Putting Evidence Into Practice: Cancer-Related Lymphedema

Fu, Mei R.; Deng, Jie; Armer, Jane M.

doi:10.1188/14.cjon.s3.68-79

Cited by 37 publications

(38 citation statements)

References 76 publications

(107 reference statements)

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“…Precision assessment of heterogeneity of lymphedema phenotype and understanding the biological mechanism of each phenotype through the exploration of inherited genetic susceptibility is a logical step for finding a cure for this chronic condition (38). For example, phenotype of fluid accumulation is identified to be associated with inflammatory mechanism as evidenced by not only significant associations with IL6 rs1800795, IL4 rs2243250 and IL4 rs2070874 but also higher BMI (>30), which is associated with polymorphisms of IL6 and elevated IL6 level (16, 17,19).…”

Section: Discussionmentioning

confidence: 99%

Precision assessment of heterogeneity of lymphedema phenotype, genotypes and risk prediction

Conley

Axelrod

et al. 2016

The Breast

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Lymphedema following breast cancer surgery is considered to be mainly due to the mechanical injury from surgery. Recent research identified that inflammation-infection and obesity may be the important predictors for lymphedema. The purpose of this exploratory research was to prospectively examine phenotype of arm lymphedema defined by limb volume and lymphedema symptoms in relation to inflammatory genes in women treated for breast cancer. A prospective, descriptive and repeated-measure design using candidate gene association method was used to enroll 140 women at pre-surgery and followed at 4–8 weeks and 12 months post-surgery. Arm lymphedema was determined by a perometer measurement of ≥5% limb volume increase from baseline of pre-surgery. Lymphedema symptom phenotype was evaluated using a reliable and valid instrument. Saliva samples were collected for DNA extraction. Genes known for inflammation were evaluated, including lymphatic specific growth factors (VEGF-C & VEGF-D), cytokines (IL1-a, IL-4, IL6, IL8, IL10, & IL13), and tumor necrosis factor-a (TNF-a). No significant associations were found between arm lymphedema phenotype and any inflammatory genetic variations. IL1-a rs17561 was marginally associated with symptom count phenotype of ≥8 symptoms. IL-4 rs2070874 was significantly associated with phenotype of impaired limb mobility and fluid accumulation. Phenotype of fluid accumulation was significantly associated with IL6 rs1800795, IL4 rs2243250 and IL4 rs2070874. Phenotype of discomfort was significantly associated with VEGF-C rs3775203 and IL13 rs1800925. Precision assessment of heterogeneity of lymphedema phenotype and understanding the biological mechanism of each phenotype through the exploration of inherited genetic susceptibility is essential for finding a cure. Further exploration of investigative intervention in the context of genotype and gene expressions would advance our understanding of heterogeneity of lymphedema phenotype.

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Section: Discussionmentioning

confidence: 99%

Precision assessment of heterogeneity of lymphedema phenotype, genotypes and risk prediction

Conley

Axelrod

et al. 2016

The Breast

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“…Without timely assessment and intervention in this early disease stage, lymphedema can progress into a chronic condition that no surgical or medical interventions at present can cure (12). Notably, the experience of lymphedema symptoms is an ongoing main debilitating complication that elicits distress and impacts the breast cancer survivors’ quality of life (QOL) (13–15).…”

Section: Introductionmentioning

confidence: 99%

mHealth self-care interventions: managing symptoms following breast cancer treatment

Fu¹,

Axelrod²,

Guth³

et al. 2016

mHealth

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Background Many women suffer from daily distressing symptoms related to lymphedema following breast cancer treatment. Lymphedema, an abnormal accumulation of lymph fluid in the ipsilateral body area or upper limb, remains an ongoing major health problem affecting more than 40% of 3.1 million breast cancer survivors in the United States. Patient-centered care related to lymphedema symptom management is often inadequately addressed in clinical research and practice. mHealth plays a significant role in improving self-care, patient-clinician communication, and access to health information. The-Optimal-Lymph-Flow health IT system (TOLF) is a patient-centered, web-and-mobile-based educational and behavioral mHealth interventions focusing on safe, innovative, and pragmatic electronic assessment and self-care strategies for lymphedema symptom management. The purpose of this paper is to describe the development and test of TOLF system. Methods The development of TOLF was guided by the Model of Self-Care for Lymphedema Symptom Management and designed based on principles fostering accessibility, convenience, and efficiency of mHealth system to enhance training and motivating assessment of and self-care for lymphedema symptoms. Test of TOLF was accomplished by conducting a psychometric study to evaluate reliability, validity, and efficiency of the electronic version of Breast Cancer and Lymphedema Symptom Experience Index (BCLE-SEI), a usability testing and a pilot feasibility testing of mHealth self-care interventions. Results Findings from the psychometric study with 355 breast cancer survivors demonstrated high internal consistency of the electronic version of the instrument: a Cronbach’s alpha coefficient of 0.959 for the total scale, 0.919 for symptom occurrence, and 0.946 for symptom distress. Discriminant validity of the instrument was supported by a significant difference in symptom occurrence (z=−6.938, P<0.000), symptom distress (z=−5.894, P<0.000), and total scale (z=−6.547, P<0.000) between breast cancer survivors with lymphedema and those without it. Findings of usability testing showed that breast cancer survivors were very satisfied with the mHealth self-care interventions: 90% rated the system having no usability problems; 10% noted minor cosmetic problems: spelling errors or text font size. The majority of participants 96.6% strongly agreed that the system was easy to use and effective in helping to learn about lymphedema, symptoms and self-care strategies. Feasibility testing demonstrated that a 12-week one group intervention using TOLF had significantly positive effects on less pain (P=0.031), less soreness (P=0.021), less aching (P=0.024), less tenderness (P=0.039), fewer numbers of lymphedema symptoms (P=0.003), and improved symptom distress (P=0.000) at 12 weeks after intervention. Themes from the qualitative data included empowerment, high quality information, loving avatar simulation videos, easy accessibility, and user-friendliness. Conclusions TOLF system using the electronic version of the ...

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“…To date, the identified risk factors include axillary surgery, axillary radiotherapy, obesity, and prior cellulitis. The perception that blood draws and blood pressure measurements using the surgical arm increase the risk for lymphedema continue to be reported by patients, despite published data that suggest otherwise [9][10][11][12][13][14] . Other historical risk factors are also frequently reported by patients 15 .…”

Section: Discussionmentioning

confidence: 96%

Perceptions of Vascular Access for Intravenous Systemic Therapy and Risk Factors for Lymphedema in Early-Stage Breast Cancer—A Patient Survey

et al. 2018

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Putting Evidence Into Practice: Cancer-Related Lymphedema

Cited by 37 publications

References 76 publications

Precision assessment of heterogeneity of lymphedema phenotype, genotypes and risk prediction

Precision assessment of heterogeneity of lymphedema phenotype, genotypes and risk prediction

mHealth self-care interventions: managing symptoms following breast cancer treatment

Perceptions of Vascular Access for Intravenous Systemic Therapy and Risk Factors for Lymphedema in Early-Stage Breast Cancer—A Patient Survey

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