: The proposed nomograms can help physicians and patients predict the 5 year probability of LE after ALND for breast cancer. Free online versions of the nomograms are available at http://www.lymphedemarisk.com/ .

Cited by 122 publications

References 52 publications

Are we ready to predict late effects? A systematic review of clinically useful prediction models

Are we ready to predict late effects? A systematic review of clinically useful prediction models

Perfil clínico dos pacientes atendidos em um ambulatório de fisioterapia em oncologia do município de São Paulo

Diagnostic Methods, Risk Factors, Prevention, and Management of Breast Cancer-Related Lymphedema: Past, Present, and Future Directions

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