Use of technology to facilitate a prospective surveillance program for breast cancer-related lymphedema at the Massachusetts General Hospital

Abstract

Breast cancer-related lymphedema (BCRL) is a negative sequela of breast cancer (BC) caused by trauma to the lymphatic system during surgery or radiation to the axillary lymph nodes. BCRL affects approximately one in five patients treated for BC, and patients are at a lifelong risk for BCRL after treatment. Early diagnosis of BCRL may prevent its progression and reduce negative effects on quality of life, necessitating comprehensive prospective screening. This paper provides an overview of technology that may be used as part of a BCRL screening program, including objective measures such as perometry, bioimpedance spectroscopy, tissue tonometry, and three-dimensional optical imaging. Furthermore, this paper comprehensively reviews the technology incorporated into the established prospective screening program at Massachusetts General Hospital. Our prospective screening program consists of longitudinal measurements via perometry, symptoms assessment, and clinical examination by a certified lymphedema therapist (CLT) as needed. Discussion about use of perometry within the screening program and incorporation of arm volume measurements into equations to determine change over time and accurate diagnosis is included [relative volume change (RVC) and weight-adjusted change (WAC) equations]. Use of technology throughout the program is discussed, including a HIPPA-compliant online research database, the patient's electronic medical record, and incorporation of BCRL-related symptoms [BC and lymphedema symptom experience index (BCLE-SEI) survey]. Ultimately, both subjective and objective data are usedto inform BCRL diagnosis and treatment by the CLT. In conclusion, the role of technology in facilitating BCRL screening is indispensable, and the continued development of objective assessment methods that are not only reliable and valid, but also cost-effective and portable will help establish BCRL screening as the standard of care for patients treated for BC.

Comparison of machine learning models for predicting the risk of breast cancer-related lymphedema in Chinese women

“…[6] The prevalence of BCRL varies from 5% to 77%. [6][7][8][9] The highest prevalence rate occurs within 3 years after the BC surgery, and the arm swelling rate increases almost 1% per year. [9][10][11] Breast cancer-related lymphedema can be a distressing side effect of BC and includes symptoms of swelling and progressive fibrotic skin changes, thus resulting in decreased quality of life (QOL) for the patient.…”

Emlőtumorhoz társuló lymphoedema és kezelése

“…L-Dex-(Lymphoedema Index) érték +7,1 egységnyi emelkedése az alapértékhez képest a nyirokoedema diagnózisát támasztja alá. Hátránya, hogy kétoldali és előrehaladott nyirokoedemában nem alkalmazható, és költséges [25,26]. A szöveti konzisztencia vizsgálható az ujjbenyomatpróbával és a bőrredővastagság mérésével.…”

“…-Többrétegű nyirokfáslizás: A gondos alábélelést követően -ujjvégtől hónaljig -több rétegben felhelyezett, rövid megnyúlású fáslik viselése 24 órában javasolt. Intenzív oedemacsökkentő hatását számos vizsgálat igazolta [24,26,30]. Ez a kompressziós rendszer nyugalomban alacsony nyomást gyakorol a szövetekre, ami lehetővé teszi a folyamatos viselést, és a mozgás során kialakuló, magas szövetek közötti nyomás hatékonyan segíti az oedema elvezetését.…”

“…A nyirokoedema kialakulása szempontjából magas rizikójú (axillaris blockdissectión, sugárkezelésen és taxánalapú kemoterápián átesett) betegek esetében a kezdődő oedema korai felismerése érdekében fontos az onkológusok és a páciens betegségre való érzékenyítése. Prospektív szűrőprogram (surveil- [25,26,35]. Elsődleges prevenció: A daganatsebészeti beavatkozás során a nyirokutak képalkotó vizsgálata és lehetőség szerinti megkímélése, valamint a nyirokoedema kialakulása szempontjából magas rizikójú betegek esetén lymphovenosus anastomosis műtét végzése ajánlható [44].…”

Produção De Vídeo Educativo Para Prevenção De Linfedema: Relato Da Experiência De Um Projeto De Extensão

“…O linfedema é considerado condição crônica (HAVENS et al, 2021) associada à disfunções físico-funcionais -inchaço, sensação de peso, dor (KORUCU et al, 2020) -e psicológicas -angústia, ansiedade, alteração da imagem corporal e impacto social (ZHAO et al, 2021) -interferindo significativamente na qualidade de vida das mulheres submetidas ao tratamento do câncer de mama (INTERNATIONAL SOCIETY OF LYMPHOLOGY, 2020;TEMUR;KAPUCU, 2019;ZHAO et al, 2021). Ocorre por acúmulo de fluido rico em proteína no espaço intersticial e pode ser causado por dissecção de linfonodos axilares, biópsia de linfonodo sentinela, radioterapia, infecção, obesidade (INTERNATIONAL SOCIETY OF LYMPHOLOGY, 2020), além de formação de seroma no pós-operatório, quimioterapia no membro homolateral à cirurgia ou estágio avançado da doença (RIBEIRO PEREIRA et al, 2017).…”