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Education With or Without Exercise and Counseling in Preventing Lymphedema in Women With Stage I, Stage II, or Stage III Breast Cancer Who Are Undergoing Axillary Lymph Node Dissection

22 januari 2019 uppdaterad av: Alliance for Clinical Trials in Oncology

A Randomized Study to Prevent Lymphedema in Women Treated for Breast Cancer

This randomized phase III trial studies how well education with or without physical therapy intervention works in preventing lymphedema in women with stage I, II, or III breast cancer who are undergoing axillary lymph node dissection (surgery to remove lymph nodes found in the armpit region). Lymphedema is a condition in which extra lymph fluid builds up in tissues and causes swelling in an arm or leg if lymph vessels are blocked, damaged, or removed by surgery. A personalized physical therapy intervention and education materials may be better than education materials alone in preventing lymphedema in women with breast cancer who are undergoing axillary lymph node dissection.

Studieöversikt

Status

Avslutad

Betingelser

Intervention / Behandling

Detaljerad beskrivning

OBJECTIVES:

I. To test, in a group randomized controlled trial, the efficacy of this program versus education only in reducing the incidence of lymphedema.

II. To compare the severity of lymphedema, in terms of changes in arm circumference at the site of greatest difference as a continuous variable between the two interventions.

III. To assess the agreement between patients' self-report of swelling (mild, moderate, and severe) and the extent of circumferential measurement difference between the treated side and the contralateral arm at the site of greatest difference.

IV. To compare the health-related quality of life (Factional Assessment of Cancer Therapy-Breast [FACT-B]+4 score) between the two interventions.

V. To characterize adherence to lymphedema prevention exercises, lymphedema knowledge, and range of motion.

OUTLINE: Patients are randomized to 1 of 2 arms.

ARM I: Six weeks after surgery, patients receive a brief initial post-operative care session describing lymphedema risk and prevention through oral instruction and written materials. Patients complete physical assessments and questionnaires at 6 weeks and at 6, 12, and 18 months. Patients are also contacted by telephone at 9 and 15 months.

ARM II: Patients receive lymphedema education and complete physical assessments and questionnaires as in Arm I. Patients also complete a personalized physical therapy intervention, receive a refrigerator magnet, and a 15-minute video that reinforces information and exercises.

Studietyp

Interventionell

Inskrivning (Faktisk)

568

Fas

  • Fas 3

Kontakter och platser

Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.

Studieorter

  • Förenta staterna
    • California
      • Castro Valley, California, Förenta staterna, 94546
        • East Bay Radiation Oncology Center
      • Castro Valley, California, Förenta staterna, 94546
        • Valley Medical Oncology Consultants - Castro Valley
      • Concord, California, Förenta staterna, 94524-4110
        • Cancer Care Center at John Muir Health - Concord Campus
      • Fremont, California, Förenta staterna, 94538
        • Valley Medical Oncology
      • Martinez, California, Förenta staterna, 94553-3156
        • Contra Costa Regional Medical Center
      • Mountain View, California, Förenta staterna, 94040
        • El Camino Hospital Cancer Center
      • Oakland, California, Förenta staterna, 94609
        • Alta Bates Summit Medical Center - Summit Campus
      • Oakland, California, Förenta staterna, 94602
        • Highland General Hospital
      • Oakland, California, Förenta staterna, 94609
        • Larry G Strieff MD Medical Corporation
      • Oakland, California, Förenta staterna, 94609
        • CCOP - Bay Area Tumor Institute
      • Oakland, California, Förenta staterna, 94609
        • Bay Area Breast Surgeons, Incorporated
      • Oakland, California, Förenta staterna, 94609
        • Tom K Lee, Incorporated
      • San Pablo, California, Förenta staterna, 94806
        • Doctors Medical Center - San Pablo Campus
      • Walnut Creek, California, Förenta staterna, 94598
        • John Muir/Mt. Diablo Comprehensive Cancer Center
    • Connecticut
      • Bridgeport, Connecticut, Förenta staterna, 06606
        • St. Vincent's Medical Center
    • Delaware
      • Lewes, Delaware, Förenta staterna, 19958
        • Tunnell Cancer Center at Beebe Medical Center
      • Newark, Delaware, Förenta staterna, 19713
        • CCOP - Christiana Care Health Services
    • District of Columbia
      • Washington, District of Columbia, Förenta staterna, 20007
        • Lombardi Comprehensive Cancer Center at Georgetown University Medical Center
      • Washington, District of Columbia, Förenta staterna, 20002
        • Kaiser Permanente at Capitol Hill Medical Center
    • Florida
      • Deerfield Beach, Florida, Förenta staterna, 33064-3596
        • North Broward Medical Center
      • Jupiter, Florida, Förenta staterna, 33458
        • Ella Milbank Foshay Cancer Center at Jupiter Medical Center
      • Miami Beach, Florida, Förenta staterna, 33140
        • CCOP - Mount Sinai Medical Center
      • Pensacola, Florida, Förenta staterna, 32504
        • Sacred Heart Cancer Center at Sacred Heart Hospital
      • Tallahassee, Florida, Förenta staterna, 32308
        • Tallahassee Memorial Hospital
    • Illinois
      • Chicago, Illinois, Förenta staterna, 60637-1470
        • University of Chicago Cancer Research Center
      • Chicago, Illinois, Förenta staterna, 60631
        • Resurrection Medical Center
      • Elk Grove Village, Illinois, Förenta staterna, 60007
        • Alexian Brothers Radiation Oncology
      • Harvey, Illinois, Förenta staterna, 60426
        • Ingalls Cancer Care Center at Ingalls Memorial Hospital
      • Moline, Illinois, Förenta staterna, 61265
      • Moline, Illinois, Förenta staterna, 61265
        • Trinity Cancer Center at Trinity Medical Center - 7th Street Campus
    • Indiana
      • La Porte, Indiana, Förenta staterna, 46350
        • Center for Cancer Therapy at LaPorte Hospital and Health Services
      • Mishawaka, Indiana, Förenta staterna, 46545-1470
        • Saint Joseph Regional Medical Center
      • South Bend, Indiana, Förenta staterna, 46601
        • Memorial Hospital of South Bend
      • South Bend, Indiana, Förenta staterna, 46601
        • CCOP - Northern Indiana CR Consortium
      • South Bend, Indiana, Förenta staterna, 46601
        • Michiana Hematology-Oncology, PC - South Bend
    • Iowa
      • Bettendorf, Iowa, Förenta staterna, 52722
    • Kansas
      • Chanute, Kansas, Förenta staterna, 66720
        • Cancer Center of Kansas, PA - Chanute
      • Dodge City, Kansas, Förenta staterna, 67801
        • Cancer Center of Kansas, PA - Dodge City
      • El Dorado, Kansas, Förenta staterna, 67042
        • Cancer Center of Kansas, PA - El Dorado
      • Fort Scott, Kansas, Förenta staterna, 66701
        • Cancer Center of Kansas - Fort Scott
      • Independence, Kansas, Förenta staterna, 67301
        • Cancer Center of Kansas-Independence
      • Kingman, Kansas, Förenta staterna, 67068
        • Cancer Center of Kansas, PA - Kingman
      • Lawrence, Kansas, Förenta staterna, 66044
        • Lawrence Memorial Hospital
      • Liberal, Kansas, Förenta staterna, 67901
        • Cancer Center of Kansas, PA - Liberal
      • McPherson, Kansas, Förenta staterna, 67460
        • Cancer Center of Kansas, PA - McPherson
      • Newton, Kansas, Förenta staterna, 67114
        • Cancer Center of Kansas, PA - Newton
      • Parsons, Kansas, Förenta staterna, 67357
        • Cancer Center of Kansas, PA - Parsons
      • Pratt, Kansas, Förenta staterna, 67124
        • Cancer Center of Kansas, PA - Pratt
      • Salina, Kansas, Förenta staterna, 67401
        • Cancer Center of Kansas, PA - Salina
      • Wellington, Kansas, Förenta staterna, 67152
        • Cancer Center of Kansas, PA - Wellington
      • Wichita, Kansas, Förenta staterna, 67208
        • Cancer Center of Kansas, PA - Medical Arts Tower
      • Wichita, Kansas, Förenta staterna, 67214
        • Cancer Center of Kansas, PA - Wichita
      • Wichita, Kansas, Förenta staterna, 67214
        • CCOP - Wichita
      • Wichita, Kansas, Förenta staterna, 67214
        • Via Christi Cancer Center at Via Christi Regional Medical Center
      • Wichita, Kansas, Förenta staterna, 67208
        • Associates in Womens Health, PA - North Review
      • Winfield, Kansas, Förenta staterna, 67156
        • Cancer Center of Kansas, PA - Winfield
    • Kentucky
      • Lexington, Kentucky, Förenta staterna, 40503-9985
        • Central Baptist Hospital
    • Maine
      • York, Maine, Förenta staterna, 03909
        • York Hospital's Oncology Treatment Center
    • Maryland
      • Baltimore, Maryland, Förenta staterna, 21244
        • Kaiser Permanente at Woodlawn Medical Center
      • Elkton, Maryland, Förenta staterna, 21921
        • Union Hospital of Cecil County
      • Gaithersburg, Maryland, Förenta staterna, 20879
        • Kaiser Permanente - Gaithersburg Medical Center
      • Largo, Maryland, Förenta staterna, 20774
        • Kaiser Permanente Mid-Atlantic Medical Group-Largo Medical Facility
      • Silver Spring, Maryland, Förenta staterna, 20910
        • Holy Cross Hospital
    • Massachusetts
      • Boston, Massachusetts, Förenta staterna, 02111
        • Tufts Medical Center Cancer Center
      • Hyannis, Massachusetts, Förenta staterna, 02601
        • Cape Cod Hospital
    • New Jersey
      • Elizabeth, New Jersey, Förenta staterna, 07207
        • Trinitas Comprehensive Cancer Center at Trinitas Hospital
      • Voorhees, New Jersey, Förenta staterna, 08043
        • Cancer Institute of New Jersey at Cooper - Voorhees
    • New York
      • Staten Island, New York, Förenta staterna, 10305
        • Nalitt Cancer Institute at Staten Island University Hospital
    • North Carolina
      • Greenville, North Carolina, Förenta staterna, 27834
        • Leo W. Jenkins Cancer Center at ECU Medical School
    • North Dakota
      • Fargo, North Dakota, Förenta staterna, 58122
        • CCOP - MeritCare Hospital
    • Ohio
      • Columbus, Ohio, Förenta staterna, 43210-1240
        • Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at Ohio State University Comprehensive Cancer Center
    • Tennessee
      • Cookeville, Tennessee, Förenta staterna, 38501
        • Cookeville Regional Medical Center
    • Texas
      • Houston, Texas, Förenta staterna, 77030-4009
        • M. D. Anderson Cancer Center at University of Texas
      • Laredo, Texas, Förenta staterna, 78045
        • Doctor's Hospital of Laredo
    • Virginia
      • Fairfax, Virginia, Förenta staterna, 22033
        • Kaiser Permanente Medical Center - Fair Oaks
      • McLean, Virginia, Förenta staterna, 22102
        • Kaiser Permanente Tysons Corner Medical Center

Deltagandekriterier

Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.

Urvalskriterier

Åldrar som är berättigade till studier

18 år och äldre (Vuxen, Äldre vuxen)

Tar emot friska volontärer

Nej

Kön som är behöriga för studier

Kvinna

Beskrivning

Eligibility Criteria:

  • Newly diagnosed with stage I-III cancer of the female breast

  • No prior history of carcinoma in situ, lobular carcinoma in situ (LCIS), ductal carcinoma in situ (DCIS), or invasive breast cancer

    * Patients with a history of other invasive malignancies are eligible as long as they have completed treatment and are 5 years post-diagnosis; patients with basal cell and squamous cell cancer of the skin are eligible

  • Neoadjuvant therapy

    • Patients scheduled to receive any type of radiation therapy to the breast or axilla are eligible; however, they must be registered to this study with pre-surgery measures taken prior to receiving neoadjuvant therapy
    • Patients scheduled to receive neoadjuvant chemotherapy are also eligible; however, they must be registered to this study with pre-surgery measurements taken prior to receiving neoadjuvant therapy
    • Patients receiving no neoadjuvant therapy are eligible
  • May be enrolled on other treatment trials; however, patients enrolled on surgery trials where only one treatment arm is full axillary node dissection are not eligible; NOTE: Patients enrolled on American College of Surgeons Oncology Group (ACOSOG)-Z1071 are eligible to participate in this study; patients concurrently enrolled on this study and ACOSOG-Z1071, may not also be enrolled on the ACOSOG-Z1071 lymphedema sub-study
  • No documented cardiac conduction disturbances, unstable angina, dementia, or any other chronic disease which, in the opinion of the treating physician, significantly increases mortality over the next 2 years
  • No diagnosed lymphedema
  • In order to be properly fitted for the elastic sleeve, eligible patients must have arm measurements for axilla, elbow, and wrist that fall within the ranges for one of the six sleeve sizes
  • Not currently homebound or dependent upon a walker or wheelchair for mobility
  • Able to participate in a mild exercise program
  • Willing to return to the study site for the duration of the study (18 months)
  • Sentinel (SND) or full axillary node dissection (AND) (no minimum number of nodes required)
  • Patients with double mastectomy, axillary node dissection and/or radiation on both arms are ineligible; patients who undergo these treatments (i.e., surgery and/or radiation) on the contralateral arm after registration to Step 2 are still eligible to remain in the study; however, it should be documented appropriately on form C-1628 at the conclusion of study participation

Studieplan

Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.

Hur är studien utformad?

Designdetaljer

  • Primärt syfte: Stödjande vård
  • Tilldelning: Randomiserad
  • Interventionsmodell: Parallellt uppdrag
  • Maskning: Ingen (Open Label)

Vapen och interventioner

Deltagargrupp / Arm
Intervention / Behandling
Experimentell: Arm I (lymphedema education)
Six weeks after surgery, patients receive a brief initial post-operative care session describing lymphedema risk and prevention through oral instruction and written materials. Patients complete physical assessments and questionnaires at 6 weeks and at 6, 12, and 18 months. Patients are also contacted by telephone at 9 and 15 months.
Övrig: quality of life assessment
Ancillary studies
Övrig: educational intervention
Receive lymphedema educational materials
Andra namn:
  • intervention, pedagogisk
Experimentell: Arm II (lymphedema education, physical therapy)
Description Patients receive lymphedema education and complete physical assessments and questionnaires as in Arm I. Patients also complete a personalized physical therapy intervention, receive a refrigerator magnet, and a 15-minute video that reinforces information and exercises.
Övrig: quality of life assessment
Ancillary studies
Övrig: educational intervention
Receive lymphedema educational materials
Andra namn:
  • intervention, pedagogisk
Procedur: Physical therapy
Complete physical therapy-focused intervention
Andra namn:
  • fysioterapi

Vad mäter studien?

Primära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Number of Participants Who Were Lymphedema-free 18 Months After Randomization
Tidsram: 18 months
To test, in a group randomized controlled trial, the efficacy of this program versus education only in reducing the incidence of lymphedema. Reported here is the proportion of patients who are lymphedema-free 18 months after randomization between the two arms
18 months

Sekundära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Change From Baseline at 18 Months in Arm Circumference at the Site of Greatest Difference
Tidsram: 18 months
To compare the severity of lymphedema in terms of changes in arm circumference at the site of greatest difference as a continuous variable between the two interventions.
18 months
Agreement Between Patients' Self-report of Swelling and the Extent of Circumferential Measurement Difference Between the Treated Side and the Contralateral Arm
Tidsram: 18 months
To assess the agreement between patients' self-report of swelling (mild, moderation and severe) and the extent of circumferential measurement difference between treated side and the contralateral arm at the site of greatest difference. Per protocol, this analysis will include all patients and not be comparing the intervention arm with the control arm.
18 months
Health-related Quality of Life as Assessed by FACT-B +4 Score
Tidsram: 18 months
To compare the health-related quality of life (FACT-B+4 score) between the two interventions. The change between baseline and month 18 for the total plus 4 score will be reported here. The total plus 4 score is an average of the physical, social, emotional, functional, FACT-G, and additional concerns sub-scales. Each sub-scale has questions ranging from 1-5. Once the average of all subscales is taken, the total plus 4 score is converted into a score out of 100. 100 being the best, 0 being the worst.
18 months
Adherence to Lymphedema Prevention Exercises, Lymphedema Knowledge, Range of Motion, and Arm Strength
Tidsram: from baseline up to 18 months
To characterize adherence to lymphedema prevention exercises, lymphedema knowledge and range of motion. The frequency of elastic sleeve use for heavy arm use/exercise/air travel will be reported here. Arm I did not receive a sleeve to wear, thus will not be reported.
from baseline up to 18 months

Samarbetspartners och utredare

Det är här du hittar personer och organisationer som är involverade i denna studie.

Sponsor

Alliance for Clinical Trials in Oncology

Samarbetspartners

National Cancer Institute (NCI)

Utredare

  • Studiestol: Electra D. Paskett, PhD, Ohio State University Comprehensive Cancer Center

Publikationer och användbara länkar

Den som ansvarar för att lägga in information om studien tillhandahåller frivilligt dessa publikationer. Dessa kan handla om allt som har med studien att göra.

Allmänna publikationer

Studieavstämningsdatum

Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.

Studera stora datum

Studiestart (Faktisk)

1 juni 2006

Primärt slutförande (Faktisk)

1 november 2015

Avslutad studie (Faktisk)

15 juni 2017

Studieregistreringsdatum

Först inskickad

13 september 2006

Först inskickad som uppfyllde QC-kriterierna

13 september 2006

Första postat (Uppskatta)

15 september 2006

Uppdateringar av studier

Senaste uppdatering publicerad (Faktisk)

7 februari 2019

Senaste inskickade uppdateringen som uppfyllde QC-kriterierna

22 januari 2019

Senast verifierad

1 januari 2019

Mer information

Termer relaterade till denna studie

Nyckelord

Ytterligare relevanta MeSH-villkor

Andra studie-ID-nummer

  • CALGB-70305
  • U10CA037447 (U.S.S. NIH-anslag/kontrakt)
  • CDR0000494652 (Registeridentifierare: NCI Physician Data Query)
  • NCI-2009-00488 (Registeridentifierare: NCI Clinical Trial Reporting Program)

Denna information hämtades direkt från webbplatsen clinicaltrials.gov utan några ändringar. Om du har några önskemål om att ändra, ta bort eller uppdatera dina studieuppgifter, vänligen kontakta register@clinicaltrials.gov. Så snart en ändring har implementerats på clinicaltrials.gov, kommer denna att uppdateras automatiskt även på vår webbplats .

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