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      Prospective Surveillance with Compression for Subclinical Lymphedema: Symptoms, Skin, and Quality-of-Life Outcomes

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          Abstract

          Background:

          Patients underwent a compression (sleeve and gauntlet) intervention for subclinical breast cancer-related lymphedema (S-BCRL). Physical, emotional, and quality-of-life (QoL) outcomes were examined. Associations of change in extracellular fluid alone through bioimpedance spectroscopy (BIS) or change in whole-arm volume through tape measure with the outcomes at time of S-BCRL were explored.

          Methods and Results:

          We enrolled newly diagnosed nonmetastatic breast cancer patients for surveillance up to 36 months postoperatively. Upon detection of S-BCRL, a 28-day compression intervention was initiated. Data were obtained through physical examination/measurement and self-report instruments: skin examination, Lymphedema Symptom Intensity and Distress Survey-Arm, and Functional Assessment of Cancer Therapy General (FACT-G), Breast (FACT-B), and FACT-B+4.

          Improvements with intervention were observed in the proportion of patients reporting symptom scores ≥3 in function (Cohen's d = −0.46, p < 0.01), in biobehavioral (Cohen's d = −0.30, p < 0.05), maximum number of skin conditions (Cohen's d = −0.34, p < 0.05. 3), FACT-B (Cohen's d = 0.52, p < 0.01), and FACT-B + four (Cohen's d = −0.42, p < 0.01). At the study endpoint, compared with those who did not progress, chronic breast cancer-related lymphedema (C-BCRL) progressing patients had higher overall symptom scores ( p = 0.037), more skin conditions ( p = 0.009), and lower total FACT-G and FACT-B scores ( p < 0.05). At the time of S-BCRL, detection of greater BIS unit change correlated with higher symptom, skin condition, and QoL values. Greater whole-arm volume change correlated with higher FACT-B+4 scores (all p < 0.05).

          Conclusions:

          Prospective surveillance, symptom assessment, and compression intervention promote low progression rates from S-BCRL to C-BCRL and as such reduce symptom burden. This closed study is registered with ClinicalTrials.gov NCT02167659

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          Most cited references20

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          Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support.

          Paul A. Harris, Robert Taylor, Robert Thielke … (2009)
          Research electronic data capture (REDCap) is a novel workflow methodology and software solution designed for rapid development and deployment of electronic data capture tools to support clinical and translational research. We present: (1) a brief description of the REDCap metadata-driven software toolset; (2) detail concerning the capture and use of study-related metadata from scientific research teams; (3) measures of impact for REDCap; (4) details concerning a consortium network of domestic and international institutions collaborating on the project; and (5) strengths and limitations of the REDCap system. REDCap is currently supporting 286 translational research projects in a growing collaborative network including 27 active partner institutions.
          Article 0 comments Cited 9880 times – based on 0 reviews     Review now
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            Lymphedema following breast cancer treatment and impact on quality of life: a review.

            Nadine Taghian, Cynthia Miller, Lauren S Jammallo … (2014)
            Lymphedema resulting from breast cancer treatment is a chronic condition which can significantly compromise quality of life. We sought to review various aspects of breast-cancer related lymphedema including measurement techniques, definitions, risk factors, and specifically, impact on physical, psychological, and emotional well-being of women treated for breast cancer. For the purpose of this review, we performed a literature search using PubMed for articles on lymphedema secondary to breast cancer treatment published since 1997. While improvements in breast cancer therapy have contributed to a decrease in the incidence of lymphedema, the overall negative impact the condition has on patients and survivors has remained unchanged. The development of lymphedema results in physical impairments including compromised function, diminished strength, fatigue, and pain in the affected arm. Affected women may have decreased self-confidence resulting from a distorted body image. Negative emotions reported by women with lymphedema include anxiety, frustration, sadness, anger, fear, and increased self-consciousness. Lymphedema secondary to breast cancer treatment remains a significant quality of life issue, with known consequences related to a woman's physical, psychological, and emotional well-being.
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              Quality of life and a symptom cluster associated with breast cancer treatment-related lymphedema.

              Sheila H Ridner (2005)
              The aim of this study was to compare quality of life and symptoms between breast cancer survivors who have developed and undergone treatment for chronic lymphedema with those who have not developed lymphedema. The cross-sectional, mixed-methods design included 64 breast cancer survivors with lymphedema and 64 breast cancer survivors without lymphedema. Variables assessed quantitatively included sociodemographic information, medical data, body mass index (BMI), arm extracellular fluid volume, quality of life (QOL), and physical and emotional symptoms. For the qualitative component, individuals with lymphedema responded in writing to the question: During the past week what other difficulties have you experienced because of your lymphedema? Compared with those without lymphedema, breast cancer survivors with lymphedema reported poorer QOL. A symptom cluster that included alteration in limb sensation, loss of confidence in body, decreased physical activity, fatigue, and psychological distress was identified. Perception of limb size influenced the cumulative symptom experience more than objective arm volume. Qualitative data revealed multiple QOL, physical health, and psychological concerns. BMI correlated with multiple outcomes. Findings suggest that current lymphedema treatments, although beneficial, may not provide complete relief of symptoms associated with lymphedema and complementary interventions are needed. The poorer QOL in breast cancer survivors with lymphedema may relate to the presence of an untreated symptom cluster.
              Article 0 comments Cited 53 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Lymphat Res Biol
                Journal ID (iso-abbrev): Lymphat Res Biol
                Journal ID (publisher-id): lrb
                Title: Lymphatic Research and Biology
                Publisher: Mary Ann Liebert, Inc., publishers (140 Huguenot Street, 3rd Floor New Rochelle, NY 10801 USA )
                ISSN (Print): 1539-6851
                ISSN (Electronic): 1557-8585
                Publication date (Print): June 2023
                Publication date (Electronic): 23 June 2023
                Publication date PMC-release: 23 June 2023
                Volume: 21
                Issue: 3
                Pages: 304-313
                Affiliations
                [ 1 ]Vanderbilt University School of Nursing, Nashville, Tennessee, USA.
                [ 2 ]Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
                [ 3 ]Australian Lymphoedema Education, Research, and Treatment (ALERT) Program, Department of Health Sciences, Macquarie University Macquarie Park, Sydney, Australia.
                [ 4 ]Sydney Adventist Hospital Integrated Cancer Centre, ICON Cancer Centre, Wahroonga, Australia.
                [ 5 ]Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA.
                [ 6 ]Mayo Clinic, Jacksonville, Florida, USA.
                [ 7 ]Northern Surgical Oncology, Sydney Adventist Hospital, Wahroonga, Australia.
                [ 8 ]Westmead Breast Cancer Center Institute, Westmead Hospital, Westmead, Australia.
                [ 9 ]Department of Surgery, The University of Sydney, Sydney, Australia.
                [ 10 ]Lakeside Specialist Breast Clinic, Lakeview Private Hospital Norwest, Norwest, Australia.
                [ 11 ]Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, Australia.
                [ 12 ]Sydney Adventist Hospital Clinical School, College of Health and Medicine, Australian National University, Canberra, Australia.
                [ 13 ]Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA.
                Author notes
                [*]Address correspondence to: Sheila H. Ridner, PhD, RN, FAAN, Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA sheila.ridner@ 123456vanderbilt.edu

                iORCID ID ( https://orcid.org/0000-0003-3208-3966).

                iiORCID ID ( https://orcid.org/0000-0003-3847-7405).

                Author information
                https://orcid.org/0000-0003-3208-3966
                https://orcid.org/0000-0003-3847-7405
                Article
                Publisher ID: 10.1089/lrb.2022.0020
                DOI: 10.1089/lrb.2022.0020
                PMC ID: 10316038
                PubMed ID: 36126315
                SO-VID: e89f1e05-70f8-4919-8226-1b9869781564
                Copyright © © Mary S. Dietrich et al. 2023; Published by Mary Ann Liebert, Inc.
                License:

                This Open Access article is distributed under the terms of the Creative Commons License [CC-BY] ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Page count
                Tables: 6, References: 24, Pages: 10
                Categories
                Subject: Original Articles

                Keywords: breast cancer,subclinical lymphedema,symptoms,skin,quality of life
                Data availability:
                Keywords: breast cancer, subclinical lymphedema, symptoms, skin, quality of life

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