Proactive approach to lymphedema risk reduction: a prospective study

Mei R Fu, Deborah Axelrod, Amber A Guth, Francis Cartwright, Zeyuan Qiu, Judith D Goldberg, June Kim, Joan Scagliola, Robin Kleinman, Judith Haber, Mei R Fu, Deborah Axelrod, Amber A Guth, Francis Cartwright, Zeyuan Qiu, Judith D Goldberg, June Kim, Joan Scagliola, Robin Kleinman, Judith Haber

Abstract

Background: Advances in cancer treatments continue to reduce the incidence of lymphedema. Yet, many breast cancer survivors still face long-term postoperative challenges as a result of developing lymphedema. The purpose of this study was to preliminarily evaluate The Optimal Lymph Flow program, a patient-centered education and behavioral program focusing on self-care strategies to enhance lymphedema risk reduction by promoting lymph flow and optimize body mass index (BMI).

Methods: A prospective, longitudinal, quasi-experimental design with repeated-measures was used. The study outcomes included lymph volume changes by infrared perometer, and BMI by a bioimpedance device at pre-surgery baseline, 2-4 weeks after surgery, 6-month and 12-month follow-up. A total of 140 patients were recruited and participated in The Optimal Lymph Flow program; 134 patients completed the study with 4 % attrition rate.

Results: Fifty-eight percent of patients had axillary node dissection and 42 % had sentinel lymph node biopsy (SLNB). The majority (97 %) of patients maintained and improved their preoperative limb volume (LV) and BMI at the study endpoint of 12 months following cancer surgery. Cumulatively, two patients with SLNB and two patients with axillary lymph node dissection had measurable lymphedema (>10 % LV change). At the 12-month follow-up, among the four patients with measurable lymphedema, two patients' LV returned to preoperative level without compression therapy but by maintaining The Optimal Lymph Flow exercises to promote daily lymph flow.

Conclusions: This educational and behavioral program is effective in enhancing lymphedema risk reduction. The study provided initial evidence for emerging change in lymphedema care from treatment-focus to proactive risk reduction.

Figures

Figure 1. Limb Volume Changes Over 12-Month…
Figure 1. Limb Volume Changes Over 12-Month Time Period
Note: As shown above, the limb volume is decreasing over time, for both affected and unaffected arms (affected p=0.0004, Unaffected p

Figure 2. Body Mass Index and Weight…

Figure 2. Body Mass Index and Weight Over 12-Month Time Period

Note: BMI and Weight…

Figure 2. Body Mass Index and Weight Over 12-Month Time Period
Note: BMI and Weight are not significantly changing over time (BMI p=0.6650, Weight p=0.4086)
Figure 2. Body Mass Index and Weight…
Figure 2. Body Mass Index and Weight Over 12-Month Time Period
Note: BMI and Weight are not significantly changing over time (BMI p=0.6650, Weight p=0.4086)

References

    1. Fu MR, Ridner SH, Hu SH, et al. Psychosocial Impact of Lymphedema: A systematic review of literature from 2004 to 2011. Psycho-Oncol. 2013;22(7):1466–84. doi: 10.1002/pon.3201. Epub 2012 Oct 9.
    1. Chachaj A, Malyszczak K, Pyszel K, et al. Physical and psychological impairments of women with upper lymphedema following breast cancer treatment. Psycho-Oncol. 2009;19:299–305.
    1. Petrek JA, Senie RT, Peters M, Rosen PP. Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis. Cancer. 2001;92(6):1368–1377.
    1. Armer JM, Stewart BR, Shook RP. 30-Month Post-Breast Cancer Treatment Lymphoedema. J Lymphoedema. 2009;4(1):14–18.
    1. International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema. Consensus document of the International Society of Lymphology Lymphology. 2003;36:84–91.
    1. Stanton AW, Modi S, Mellor RH, et al. Recent advances in breast cancer-related lymphedema of the arm: lymphatic pump failure and predisposing factors. Lymphatic Res & Biol. 2009;7(1):29–45.
    1. Brorson H, Aberg M, Svensson H. Chronic lymphedema and adipocyte proliferation: Clinical therapeutic implications. The Lymphatic Continuum. National Institutes of Health, Bethesda, USA, 2002. Lymphat Res Biol. 2003;1:88.
    1. Mak SS, Yeo W, Lee YM, et al. Predictors of lymphedema in patients with breast cancer undergoing axillary lymph node dissection in Hong Kong. Nurs Res. 2008;57:416–425.
    1. Kwan ML, Darbinian J, Schmitz KH, et al. Risk factors for lymphedema in a prospective breast cancer survivorship study: the Pathways Study. Arch Surg. 2010;145:1055–1063. doi: 10.1001/archsurg.2010.231.
    1. Ahmed RL, Schmitz KH, Prizment AE, et al. Risk factors for lymphedema in breast cancer survivors, the Iowa Women's Health Study. Breast Cancer Res Treat. 2001;130:981–991. doi: 10.1007/s10549-011-1667-z.
    1. Paskett ED, Naughton MJ, McCoy TP, et al. The epidemiology of arm and hand swelling in premenopausal breast cancer survivors. Cancer Epidemiol Biomarkers Prev. 2007;16:775–782.
    1. Ruocco V, Schwartz RA, Ruocco E. Lymphedema: An immunologically vulnerable site for development of neoplasms. J Am Acad Dermat. 2002;47:124–127.
    1. Fu MR, Chen C, Haber J, et al. The effect of providing information about lymphedema on the cognitive and symptom outcomes of breast cancer survivors. Ann Surg Oncol. 2010;17(7):1847–1853. doi: 10.1245/s10434-010-0941-3. Epub 2010 Feb 6.
    1. Cemal Y, Pusic A, Mehrara BJ. Preventative measures for lymphedema: separating fact from fiction. J Am Coll Surg Oct. 2011;213(4):543–51.
    1. Nielsen I, Gordon S, Selby A. Breast cancer-related lymphoedema risk reduction advice: a challenge for health professionals. Cancer Treat Rev. 2008;34(7):621–8.
    1. Stout NL, Binkley JM, Schmitz KH, Andrews K, Hayes SC, Campbell KL, et al. A prospective surveillance model for rehabilitation for women with breast cancer. Cancer. 2012;118(8 Suppl):2191–200.
    1. Armer JM, Stewart BR. A comparison of four diagnostic criteria for lymphedema in a post-breast cancer population. Lymphat Res Biol. 2005;3:208–217.
    1. McLaughlin SA, Bagaria S, Gibson T, et al. Trends in risk reduction practices for the prevention of lymphedema in the first 12 months after breast cancer surgery. J Am Coll Surg. 2013;216:380–389. 216 (3)
    1. Lasinski BB, Thrift KM, Squire D, et al. A systematic review of the evidence for complete decongestive therapy in the treatment of lymphedema from 2004 to 2011. Physic Med & Rehab. 2012;4(8):580–601.
    1. American Cancer Society. Breast Cancer Facts & Figures 2013-2014. Atlanta: American Cancer Society, Inc.; 2013.
    1. Shih YC, Xu Y, Cormier JN, et al. Incidence, treatment costs, and complications of lymphedema after breast cancer among women of working age: a 2-year follow-up study. J Clin Oncol. 2009;27(12):2007–14.
    1. McLaughlin SA, Wright MJ, Morris KT, et al. Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements. J Clin Oncol. 2008;26(32):5213–5219.
    1. Fitzmaurice G, Laird N, Ware J. Applied Longitudinal Data Analysis. New Jersey: John Wiley & Sons; 2004.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel