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Meilani E, Zanudin A, Nordin NAM. Psychometric Evaluation of the Bahasa Malaysia Version of the Lymphedema Functioning, Disability, and Health Questionnaire for Upper Limb Lymphedema in Patients with Breast Cancer-Related Lymphedema. Lymphat Res Biol 2024. [PMID: 38608242 DOI: 10.1089/lrb.2023.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Abstract
Background: Breast cancer-related lymphedema (BCRL) is the most prevalent comorbidity that occurs following breast cancer treatments and has negative impact on the patients' quality of life (QoL). The Lymphedema Functioning, Disability, and Health Questionnaire for Upper Limb Lymphedema (Lymph-ICF-UL) is a valid and reliable instrument in assessing the QoL of patients with BCRL. However, the Bahasa Malaysia (BM) version is not available yet. This study aimed to translate the Lymph-ICF-UL into BM and to evaluate its validity and reliability. Methods and Results: A forward-backward translation was performed based on Sousa's guideline, and then, the face, content, construct validity, internal consistency, and test-retest reliability were tested. Face validity was assessed by five patients, and content validity was evaluated by six experts. Then, construct validity and internal validity were assessed in 107 patients. Finally, test-retest reliability was analyzed in 21 patients. Two items were eliminated following suggestions from the patients and experts. All patients found the scoring system and items clear and relevant. The results showed sufficient content validity index and modified kappa statistics value. Confirmatory factor analysis showed acceptable fit indices. Cronbach's alpha values ranged from 0.67 to 0.95, intraclass correlation coefficient ranged from 0.88 to 0.99, standard error measurement was 2.29-6.15, and the Bland-Altman plot showed an agreement between two test occasions. Conclusion: These results suggested that the Lymph-ICF-UL BM has good validity and reliability in evaluating the QoL of patients with BCRL in Malaysia.
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Affiliation(s)
- Estu Meilani
- Physiotherapy Programme, Faculty of Vocational Studies, Airlangga University, Surabaya, Indonesia
| | - Asfarina Zanudin
- Physiotherapy Programme, Centre for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nor Azlin Mohd Nordin
- Physiotherapy Programme, Centre for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Jia M, Pan L, Yang H, Gao J, Guo F. Impact of neoadjuvant chemotherapy on breast cancer-related lymphedema after axillary lymph node dissection: a retrospective cohort study. Breast Cancer Res Treat 2024; 204:223-235. [PMID: 38097882 DOI: 10.1007/s10549-023-07183-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 11/05/2023] [Indexed: 03/19/2024]
Abstract
PURPOSE We aimed to evaluate whether neoadjuvant chemotherapy (NAC) could be a risk factor for breast cancer-related lymphedema (BCRL) associated with axillary lymph node dissection (ALND). PATIENTS AND METHODS A total of 596 patients with cT0-4N0-3M0 breast cancer who underwent ALND and chemotherapy were retrospectively analyzed between March 2012 and March 2022. NAC was administered in 188 patients (31.5%), while up-front surgery in 408 (68.5%). Univariate and multivariable Cox regression analyses were performed to determine whether NAC was an independent risk factor for BCRL. With propensity score matching (PSM), the NAC group and up-front surgery group were matched 1:1 by age, body mass index (BMI), molecular subtypes, type of breast surgery, and the number of positive lymph nodes. Kaplan-Meier survival analyses were performed for BCRL between groups before and after PSM. Subgroup analyses were conducted to explore whether NAC differed for BCRL occurrence in people with different characteristics. RESULTS At a median follow-up of 36.3 months, 130 patients (21.8%) experienced BCRL [NAC, 50/188 (26.60%) vs. up-front surgery, 80/408 (19.61%); P = 0.030]. Multivariable analysis identified that NAC [hazard ratio, 1.503; 95% CI (1.03, 2.19); P = 0.033] was an independent risk factor for BCRL. In addition, the hormone receptor-negative/human epidermal growth factor receptor 2-negative (HR-/HER2-) subtype, breast-conserving surgery (BCS), and increased positive lymph nodes significantly increased BCRL risk. After PSM, NAC remained a risk factor for BCRL [hazard ratio, 1.896; 95% CI (1.18, 3.04); P = 0.007]. Subgroup analyses showed that NAC had a consistent BCRL risk in most clinical subgroups. CONCLUSION NAC receipt has a statistically significant increase in BCRL risk in patients with ALND. These patients should be closely monitored and may benefit from early BCRL intervention.
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Affiliation(s)
- Miaomiao Jia
- Department of Breast Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
| | - Lihui Pan
- Department of Breast Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
| | - Haibo Yang
- Department of Breast Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
| | - Jinnan Gao
- Department of Breast Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
| | - Fan Guo
- Department of Breast Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China.
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Knowlton SE, Cristian A, Orada R, Sokolof J. Medical and Cardiac Risk Stratification and Exercise Prescription in Persons With Cancer. Am J Phys Med Rehabil 2024; 103:S16-S22. [PMID: 38364025 DOI: 10.1097/phm.0000000000002381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
ABSTRACT Cancer patients are recommended to exercise at all stages of disease given the multiple health and functional benefits of physical activity. Certain safety precautions, including a preparticipation medical evaluation and periodic re-evaluations, should be undertaken before creating an exercise program based on individual cancer and treatment history. When designing an exercise program, physiatrists should use similar principles of frequency, intensity, timing, and type for cancer patients that are used for noncancer patients. Special attention to risks of cardiac and pulmonary disease along with risks of sarcopenia, thrombocytopenia, anemia, neutropenia, fracture risk, neurotoxicity, lymphedema, and metastases should be made. This article will outline these specific risks and necessary modifications to the exercise prescription for cancer patients that can be used to enable safe participation in recommended exercise.
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Affiliation(s)
- Sasha E Knowlton
- From the Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, North Carolina (SEK); Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina (SEK); Miami Cancer Institute, Miami, Florida (AC, RO); and Department of Functional Medicine and Oncological Rehabilitation, Catholic Health-Saint Francis Hospital East Hills, New York (JS)
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Chiu ST, Lai UH, Huang YC, Leong CP, Chen PC. Effect of various photobiomodulation regimens on breast cancer-related lymphedema: A systematic review and meta-analysis. Lasers Med Sci 2023; 39:11. [PMID: 38129368 DOI: 10.1007/s10103-023-03959-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
Breast cancer-related lymphedema (BCRL) is common among patients who have completed their cancer treatment. Although low-level laser therapy (LLLT) has been explored as a treatment option for BCRL, we could not find a regimen that is more effective than others. This meta-analysis aimed to organize existing research and determine the optimal combination of LLLT parameters for BCRL treatment. Studies were collected from four online databases: Embase, Ovid Medline, Cochrane, and Cinahl. The collected studies were reviewed by two of the authors. We focused on the aspects of the treatment area, treatment regimen, and total treatment sessions across the included studies. The comparisons between LLLT and non-LLLT were performed through a meta-analysis. Post-treatment QOL was significantly better in the axillary group. The group treated "three times/week with a laser density of 1.5-2 J/cm2" had significantly better outcomes in terms of swelling reduction, both immediately post-treatment and at 1-3 months follow-ups. The group with > 15 treatment sessions had significantly better post-treatment outcomes regarding reduced swelling and improved grip strength. According to these results, LLLT can relieve the symptoms of BCRL by reducing limb swelling and improving QOL. Further exploration found that a treatment approach targeting the axilla, combined with an increased treatment frequency, appropriate laser density, and extended treatment course, yielded better outcomes. However, further rigorous, large-scale studies, including long-term follow-up, are needed to substantiate this regimen.
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Affiliation(s)
- Shao-Tang Chiu
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - U-Hin Lai
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Yu-Chi Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chau-Peng Leong
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Po-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan.
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da Silva Tozzo FCB, Sarri AJ, Pirola WE, da Silva UBC, de Oliveira MA, de Pádua Souza C, da Costa Vieira RA. Evaluation of upper limb lymphoedema and diagnostic accuracy of bioimpedance spectroscopy. A comprehensive validation in a Brazilian population. Ecancermedicalscience 2023; 17:1649. [PMID: 38419858 PMCID: PMC10901233 DOI: 10.3332/ecancer.2023.1649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Indexed: 03/02/2024] Open
Abstract
Lymphoedema is a complication of breast cancer treatment. Its early diagnosis is related to a good prognosis for lymphoedema treatment. The bioimpedance spectroscopy (BIS) evaluates changes in extracellular fluid. The objective of our study was to evaluate the validity, agreement and accuracy of BIS in the diagnosis of breast cancer-related lymphoedema in a Brazilian population. Methods This is a prospective, cross-sectional study of a convenience sample of 462 women who underwent surgical treatment for breast cancer (mastectomy or breast-conserving treatment). The validity, agreement and accuracy were performed comparing BIS (lymphoedema index (L-DEX) ≥ 6.5 or 10) with volumetry by water displacement, which is the gold standard for evaluating lymphoedema. Receiver operating characteristic curve was performed. Additionally, other methods like perimetry and indirect volumetry of the upper limbs were compared with water displacement volumetry (direct volumetry), and the BIS were compared with subjective evaluation. Results Considering L-DEX ≥ 10 the sensitivity of the BIS was 44.1%, specificity 95.4%, positive predictive value (PPV) was 70.7%, negative predictive value (NPV) was 87% and kappa was 0.459. The BIS with L-DEX ≥ 6.5, the sensitivity, specificity, PPV, NPV and kappa were 57%, 88.5%, 55.8%, 89% and 0.452, respectively. Area under curve was 0.724 and a possible cut-off point of L-DEX ≥ 7.35 with sensitivity of 57%, specificity of 90.7% and kappa value = 0.489. Conclusion Although BIS was significantly associated with the subjective evaluation of lymphoedema, it showed low sensitivity and agreement and moderate correlation when used as a method for diagnosing the condition. Thus, it is not the most valid method for evaluating lymphoedema. In addition, it was not the most accurate method when compared with other objective evaluation tools. Public health resources are scarce and must be used consciously. The knowledge that BIS is not a more accurate method than other, lower-cost instruments allows for better targeting of these resources.
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Affiliation(s)
| | - Almir José Sarri
- Department of Physical Therapy, Barretos Cancer Hospital, São Paulo 14784-390, Brazil
- https://orcid.org/0000-0001-9184-584X
| | - Willian Eduardo Pirola
- Post-Graduate Program, Barretos Cancer Hospital, São Paulo 14784-400, Brazil
- https://orcid.org/0000-0003-3372-2504
| | | | - Marco Antonio de Oliveira
- Center of Epidemiology and Biostatistics, Barretos Cancer Hospital, São Paulo 14784-400, Brazil
- https://orcid.org/0000-0001-6879-2778
| | - Cristiano de Pádua Souza
- Post-Graduate Program, Barretos Cancer Hospital, São Paulo 14784-400, Brazil
- https://orcid.org/0000-0002-6412-8041
| | - René Aloisio da Costa Vieira
- Post-Graduate Program, Barretos Cancer Hospital, São Paulo 14784-400, Brazil
- Department of Breast Cancer, Barretos Cancer Hospital, São Paulo 14784-400, Brazil
- https://orcid.org/0000-0003-2014-9016
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Xu J, Du Y, Han T, Zhu N, Zhu S. Protein@Cyanine-Based NIR-II Lymphography Enables the Supersensitive Visualization of Lymphedema and Tumor Lymphatic Metastasis. Adv Healthc Mater 2023; 12:e2301051. [PMID: 37264990 DOI: 10.1002/adhm.202301051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/24/2023] [Indexed: 06/03/2023]
Abstract
Visualization of the lymphatic system is clinically indispensable for the diagnosis and/or treatment of lymphatic diseases. Although indocyanine green (ICG) lymphography becomes an alternate imaging modality compared to traditional lymphoscintigraphy, it is still far from ideal due to the insufficient detection depth and low spatiotemporal resolution. Herein, protein@cyanine probes are rationally developed to solve the limitations of the current near-infrared-I (NIR-I) lymphography. The protein@cyanine probes are synthesized following a chlorine-containing dye-labeling strategy based on structure-selectivity (facile covalent binding between the dye and protein with a 1:1 molar ratio). As expected, the probes display exceptional NIR-II imaging ability with much-improved imaging contrast/resolution and controllable pharmacokinetics, superior to the clinical ICG. The protein@cyanine probes locate lymph nodes and delineate lymphatic vessels with super-high sensitivity and signal-to-background ratio, enabling real-time diagnosing lymphatic diseases such as lymphedema and tumor lymphatic metastasis. In particular, the NIR-II lymphography provides an opportunity to discover the disparate morbidity rate of primary lymphedema in different types of mice. Given the fact of lacking clinically transferable NIR-II probes, this work not only provides a promising strategy for enriching of the current library of NIR-II probes, but also promotes the clinical translation of NIR-II lymphography technology.
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Affiliation(s)
- Jiajun Xu
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, First Hospital of Jilin University, Changchun, 130021, P. R. China
- State Key Laboratory of Supramolecular Structure and Materials, Center for Supramolecular Chemical Biology, College of Chemistry, Jilin University, Changchun, 130012, P. R. China
| | - Yijing Du
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, First Hospital of Jilin University, Changchun, 130021, P. R. China
- State Key Laboratory of Supramolecular Structure and Materials, Center for Supramolecular Chemical Biology, College of Chemistry, Jilin University, Changchun, 130012, P. R. China
| | - Tianyang Han
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, First Hospital of Jilin University, Changchun, 130021, P. R. China
- State Key Laboratory of Supramolecular Structure and Materials, Center for Supramolecular Chemical Biology, College of Chemistry, Jilin University, Changchun, 130012, P. R. China
| | - Ningning Zhu
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, First Hospital of Jilin University, Changchun, 130021, P. R. China
- State Key Laboratory of Supramolecular Structure and Materials, Center for Supramolecular Chemical Biology, College of Chemistry, Jilin University, Changchun, 130012, P. R. China
| | - Shoujun Zhu
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, First Hospital of Jilin University, Changchun, 130021, P. R. China
- State Key Laboratory of Supramolecular Structure and Materials, Center for Supramolecular Chemical Biology, College of Chemistry, Jilin University, Changchun, 130012, P. R. China
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Bernas M, Al-Ghadban S, Thiadens SRJ, Ashforth K, Lin WC, Safa B, Buntic R, Paukshto M, Rovnaya A, McNeely ML. Etiology and treatment of cancer-related secondary lymphedema. Clin Exp Metastasis 2023:10.1007/s10585-023-10232-8. [PMID: 37777696 DOI: 10.1007/s10585-023-10232-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/28/2023] [Indexed: 10/02/2023]
Abstract
Lymphedema and specifically cancer-related lymphedema is not the main focus for both patients and physicians dealing with cancer. Its etiology is an unfortunate complication of cancer treatment. Although lymphedema treatments have gained an appreciable consensus, many practitioners have developed and prefer their own specific protocols and this is especially true for conventional (manual) versus surgical treatments. This collection of presentations explores the incidence and genetics of cancer-related lymphedema, early detection and monitoring techniques, both conventional and operative treatment options, and the importance and role of exercise for patients with cancer-related lymphedema. These assembled presentations provide valuable insights into the challenges and opportunities presented by cancer-related lymphedema including the latest research, treatments, and exercises available to improve patient outcomes and quality of life.
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Affiliation(s)
- Michael Bernas
- Anne Burnett Marion School of Medicine at Texas Christian University, Fort Worth, TX, USA.
| | - Sara Al-Ghadban
- University of North Texas Health Science Center, Fort Worth, TX, USA
| | | | - Karen Ashforth
- St. Joseph's Medical Center, University of the Pacific, Stockton, CA, USA
| | - Walter C Lin
- Buncke Clinic, San Francisco, CA, USA
- Department of Surgery, Saint Francis Memorial Hospital, San Francisco, CA, USA
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Goerge A, Sanderson M, Flewellen C, Busen K, Nechuta S. The Role of Spirituality on Physical Activity and Sleep Among African American Long-Term Breast Cancer Survivors. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01791-3. [PMID: 37721666 DOI: 10.1007/s40615-023-01791-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND African Americans with chronic conditions have reported the importance of spirituality in their lives. Aspects of spirituality have been shown to be related to physical activity (PA) and sleep, and PA and sleep affect quality of life (QOL). This study examined the association between spirituality, PA, and sleep in long-term African American breast cancer survivors. METHODS This cross-sectional study included 323 breast cancer survivors who previously participated in a case-only study. During 2015-2016, participants completed a questionnaire focused on survivorship that used validated measures for spirituality, PA, and sleep. Adjusted binary and multinomial logistic regression models estimated odds ratios (aORs) and 95% confidence intervals (CIs) for the associations of spirituality with total PA, meeting PA guidelines, sleep duration, and sleep medication. RESULTS The mean age at diagnosis was 54.8 (SD = 9.89) years. The range of spirituality scores was 7-48 (median = 44). Among participants who had a score ≥ 44, 59% had high total PA, 61% met PA guidelines, 59% had high sleep duration, and 55% did not use sleep medication. Higher spirituality score was associated with higher total PA (aOR for ≥ 681 min/week: 1.90, 95% CI: 1.03-3.50), meeting PA guidelines (aOR: 1.78, 95% CI: 1.06-2.98), sleep duration > 7 h/night (aOR: 1.72, 95% CI 1.05-2.83), and lack of sleep medication use (aOR: 0.45, 95% CI: 0.24-0.84). CONCLUSION In African American long-term breast cancer survivors, a higher spirituality score increased the likelihood of greater PA and high sleep duration. These results indicate that interventions surrounding spirituality may benefit the QOL of African American breast cancer survivors.
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Affiliation(s)
- Ally Goerge
- College of Health Professions, School of Interdisciplinary Health, Grand Valley State University, 500 Lafayette Street, Grand Rapids, MI, 49503, USA
| | - Maureen Sanderson
- Meharry Medical College, School of Medicine, 1005 Dr. DB Todd Jr. Blvd, Nashville, TN, 37208, USA
| | - Cristen Flewellen
- Meharry Medical College, School of Medicine, 1005 Dr. DB Todd Jr. Blvd, Nashville, TN, 37208, USA
| | - Katherine Busen
- College of Health Professions, School of Interdisciplinary Health, Grand Valley State University, 500 Lafayette Street, Grand Rapids, MI, 49503, USA
| | - Sarah Nechuta
- College of Health Professions, School of Interdisciplinary Health, Grand Valley State University, 500 Lafayette Street, Grand Rapids, MI, 49503, USA.
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Lynn JV, Hespe GE, Akhter MF, David CM, Kung TA, Myers PL. Cross-Sectional Analysis of Insurance Coverage for Lymphedema Treatments in the United States. JAMA Surg 2023; 158:920-926. [PMID: 37285151 PMCID: PMC10248808 DOI: 10.1001/jamasurg.2023.2017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/21/2023] [Indexed: 06/08/2023]
Abstract
Importance Lymphedema is a debilitating condition that affects approximately 1 in 1000 individuals in the United States. Complete decongestive therapy is currently the standard of care, and innovative surgical techniques have demonstrated potential to further improve outcomes. Despite the growing armamentarium of treatment options, a large proportion of patients with lymphedema continue to struggle because of limited access to care. Objective To define the current state of insurance coverage for lymphedema treatments in the United States. Design, Setting, and Participants A cross-sectional analysis of insurance reimbursement for lymphedema treatments in 2022 was designed. The top 3 insurance companies per state based on market share and enrollment data maintained by the Kaiser Family Foundation were included. Established medical policies were gathered from insurance company websites and phone interviews, and descriptive statistics were performed. Main Outcomes and Measures Treatments of interest included nonprogrammable pneumatic compression, programmable pneumatic compression, surgical debulking, and physiologic procedures. Primary outcomes included level of coverage and criteria for coverage. Results This study included 67 health insurance companies representing 88.7% of the US market share. Most insurance companies offered coverage for nonprogrammable (n = 55, 82.1%) and programmable (n = 53, 79.1%) pneumatic compression. However, few insurance companies offered coverage for debulking (n = 13, 19.4%) or physiologic (n = 5, 7.5%) procedures. Geographically, the lowest rates of coverage were seen in the West, Southwest, and Southeast. Conclusions and Relevance This study suggests that in the United States, less than 12% of individuals with health insurance, and even fewer patients without health insurance, have access to pneumatic compression and surgical treatments for lymphedema. The stark inadequacy of insurance coverage must be addressed through research and lobbying efforts to mitigate health disparities and promote health equity among patients with lymphedema.
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Affiliation(s)
- Jeremy V. Lynn
- Department of Surgery, University of Michigan, Ann Arbor
| | | | | | | | | | - Paige L. Myers
- Department of Surgery, University of Michigan, Ann Arbor
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Sierla R, Dylke E, Poon S, Shaw T, Kilbreath S. Attaining consensus on a core dataset for upper limb lymphoedema using the Delphi method: A foundational step in creating a clinical support system. HEALTH INF MANAG J 2023:18333583231188396. [PMID: 37653585 DOI: 10.1177/18333583231188396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Background: Lymphoedema is a condition of localised swelling caused by a compromised lymphatic system. The protein-rich fluid accumulating in the interstitial tissue can create inflammation and irreversible changes to the skin and underlying tissue. An array of methods has been used to assess and report these changes. Heterogeneity is evident in the clinic and in the literature for the domains assessed, outcomes and outcome measures selected, measurement protocols followed, methods of analysis, and descriptors used to report change. Objective: This study seeks consensus on the required items for inclusion in a core data set for upper limb lymphoedema to digitise the monitoring and reporting of upper limb lymphoedema. Methods: The breadth of outcomes and descriptors in common use were captured in prior studies by this research group. This list was refined by frequency and proposed to experts in the field (n = 70) through a two-round online modified Delphi study. These participants rated the importance of each item for inclusion in the dataset and identified outcomes or descriptors they felt were missing in Round 1. In Round 2, participants rated any new outcomes or descriptors proposed and preference for how numeric data is displayed. Results: The core dataset was confirmed on completion of Round 2. Interlimb difference as a percentage, and limb volume were preferred for graphed display over time; and descriptors for observed and palpated change narrowed from 42 to 20. Conclusion: This dataset provides the foundation to create a clinical support system for upper limb lymphoedema.
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Affiliation(s)
- Robyn Sierla
- The University of Sydney, Australia
- Royal Prince Alfred Hospital, Australia
| | | | | | - Tim Shaw
- The University of Sydney, Australia
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Mahmut Z, Zhang C, Ruan F, Shi N, Zhang X, Wang Y, Zheng X, Tang Z, Dong B, Gao D, Sun J. Medical Applications and Advancement of Near Infrared Photosensitive Indocyanine Green Molecules. Molecules 2023; 28:6085. [PMID: 37630337 PMCID: PMC10459369 DOI: 10.3390/molecules28166085] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/30/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
Indocyanine green (ICG) is an important kind of near infrared (NIR) photosensitive molecules for PTT/PDT therapy as well as imaging. When exposed to NIR light, ICG can produce reactive oxygen species (ROS), which can kill cancer cells and pathogenic bacteria. Moreover, the absorbed light can also be converted into heat by ICG molecules to eliminate cancer cells. In addition, it performs exceptionally well in optical imaging-guided tumor therapy and antimicrobial therapy due to its deeper tissue penetration and low photobleaching properties in the near-infrared region compared to other dyes. In order to solve the problems of water and optical stability and multi-function problem of ICG molecules, composite nanomaterials based on ICG have been designed and widely used, especially in the fields of tumors and sterilization. So far, ICG molecules and their composite materials have become one of the most famous infrared sensitive materials. However, there have been no corresponding review articles focused on ICG molecules. In this review, the molecular structure and properties of ICG, composite material design, and near-infrared light- triggered anti-tumor, and antibacterial, and clinical applications are reviewed in detail, which of great significance for related research.
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Affiliation(s)
- Zulpya Mahmut
- Department of Cell Biology and Medical Genetics, College of Basic Medical Science, Jilin University, Changchun 130021, China; (Z.M.); (C.Z.); (X.Z.); (Y.W.); (X.Z.)
| | - Chunmei Zhang
- Department of Cell Biology and Medical Genetics, College of Basic Medical Science, Jilin University, Changchun 130021, China; (Z.M.); (C.Z.); (X.Z.); (Y.W.); (X.Z.)
| | - Fei Ruan
- State Key Laboratory on Integrated Optoelectronics, College of Electronic Science and Engineering, Jilin University, Changchun 130012, China; (F.R.); (Z.T.)
| | - Nan Shi
- Department of Respiratory Medicine, No. 964 Hospital of People’s Liberation Army, 4799 Xi’an Road, Changchun 130062, China;
| | - Xinyao Zhang
- Department of Cell Biology and Medical Genetics, College of Basic Medical Science, Jilin University, Changchun 130021, China; (Z.M.); (C.Z.); (X.Z.); (Y.W.); (X.Z.)
| | - Yuda Wang
- Department of Cell Biology and Medical Genetics, College of Basic Medical Science, Jilin University, Changchun 130021, China; (Z.M.); (C.Z.); (X.Z.); (Y.W.); (X.Z.)
| | - Xianhong Zheng
- Department of Cell Biology and Medical Genetics, College of Basic Medical Science, Jilin University, Changchun 130021, China; (Z.M.); (C.Z.); (X.Z.); (Y.W.); (X.Z.)
| | - Zixin Tang
- State Key Laboratory on Integrated Optoelectronics, College of Electronic Science and Engineering, Jilin University, Changchun 130012, China; (F.R.); (Z.T.)
| | - Biao Dong
- State Key Laboratory on Integrated Optoelectronics, College of Electronic Science and Engineering, Jilin University, Changchun 130012, China; (F.R.); (Z.T.)
| | - Donghui Gao
- Department of Anesthesiology and Operating Room, School and Hospital of Stomatology, Jilin University, Changchun 130012, China
| | - Jiao Sun
- Department of Cell Biology and Medical Genetics, College of Basic Medical Science, Jilin University, Changchun 130021, China; (Z.M.); (C.Z.); (X.Z.); (Y.W.); (X.Z.)
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Skjødt Rafn B, Jensen S, Bjerre ED, Wittenkamp MC, Benjaminsen K, Christensen LP, Flyger H, Christiansen P, Johansen C. Prospective surveillance for breast cancer-related lymphedema (PROTECT). Acta Oncol 2023; 62:808-813. [PMID: 37042161 DOI: 10.1080/0284186x.2023.2197125] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/26/2023] [Indexed: 04/13/2023]
Affiliation(s)
- Bolette Skjødt Rafn
- Danish Cancer Society National Cancer Survivorship and Late Effects Research Center (CASTLE), Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Sandra Jensen
- Danish Cancer Society National Cancer Survivorship and Late Effects Research Center (CASTLE), Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Merete Celano Wittenkamp
- Department of Physiotherapy and Occupational Therapy, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | | | - Louise Pia Christensen
- Department of Occupational and Physical Therapy, Zealand University Hospital, Roskilde, Denmark
| | - Henrik Flyger
- Department of Breast Surgery, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Peer Christiansen
- Danish Breast Cancer Group Center and Clinic for Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Christoffer Johansen
- Danish Cancer Society National Cancer Survivorship and Late Effects Research Center (CASTLE), Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Zhu J, Niu H, Lu D, Li Y, Ding M. Research on the applicability of an exercise rehabilitation app aiming to improve the mental and physical health of breast cancer patients in the post-operative period. Front Psychol 2023; 14:1126284. [PMID: 37457078 PMCID: PMC10349282 DOI: 10.3389/fpsyg.2023.1126284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/09/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose Breast cancer is one of the most common malignant cancers in women, seriously endangering the physical and mental health of patients. In this study, we developed an app for breast cancer patients undergoing radiotherapy or chemotherapy with a focus on exercise interventions, supplemented by nutritional and psychological interventions, to verify the applicability of the app for these patients and its impact on their quality of life, sleep, and psychological state. We also investigated the patients' experience and perceptions of the app. Methods A total of 17 participants, aged 42-58 years, were recruited for this study using a mixed-methods design, including quantitative group pre-and post-test scores and qualitative interview results. The participants used the app for 8-18 weeks depending on their radiotherapy or chemotherapy cycle. During the radiotherapy or chemotherapy period, the participants used the "Yun Dong Ru Kang" exercise rehabilitation app to perform aerobic exercises twice a week, as well as rehabilitation exercises appropriate to their radiotherapy or chemotherapy stage, and used the app on their own the rest of the time. The primary results included their scores on the PSSUQ overall assessment usability questionnaire, the users' use of the app, and the results of the interviews; the secondary indicators were quality of life, sleep status, and anxiety and depression status. Results An overall score of 6.2 (out of 7 points) on the PSSUQ questionnaire indicates the high usability; the average use time per subject per week was 97.69 ± 11.82 min, which exceeds the minimum use time, but the average use time tended to decrease as the use time was postponed. Promoted articles on nutritional diets received the most hits. The results of the interviews were consistent with the questionnaire scores, with the majority of participants believing that the means of exercise should be enriched and the interface optimized, while the reduction in the length of use was related to the participants' own state of learning about calisthenics. In the results of the Breast Cancer-Specific Scale FACT-B, there was a significant increase (p < 0.05) in the Emotional Status dimension score and a significant decrease (p < 0.05) on the Additional Concerns dimension score. In the results of the Pittsburgh Sleep Quality Inventory PSQI, there was a non-significant improvement in all items except for a significant increase (p < 0.05) for the Hypnotic Medication item. In the Hospital Anxiety and Depression Scale (HADS), there was no significant improvement in any of the anxiety and depression factors. Conclusions The "Yun Dong Ru Kang "app has certain applicability, and the use of the exercise rehabilitation app may effectively reduce the negative impact of chemotherapy side effects on the quality of life, sleep and depression of breast cancer patients in the chemotherapy or radiotherapy phase. Before it is put into use in the future, the app should be enriched with exercise tools, the interface should be optimized, and articles on nutrition and diet should be promoted.
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Affiliation(s)
- Jiaxin Zhu
- College of Physical Education, Shandong Normal University, Jinan, China
| | - Hu Niu
- Department of Breast and Thyroid Surgery, Jinan Central Hospital affiliated to Shandong First Medical University, Jinan, China
| | - Dianjie Lu
- School of Information Science and Engineering, Shandong Normal University, Jinan, China
| | - Yuqi Li
- Jinan Zhensheng School, Jinan, China
| | - Meng Ding
- College of Physical Education, Shandong Normal University, Jinan, China
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14
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Li M, Sun J, Shi G. Application of CRISPR screen in mechanistic studies of tumor development, tumor drug resistance, and tumor immunotherapy. Front Cell Dev Biol 2023; 11:1220376. [PMID: 37427373 PMCID: PMC10326906 DOI: 10.3389/fcell.2023.1220376] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Tumor is one of the biggest threats to human health. Though tumor therapy has been dramatically advanced by the progress of technology and research in recent decades, it is still far from expectations. Thus, it is of great significance to explore the mechanisms of tumor growth, metastasis, and resistance. Screen based on Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)-CRISPR-associated protein (Cas) 9 gene editing technology are powerful tools for exploring the abovementioned facets. This review summarizes the recent screen performed in cancer cells and immune cells in the tumor microenvironment. The screens in cancer cells mainly focus on exploring the mechanisms underlying cancer cells' growth, metastasis, and how cancer cells escape from the FDA approved drugs or immunotherapy. And the studies in tumor-associated immune cells are primarily aimed at identifying signaling pathways that can enhance the anti-tumor function of cytotoxic T lymphocytes (CTLs), CAR-T cells, and macrophages. Moreover, we discuss the limitations, merits of the CRISPR screen, and further its future application in tumor studies. Importantly, recent advances in high throughput tumor related CRISPR screen have deeply contributed to new concepts and mechanisms underlying tumor development, tumor drug resistance, and tumor immune therapy, all of which will eventually potentiate the clinical therapy for tumor patients.
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Affiliation(s)
- Min Li
- Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Graduate School of Chinese Academy of Sciences, Shanghai, China
| | - Jin Sun
- Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Graduate School of Chinese Academy of Sciences, Shanghai, China
| | - Guohai Shi
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Shanghai, China
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15
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Rochlin DH, Coriddi MR, Nelson JA, Dayan JH, Mehrara BJ. Immediate Lymphatic Reconstruction and the Current Value Problem. Ann Surg 2023; 277:e1197-e1199. [PMID: 36735454 PMCID: PMC10397360 DOI: 10.1097/sla.0000000000005814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Immediate lymphatic reconstruction (ILR) may prevent lymphedema and decrease costs. Nationwide data suggest that current relative value unit (RVU) allocation undervalues ILR, thus introducing inefficiency into breast cancer operations when coupled with ILR. The RVUs assigned to ILR should be reevaluated in order to protect patient access to this procedure.
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Affiliation(s)
- Danielle H Rochlin
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center New York, NY
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16
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Donahue PMC, MacKenzie A, Filipovic A, Koelmeyer L. Advances in the prevention and treatment of breast cancer-related lymphedema. Breast Cancer Res Treat 2023; 200:1-14. [PMID: 37103598 DOI: 10.1007/s10549-023-06947-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/06/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE Breast cancer-related lymphedema (BCRL) represents a lifelong risk for breast cancer survivors and once acquired becomes a lifelong burden. This review summarizes current BCRL prevention and treatment strategies. FINDINGS Risk factors for BCRL have been extensively studied and their identification has affected breast cancer treatment practice, with sentinel lymph node removal now standard of care for patients with early stage breast cancer without sentinel lymph node metastases. Early surveillance and timely management aim to reduce BCRL incidence and progression, and are further facilitated by patient education, which many breast cancer survivors report not having adequately received. Surgical approaches to BCRL prevention include axillary reverse mapping, lymphatic microsurgical preventative healing (LYMPHA) and Simplified LYMPHA (SLYMPHA). Complete decongestive therapy (CDT) remains the standard of care for patients with BCRL. Among CDT components, facilitating manual lymphatic drainage (MLD) using indocyanine green fluorescence lymphography has been proposed. Intermittent pneumatic compression, nonpneumatic active compression devices, and low-level laser therapy appear promising in lymphedema management. Reconstructive microsurgical techniques such as lymphovenous anastomosis and vascular lymph node transfer are growing surgical considerations for patients as well as liposuction-based procedures for addressing fatty fibrosis formation from chronic lymphedema. Long-term self-management adherence remains problematic, and lack of diagnosis and measurement consensus precludes a comparison of outcomes. Currently, no pharmacological approaches have proven successful. CONCLUSION Progress in prevention and treatment of BCRL continues, requiring advances in early diagnosis, patient education, expert consensus and novel treatments designed for lymphatic rehabilitation following insults.
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Affiliation(s)
- Paula M C Donahue
- Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, 2201 21St Children's Way, Suite 1218, Nashville, TN, 37212, USA.
- Dayani Center for Health and Wellness, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Adrien MacKenzie
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Louise Koelmeyer
- Faculty of Medicine, Health, and Human Sciences, Australian Lymphoedema Education, Research, and Treatment (ALERT), Macquarie University, Sydney, Australia
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Shimizu Y, Che Y, Murohara T. Therapeutic Lymphangiogenesis Is a Promising Strategy for Secondary Lymphedema. Int J Mol Sci 2023; 24:7774. [PMID: 37175479 PMCID: PMC10178056 DOI: 10.3390/ijms24097774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/15/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
Secondary lymphedema is caused by lymphatic insufficiency (lymphatic drainage failure) following lymph node dissection during the surgical treatment or radiation therapy of breast or pelvic cancer. The clinical problems associated with lymphedema are reduced quality of life in terms of appearance and function, as well as the development of skin ulcers, recurrent pain, and infection. Currently, countermeasures against lymphedema are mainly physical therapy such as lymphatic massage, elastic stockings, and skin care, and there is no effective and fundamental treatment with a highly recommended grade. Therefore, there is a need for the development of a fundamental novel treatment for intractable lymphedema. Therapeutic lymphangiogenesis, which has been attracting attention in recent years, is a treatment concept that reconstructs the fragmented lymphatic network to recover lymphatic vessel function and is revolutionary to be a fundamental cure. This review focuses on the translational research of therapeutic lymphangiogenesis for lymphedema and outlines the current status and prospects in the development of therapeutic applications.
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Affiliation(s)
- Yuuki Shimizu
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
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Perdomo M, Davies C, Levenhagen K, Ryans K, Gilchrist L. Patient education for breast cancer-related lymphedema: a systematic review. J Cancer Surviv 2023; 17:384-398. [PMID: 36207626 PMCID: PMC9546750 DOI: 10.1007/s11764-022-01262-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/22/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim was to identify the impact of the (a) components of breast cancer-related lymphedema (BCRL) educational content, (b) modes of education, and (c) timing of education on arm volume, quality of life, function, complications associated with BCRL, adherence to interventions, and knowledge acquisition in individuals diagnosed with breast cancer (BC). METHODS This review followed the Preferred Reported Items for Systematic Review and Meta-analysis (PRISMA) guidelines (PROSPERO CRD42021253084). Databases searched included PubMed, CINAHL, Web of Science, Google Scholar, and Scopus from January 2010 to December 2021. Study quality and bias were assessed using the American Physical Therapy Association's Critical Appraisal Tool for Experimental Intervention Studies. RESULTS Forty-five studies were eligible, and 15 met the inclusion criteria (4 acceptable and 11 low quality). This review was unable to determine the optimal content, mode, and timing for BCRL education across survivorship. Content included a brief overview of BCRL, early signs and symptoms, risk reduction practices, and a point of contact. Delivery was multi-modal, and knowledge acquisition was rarely assessed. Education was provided pre/post operatively and after BCRL developed. CONCLUSIONS Individualized BCRL education via a multi-modal approach, repeated at multiple time points, and assessment of survivors' knowledge acquisition is recommended. Consideration of the survivors' phase of treatment, content volume, and time required to complete the program is advised when developing the educational intervention. IMPLICATIONS FOR CANCER SURVIVORS Survivors of BC may need to advocate for BCRL education based on their individual risk and needs, request a point of contact for questions/follow up, and express their preferred style of learning.
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Affiliation(s)
- Marisa Perdomo
- Division of Biokinesiology and Physical Therapy @ the Ostrow School of Dentistry, University of Southern California, 1540 Alcazar Street CHP 155, Los Angeles, CA, 90089, USA.
| | - Claire Davies
- Nursing and Allied Health Research Office, Baptist Health Lexington, 1740 Nicholasville Road, Lexington, KY, 40503, USA
| | - Kimberly Levenhagen
- Saint Louis University Program in Physical Therapy, 3437 Caroline Street Suite 1026, St Louis, MO, 63104, USA
| | - Kathryn Ryans
- Mercy College Doctor of Physical Therapy Program, 555 Broadway, , Dobbs Ferry, NY, 10522, USA
| | - Laura Gilchrist
- St. Catherine Univeristy, Doctor of Physical Therapy Program, 2004 Randolph Ave, St. Paul, MN, 55105, USA
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Chang K, Xia S, Liang C, Sun Y, Xin J, Shen W. A clinical study of liposuction followed by lymphovenous anastomosis for treatment of breast cancer-related lymphedema. Front Surg 2023; 10:1065733. [PMID: 37009601 PMCID: PMC10050413 DOI: 10.3389/fsurg.2023.1065733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/23/2023] [Indexed: 03/17/2023] Open
Abstract
ObjectiveIn this work, we studied the clinical effect of liposuction followed by lymphovenous anastomosis (LVAs) for the treatment of breast cancer-related lymphedema (BCRL).MethodsWe analyzed 158 patients with unilateral upper limb BCRL who underwent liposuction followed by LVAs 2–4 months later. Arm circumferences before and 7 days after the combined treatments were prospectively recorded. Circumferences of different upper extremities were measured before the procedure, 7 days after LVAs, and during the follow-ups. Volumes were calculated with the frustum method. During the follow-ups, the conditions of patients’ treated arms, i.e., the frequency of erysipelas episodes and dependence on compression garments, were recorded.ResultsThe mean circumference difference between two upper limbs decreased significantly from M (P25, P75) of 5.3 (4.1, 6.9) preoperatively to 0.5 (−0.8, 1.0) (P < 0.05) 7 days after treatments, while at follow-up 0.3 (−0.4, 1.0). The mean volume difference decreased significantly from M (P25, P75) of 838.3 (662.4, 1,129.0) preoperatively to 7.8 (−120.3, 151.4) (P < 0.05) 7 days after treatments, while at follow-up 43.7 (−59.4, 161.1). The incidence of erysipelas also significantly decreased (P < 0.05). 6.3% of patients were already independent of compression garments during the past six months or even more.ConclusionLiposuction followed by LVAs is an effective method for the treatment of BCRL.
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Chen H, Wang X, Lan X, Yu T, Li L, Tang S, Liu S, Jiang F, Wang L, Zhang J. A radiomics model development via the associations with genomics features in predicting axillary lymph node metastasis of breast cancer: a study based on a public database and single-centre verification. Clin Radiol 2023; 78:e279-e287. [PMID: 36623978 DOI: 10.1016/j.crad.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/17/2022] [Accepted: 11/29/2022] [Indexed: 12/27/2022]
Abstract
AIM To evaluate the predictive performance of the radiomics model in predicting axillary lymph node (ALN) metastasis through the associations between radiomics features and genomic features in patients with breast cancer. MATERIALS AND METHODS Patients with breast cancer were enrolled retrospectively from a public database (111 patients as training group) and one hospital (15 patients as external validation group). The genomics features from transcriptome data and radiomics features from dynamic contrast-enhanced magnetic resonance imaging (MRI) were collected. Firstly, overlapping genes were identified using the Kyoto Encyclopedia of Genes and Genomes and differentially expressed gene analysis, while radiomics features were reduced using a data-driven method. Then, the associations between overlapping genes and retained radiomics features were assessed to obtain key pairs of radiomics-genomics features. Furthermore, the least absolute shrinkage and selection operator (LASSO) algorithm was used to detect the key-pairs features. Finally, radiomics and genomics models were constructed to predict ALN metastasis. RESULTS After using the hybrid data- and gene-driven selection method, key pairs of features were detected, which consisted of six radiomic features associated with four genomic features. The radiomics model exhibited comparable performance to the genomics model in predicting ALN metastasis (radiomic model: area under the curve [AUC] = 0.71, sensitivity = 77%, specificity = 56%; genomic model: AUC = 0.72, sensitivity = 85%, specificity = 74%). The four genomic features were enriched in six pathways and related to metabolism and human diseases. CONCLUSION The radiomics model established using the gene-driven hybrid selection method could predict ALN metastasis in breast cancer, which showed comparable performance to the genomics model.
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Affiliation(s)
- H Chen
- Department of Radiology, Chongqing University Cancer Hospital, Chongqing, PR China
| | - X Wang
- Department of Radiology, Chongqing University Cancer Hospital, Chongqing, PR China
| | - X Lan
- Department of Radiology, Chongqing University Cancer Hospital, Chongqing, PR China
| | - T Yu
- Department of Radiology, Chongqing University Cancer Hospital, Chongqing, PR China
| | - L Li
- Department of Radiology, Chongqing University Cancer Hospital, Chongqing, PR China
| | - S Tang
- Department of Radiology, Chongqing University Cancer Hospital, Chongqing, PR China
| | - S Liu
- Department of Radiology, Chongqing University Cancer Hospital, Chongqing, PR China
| | - F Jiang
- Department of Radiology, Chongqing University Cancer Hospital, Chongqing, PR China
| | - L Wang
- Department of Radiology, Chongqing University Cancer Hospital, Chongqing, PR China
| | - J Zhang
- Department of Radiology, Chongqing University Cancer Hospital, Chongqing, PR China.
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Zoth N, Böhlke L, Theurich S, Baumann FT. [Physical activity and exercise therapy in oncology]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2023; 64:19-24. [PMID: 36594967 DOI: 10.1007/s00108-022-01450-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 01/04/2023]
Abstract
Optimized and individualized treatment options in oncology significantly improve the prognosis of patients. Accordingly, the management of side effects and the avoidance of long-term consequences is becoming increasingly more important. Numerous studies have shown a positive impact of physical activity and targeted exercise therapy on certain patient-related outcomes. Ideally, patients are introduced to exercise therapy directly after the diagnosis is made in order to enable adequate supportive monitoring and to sustainably reduce therapy-associated side effects. Meanwhile, scientific findings have resulted in concrete recommendations for action to effectively improve the main patient-related outcomes, such as fatigue or depression. A moderate endurance training in combination with individualized strength training seems to be of particular importance. In principle, oncological training and exercise therapy can be recommended to every cancer patient regardless of the form of cancer and the timing of therapy but taking the contraindications into account. Therefore, the aim of communal as well as national efforts should be to implement a comprehensive offer of professional exercise therapy to facilitate access of cancer patients to these services as well as to ensure adequate care during and after treatment.
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Affiliation(s)
- Nora Zoth
- Centrum für integrierte Onkologie (CIO) Aachen, Bonn, Köln, Düsseldorf, Klinik für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Lena Böhlke
- Centrum für integrierte Onkologie (CIO) Aachen, Bonn, Köln, Düsseldorf, Klinik für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Sebastian Theurich
- Medizinische Klinik und Poliklinik III, Comprehensive Cancer Center München (CCCM), LMU München, München, Deutschland
| | - Freerk T Baumann
- Centrum für integrierte Onkologie (CIO) Aachen, Bonn, Köln, Düsseldorf, Klinik für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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Risk factors for arm lymphedema following breast cancer surgery: a Japanese nationwide database study of 84,022 patients. Breast Cancer 2023; 30:36-45. [PMID: 35997891 DOI: 10.1007/s12282-022-01395-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/14/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Although arm lymphedema is a well-known complication following breast cancer surgery, previous studies involving a small population showed inconsistent results regarding the risk. Therefore, we examined the risk factors using a Japanese nationwide database. METHODS Female patients who underwent breast cancer surgery from April, 2016, to March, 2020, were identified from a Japanese nationwide database. Multivariable survival analyses for 19 baseline factors (12 patient characteristics, four tumor characteristics, and three surgical procedures) were conducted to investigate risk factors associated with treatments for postoperative lymphedema (such as lymphatic bypass, compositive drainage therapy, hospitalization, and Kampo use) with a multilevel model to adjust for within-hospital clustering. We also conducted multivariable analysis for five postoperative factors (two local complications and three postoperative therapies) with adjustment for 19 baseline factors. RESULTS The study included 84,022 patients; 1547 (1.8%) received treatments for lymphedema during a median follow-up of 119 weeks (interquartile range, 59-187 weeks). Young age, obesity, smoking, collagen diseases, advanced cancer stage, total mastectomy, axillary dissection, postoperative bleeding, chemotherapy, and radiotherapy were identified as risk factors. Postoperative chemotherapy (hazard ratio, 3.78 [95% confidence interval, 3.35-4.26]) and axillary dissection (2.46 [1.95-3.11]) showed the highest odds ratio among the risk factors. The cumulative probabilities in high-risk patients reached approximately 3% at 1 year and 6% at 4 years after surgery. CONCLUSIONS This study identified several risk factors for postoperative lymphedema in breast cancer surgery. The treatment initiation increased markedly within the first year and gradually after 1 year post-surgery.
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Li MM, Wu PP, Qiang WM, Li JQ, Zhu MY, Yang XL, Wang Y. Development and validation of a risk prediction model for breast cancer-related lymphedema in postoperative patients with breast cancer. Eur J Oncol Nurs 2022; 63:102258. [PMID: 36821887 DOI: 10.1016/j.ejon.2022.102258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/05/2022] [Accepted: 12/14/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Breast cancer-related lymphedema (BCRL) is a common post-operative complication in patients with breast cancer. Here, we sought to develop and validate a predictive model of BCRL in Chinese patients with breast cancer. METHODS Clinical and demographic data on patients with breast cancer were collected between 2016 and 2021 at a Cancer Hospital in China. A nomogram for predicting the risk of lymphedema in postoperative patients with breast cancer was constructed and verified using R 3.5.2 software. Model performance was evaluated using area under the ROC curve (AUC) and goodness-of-fit statistics, and the model was internally validated. RESULTS A total of 1732 postoperative patients with breast cancer, comprising 1212 and 520 patients in the development and validation groups, respectively, were included. Of these 438 (25.39%) developed lymphedema. Significant predictors identified in the predictive model were time since breast cancer surgery, level of lymph node dissection, number of lymph nodes dissected, radiotherapy, and postoperative body mass index. At the 31.9% optimal cut-off the model had AUC values of 0.728 and 0.710 in the development and validation groups, respectively. Calibration plots showed a good match between predicted and observed rates. In decision curve analysis, the net benefit of the model was better between threshold probabilities of 10%-80%. CONCLUSION The model has good discrimination and accuracy for lymphedema risk assessment, which can provide a reference for individualized clinical prediction of the risk of BCRL. Multicenter prospective trials are required to verify the predictive value of the model.
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Affiliation(s)
- Miao-Miao Li
- Breast Oncology Department, Tianjin Medical University Cancer Institute & Hospital, Tianjin, 300060, China.
| | - Pei-Pei Wu
- Nursing Department, Tianjin Medical University Cancer Institute & Hospital, Tianjin, 300060, China.
| | - Wan-Min Qiang
- Nursing Department, Tianjin Medical University Cancer Institute & Hospital, Tianjin, 300060, China.
| | - Jia-Qian Li
- Breast Oncology Department, Tianjin Medical University Cancer Institute & Hospital, Tianjin, 300060, China.
| | - Ming-Yu Zhu
- Breast Oncology Department, Tianjin Medical University Cancer Institute & Hospital, Tianjin, 300060, China.
| | - Xiao-Lin Yang
- Breast Oncology Department, Tianjin Medical University Cancer Institute & Hospital, Tianjin, 300060, China.
| | - Ying Wang
- Nursing Department, Tianjin Medical University Cancer Institute & Hospital, Tianjin, 300060, China.
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Chen H, Lan X, Yu T, Li L, Tang S, Liu S, Jiang F, Wang L, Huang Y, Cao Y, Wang W, Wang X, Zhang J. Development and validation of a radiogenomics model to predict axillary lymph node metastasis in breast cancer integrating MRI with transcriptome data: A multicohort study. Front Oncol 2022; 12:1076267. [PMID: 36644636 PMCID: PMC9837803 DOI: 10.3389/fonc.2022.1076267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/01/2022] [Indexed: 12/31/2022] Open
Abstract
Introduction To develop and validate a radiogenomics model for predicting axillary lymph node metastasis (ALNM) in breast cancer compared to a genomics and radiomics model. Methods This retrospective study integrated transcriptomic data from The Cancer Genome Atlas with matched MRI data from The Cancer Imaging Archive for the same set of 111 patients with breast cancer, which were used as the training and testing groups. Fifteen patients from one hospital were enrolled as the external validation group. Radiomics features were extracted from dynamic contrast-enhanced (DCE)-MRI of breast cancer, and genomics features were derived from differentially expressed gene analysis of transcriptome data. Boruta was used for genomics and radiomics data dimension reduction and feature selection. Logistic regression was applied to develop genomics, radiomics, and radiogenomics models to predict ALNM. The performance of the three models was assessed by receiver operating characteristic curves and compared by the Delong test. Results The genomics model was established by nine genomics features, and the radiomics model was established by three radiomics features. The two models showed good discrimination performance in predicting ALNM in breast cancer, with areas under the curves (AUCs) of 0.80, 0.67, and 0.52 for the genomics model and 0.72, 0.68, and 0.71 for the radiomics model in the training, testing and external validation groups, respectively. The radiogenomics model integrated with five genomics features and three radiomics features had a better performance, with AUCs of 0.84, 0.75, and 0.82 in the three groups, respectively, which was higher than the AUC of the radiomics model in the training group and the genomics model in the external validation group (both P < 0.05). Conclusion The radiogenomics model combining radiomics features and genomics features improved the performance to predict ALNM in breast cancer.
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Li M, Liu B, Chen C, Liu H, He S, Sun W, Yan Q, Rao X, Jin Y, Tan L. Prevention of breast cancer-related lymphoedema: Quality of clinical practice guidelines and variations in recommendations. Int J Nurs Pract 2022:e13127. [PMID: 36543600 DOI: 10.1111/ijn.13127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 10/19/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022]
Abstract
AIM We aimed to evaluate the quality of clinical practice guidelines (CPGs) for breast cancer related lymphoedema (BCRL) and compare the similarities and differences in recommendations. BACKGROUND Many CPGs of BCRL have been developed; however, their recommendations and quality are controversial. METHODS Relevant papers were retrieved from electronic databases, professional associations and guideline development organizations, from 1 January 2015 to 30 September 2021. The Appraisal of Guidelines Research and Evaluation (AGREE) II instrument was used to evaluate the quality of the guidelines. Intraclass correlation coefficient (ICC) analysis was used to evaluate the overall consistency among evaluators. RESULTS Eight CPGs were included. The ICC values evaluation for CPGs ranged from 0.76 to 0.95, with good consensus among evaluators. The highest median score was 68.75% (61.46, 72.22%) for clarity, and the lowest was 37.50% (25.78, 51.30%) for applicability. The NICE, ACS/ACSO and APTA CPGs were rated well in most areas. Professional health education, individualized exercise programme and regular surveillance are the main methods to prevent lymphoedema. CONCLUSION In the past 6 years, the quality of BCRL guidelines has varied greatly, especially in the domains of rigour and applicability. Interrater agreement was excellent, but recommendation showed some inconsistencies in the details.
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Affiliation(s)
- Mingzhen Li
- Precision Medicine Center, The Second People's Hospital of Huaihua, Huaihua, Hunan, China
| | - Boxuan Liu
- Precision Medicine Center, The Second People's Hospital of Huaihua, Huaihua, Hunan, China
| | - Cheng Chen
- Precision Medicine Center, The Second People's Hospital of Huaihua, Huaihua, Hunan, China
| | - Huan Liu
- Precision Medicine Center, The Second People's Hospital of Huaihua, Huaihua, Hunan, China
| | - Shaohua He
- Precision Medicine Center, The Second People's Hospital of Huaihua, Huaihua, Hunan, China
| | - Weihua Sun
- Department of Breast Surgery, The Second People's Hospital of Huaihua, Huaihua, Hunan, China
| | - Qiang Yan
- Early Cancer Screening Center, The Second People's Hospital of Huaihua, Huaihua, Hunan, China
| | - Xiaohua Rao
- Department of Nursing, The Second People's Hospital of Huaihua, Huaihua, Hunan, China
| | - Yinghui Jin
- Precision Medicine Center, The Second People's Hospital of Huaihua, Huaihua, Hunan, China
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Liming Tan
- Department of Clinical Pharmacy, The Second People's Hospital of Huaihua, Huaihua, Hunan, China
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Sano M, Hirakawa S, Sasaki T, Inuzuka K, Katahashi K, Kayama T, Yamanaka Y, Tsuyuki H, Endo Y, Naruse E, Yokoyama Y, Sato K, Yamauchi K, Takeuchi H, Unno N. Role of Subcutaneous Adipose Tissues in the Pathophysiology of Secondary Lymphedema. Lymphat Res Biol 2022; 20:593-599. [PMID: 35394362 DOI: 10.1089/lrb.2021.0054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background: Secondary lymphedema (LE) occurs due to the disruption of lymphatic circulation. Lymphatic fluid accumulation in subcutaneous tissues induces adipocyte proliferation. Obesity is an important risk factor for the occurrence and deterioration of LE. Although the relationship between LE and subcutaneous adipose tissue increase has been reported clinically, their pathophysiological relationship remains unknown. Thus, we aimed to verify whether subcutaneous adipose tissue increase is involved in the pathophysiology of secondary LE. Methods and Results: The hindlimb model of secondary LE was created using male Sprague-Dawley rats (control and LE groups; n = 5 each). Skin samples were obtained on postoperative day 168. Histological examination and quantitative real-time polymerase chain reaction analysis of inflammatory adipokines, tumor necrosis factor-alpha (Tnf-α), C-C chemokine ligand 2 (Ccl2), and interleukin-6 (Il-6) were performed. Limb volume and subcutaneous adipose tissues significantly increased in the LE group compared with those in the control. Macrophages aggregated in the augmented adipose tissues, around the adipocytes, and formed crown-like structures (CLSs). The number of CLSs significantly increased in the LE group. These macrophages expressed transforming growth factor-beta 1 (TGF-β1). Inflammatory adipokine secretion was not observed. Although Il-6 expression increased in the LE group, IL-6 was expressed in subcutaneous myofibroblasts but not in subcutaneous adipocytes. Conclusion: As TGF-β1 derived from subcutaneous myofibroblasts is involved in skin fibrosis during LE, TGF-β1 derived from adipose tissues may also play a similar role. Drug treatment for subcutaneous adipose tissue reduction may improve the skin condition in secondary LE and may be a new therapeutic strategy.
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Affiliation(s)
- Masaki Sano
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Satoshi Hirakawa
- Preeminent Medical Photonics Education and Research Center Institute for NanoSuit Research, Departments of Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takeshi Sasaki
- Anatomy and Neuroscience and Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazunori Inuzuka
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazuto Katahashi
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takafumi Kayama
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuta Yamanaka
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hajime Tsuyuki
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yusuke Endo
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Ena Naruse
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yurina Yokoyama
- Rehabilitation, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kohji Sato
- Anatomy and Neuroscience and Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Katsuya Yamauchi
- Rehabilitation, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroya Takeuchi
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naoki Unno
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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27
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Karim MA, Talluri R, Shastri SS, Kum HC, Shete S. Financial Toxicities Persist for Cancer Survivors Irrespective of Current Cancer Status: An Analysis of Medical Expenditure Panel Survey. CANCER RESEARCH COMMUNICATIONS 2022; 2:1119-1128. [PMID: 36531523 PMCID: PMC9757609 DOI: 10.1158/2767-9764.crc-22-0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study estimates the out-of-pocket (OOP) expenditures for different cancer types among survivors with current vs no current cancer condition and across sex, which is understudied in the literature. This is a cross-sectional study of Medical Expenditure Panel Survey data for 2009-2018 where the primary outcome was the average per year OOP expenditure incurred by cancer survivors. Of 189 285 respondents, 15 010 (7.93%) were cancer survivors; among them, 46.28% had a current cancer condition. Average per year OOP expenditure for female survivors with a current condition of breast cancer ($1730), lung cancer ($1679), colon cancer ($1595), melanoma ($1783), non-Hodgkin lymphoma ($1656), nonmelanoma/other skin cancer (NMSC, $2118) and two or more cancers ($2310) were significantly higher than that of women with no history of cancer ($853, all P < .05). Similarly, average per year OOP expenditure for male survivors with a current condition of prostate cancer ($1457), lung cancer ($1131), colon cancer ($1471), melanoma ($1474), non-Hodgkin's lymphoma ($1653), NMSC ($1789), and bladder cancer ($2157) were significantly higher compared with the men with no history of cancer ($621, all P < .05). These differences persisted in survivors with no current cancer condition for breast cancer among women; prostate, lung, colon, and bladder cancer among men; and melanoma, NMSC, and two or more cancers among both sexes. OOP expenditure varied across cancer types and by sex for survivors with and without a current cancer condition. These findings highlight the need for targeted interventions for cancer survivors.
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Affiliation(s)
- Mohammad A. Karim
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Population Informatics Lab, Texas A&M University, College Station, Texas
| | - Rajesh Talluri
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Surendra S. Shastri
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hye-Chung Kum
- Population Informatics Lab, Texas A&M University, College Station, Texas
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, Texas
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Division of Cancer Prevention and Population Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Corresponding Author: Sanjay Shete, Biostatistics, Unit 1411, The University of Texas MD Anderson Cancer Center, 1400 Pressler Dr, FCT4.6002, Houston, TX 77030. Phone: (713) 745-2483; E-mail:
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Breast Cancer Treatment Decreases Serum Levels of TGF-β1, VEGFR2, and TIMP-2 Compared to Healthy Volunteers: Significance for Therapeutic Outcomes? PATHOPHYSIOLOGY 2022; 29:537-554. [PMID: 36136069 PMCID: PMC9500649 DOI: 10.3390/pathophysiology29030042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 11/25/2022] Open
Abstract
Various complications from a breast cancer treatment, in the pathogenesis of which excessive tissue fibrosis plays a leading role, are a common pathology. In this study, the levels of TGF-β1, VEGFR-2, and TIMP-2 were determined by the immuno-enzyme serum analysis for patients during the long-term period after breast cancer treatment as potential markers of fibrosis. The single-center study enrolled 92 participants, which were divided into two age-matched groups: (1) 67 patients following breast cancer treatment, and (2) 25 healthy female volunteers. The intergroup analysis demonstrated that the patients after breast cancer treatment showed a decrease in the serum levels of TGF-β1 (U = 666, p < 0.001) and TIMP-2 (U = 637, p < 0.001) as compared to the group of healthy volunteers. The levels of VEGFR-2 in these groups were comparable (U = 1345, p = 0.082). It was also found that the type of treatment, the presence of lymphedema, shoulder joint contracture, and changes in lymphoscintigraphy did not affect the levels of TGF-β1, VEGFR-2, and TIMP-2 within the group of patients after breast cancer treatment. These results may indicate that these biomarkers do not play a leading role in the maintenance and progression of fibrosis in the long-term period after breast cancer treatment. The reduced levels of TGF-β1 and TIMP-2 may reflect endothelial dysfunction caused by the antitumor therapy.
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29
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Aldrich MB, Rasmussen JC, DeSnyder SM, Woodward WA, Chan W, Sevick-Muraca EM, Mittendorf EA, Smith BD, Stauder MC, Strom EA, Perkins GH, Hoffman KE, Mitchell MP, Barcenas CH, Isales LE, Shaitelman SF. Prediction of breast cancer-related lymphedema by dermal backflow detected with near-infrared fluorescence lymphatic imaging. Breast Cancer Res Treat 2022; 195:33-41. [PMID: 35816269 PMCID: PMC9272652 DOI: 10.1007/s10549-022-06667-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/21/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Mild breast cancer-related lymphedema (BCRL) is clinically diagnosed as a 5%-10% increase in arm volume, typically measured no earlier than 3-6 months after locoregional treatment. Early BCRL treatment is associated with better outcomes, yet amid increasing evidence that lymphedema exists in a latent form, treatment is typically delayed until arm swelling is obvious. In this study, we investigated whether near-infrared fluorescence lymphatic imaging (NIRF-LI) surveillance could characterize early onset of peripheral lymphatic dysfunction as a predictor of BCRL. METHODS In a prospective, longitudinal cohort/observational study (NCT02949726), subjects with locally advanced breast cancer who received axillary lymph node dissection and regional nodal radiotherapy (RT) were followed serially, between 2016 and 2021, before surgery, 4-8 weeks after surgery, and 6, 12, and 18 months after RT. Arm volume was measured by perometry, and lymphatic (dys) function was assessed by NIRF-LI. RESULTS By 18 months after RT, 30 of 42 study subjects (71%) developed mild-moderate BCRL (i.e., ≥ 5% arm swelling relative to baseline), all manifested by "dermal backflow" of lymph into lymphatic capillaries or interstitial spaces. Dermal backflow had an 83% positive predictive value and 86% negative predictive value for BCRL, with a sensitivity of 97%, specificity of 50%, accuracy of 83%, positive likelihood ratio of 1.93, negative likelihood ratio of 0.07, and odds ratio of 29.00. Dermal backflow appeared on average 8.3 months, but up to 23 months, before the onset of mild BCRL. CONCLUSION BCRL can be predicted by dermal backflow, which often appears months before arm swelling, enabling early treatment before the onset of edema and irreversible tissue changes.
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Affiliation(s)
- Melissa B Aldrich
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, 1825 Pressler, 330D, Houston, TX, 77030, USA.
| | - John C Rasmussen
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, 1825 Pressler, 330D, Houston, TX, 77030, USA
| | - Sarah M DeSnyder
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1502, Houston, TX, 77030, USA
| | - Wendy A Woodward
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1502, Houston, TX, 77030, USA
| | - Wenyaw Chan
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, 1825 Pressler, 330D, Houston, TX, 77030, USA
| | - Eva M Sevick-Muraca
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, 1825 Pressler, 330D, Houston, TX, 77030, USA
| | - Elizabeth A Mittendorf
- Dana Farber/Brigham and Women's Cancer Center, 450 Brookline Avenue, Boston, MA, 02115, USA
| | - Benjamin D Smith
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1502, Houston, TX, 77030, USA
| | - Michael C Stauder
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1502, Houston, TX, 77030, USA
| | - Eric A Strom
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1502, Houston, TX, 77030, USA
| | - George H Perkins
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1502, Houston, TX, 77030, USA
| | - Karen E Hoffman
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1502, Houston, TX, 77030, USA
| | - Melissa P Mitchell
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1502, Houston, TX, 77030, USA
| | - Carlos H Barcenas
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1502, Houston, TX, 77030, USA
| | - Lynn E Isales
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1502, Houston, TX, 77030, USA
| | - Simona F Shaitelman
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1502, Houston, TX, 77030, USA
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30
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Wang L, Shi YX, Wang TT, Chen KX, Shang SM. Breast cancer-related lymphoedema and resistance exercise: An evidence-based review of guidelines, consensus statements and systematic reviews. J Clin Nurs 2022; 32:2208-2227. [PMID: 35894167 DOI: 10.1111/jocn.16437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 06/11/2022] [Accepted: 06/20/2022] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES Breast cancer-related lymphoedema (BCRL) is a side effect of cancer treatment and can be alleviated by resistance exercise. This systematic, evidence-based review examined the existing best evidence on resistance exercise for BCRL to accurately describe the current status of the field and offer recommendations for clinicians. METHODS This review adheres to the PRISMA guidelines. Clinical practice guidelines, consensus documents, systematic reviews and other related evidence-based resources about resistance exercise for BCRL were retrieved through the English databases and guideline websites. The publication data limit was set to December 2020. The following search terms were used: 'breast cancer/breast neoplasm/breast carcinoma/breast tumor/breast malignancy, lymphedema/swelling/edema/lymphoedema, resistance/weight/strength training, best practice/clinical practice/guideline/consensus documents'. The quality of the included studies was evaluated by two authors independently using AGREE II and AMSTAR II tools. Evidence-based recommendations on resistance exercise relevant for BCRL were synthesised and categorised. RESULTS Twenty two articles (seven guidelines, four consensus documents and eleven systematic reviews) were included. The overall quality of the eleven eligible guidelines and consensus documents was moderate to high according to the AGREE II criteria. The quality of the eleven systematic reviews was critically low to high according to the AMSTAR criteria. Six clinical topics involving 43 recommendations were identified. Recommendations were categorised by safety of resistance training, effectiveness of resistance training, evaluation prior to resistance exercise, resistance exercise prescription, resistance training outcome index and points for attention. CONCLUSIONS This study summarises 43 recommendations for resistance training for BCRL and provides guidance for clinicians. Based on randomised trials and systematic reviews published in recent years, there is an urgent need to update the guidelines and consensus documents in terms of topics, for example effectiveness of resistance training and resistance training outcome index.
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Affiliation(s)
- Ling Wang
- School of Nursing, Peking University, Beijing, China.,School of Nursing, Wannan Medical College, Wuhu, China
| | - Yue Xian Shi
- School of Nursing, Peking University, Beijing, China
| | - Ting Ting Wang
- Department of Lymphatic Surgery, Beijing Shijitan Hospital, Beijing, China
| | - Ke Xin Chen
- School of Nursing, Peking University, Beijing, China
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Farley CR, Irwin S, Adesoye T, Sun SX, DeSnyder SM, Lucci A, Shaitelman SF, Chang EI, Ueno NT, Woodward WA, Teshome M. Lymphedema in Inflammatory Breast Cancer Patients Following Trimodal Treatment. Ann Surg Oncol 2022; 29:6370-6378. [PMID: 35854031 DOI: 10.1245/s10434-022-12142-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Breast cancer-related lymphedema (BCRL) is a debilitating sequela of breast cancer treatment and is becoming a greater concern in light of improved long-term survival. Inflammatory breast cancer (IBC) is a rare and aggressive malignancy for which systemic therapy, surgery, and radiotherapy remain the standard of care, thereby making IBC patients highly susceptible to developing BCRL. This study evaluated BCRL in IBC following trimodal therapy. METHODS IBC patients treated from 2016 to 2019 were identified from an institutional database. Patients were excluded if they presented with recurrent disease, underwent bilateral axillary surgery, did not complete trimodal therapy, or were lost to follow-up. Demographic, clinicopathologic factors, oncologic outcomes, and perometer measurements were recorded. BCRL was defined by clinician diagnosis and/or objective perometer measurements when available. Time to development of BCRL and treatment received were captured. RESULTS Eighty-three patients were included. Median follow-up was 33 months. The incidence of BCRL was 50.6% (n = 42). Mean time to BCRL from surgery was 13 (range 2-24) months. Demographic and clinicopathologic features were similar between patients with and without BCRL with exception of higher proportion receiving delayed reconstruction in the BCRL group (38.1% vs. 14.6%, p = 0.03). Forty patients (95.2%) underwent BCRL treatment, which included physical therapy (n = 39), compression (n = 38), therapeutic lymphovenous bypass (n = 13), and/or vascularized lymph node transfer (n = 12). CONCLUSIONS IBC patients are at high-risk for BCRL after treatment, impacting 51% of patients in this cohort. Strategies to reduce or prevent BCRL and improve real-time diagnosis should be implemented to better direct early management in this patient population.
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Affiliation(s)
- Clara R Farley
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shelby Irwin
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Taiwo Adesoye
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susie X Sun
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sarah M DeSnyder
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anthony Lucci
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Simona F Shaitelman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Edward I Chang
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naoto T Ueno
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wendy A Woodward
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mediget Teshome
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Skarping I, Nilsson K, Dihge L, Fridhammar A, Ohlsson M, Huss L, Bendahl PO, Steen Carlsson K, Rydén L. The implementation of a noninvasive lymph node staging (NILS) preoperative prediction model is cost effective in primary breast cancer. Breast Cancer Res Treat 2022; 194:577-586. [PMID: 35790694 PMCID: PMC9287207 DOI: 10.1007/s10549-022-06636-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/13/2022] [Indexed: 11/29/2022]
Abstract
Purpose The need for sentinel lymph node biopsy (SLNB) in clinically node-negative (cN0) patients is currently questioned. Our objective was to investigate the cost-effectiveness of a preoperative noninvasive lymph node staging (NILS) model (an artificial neural network model) for predicting pathological nodal status in patients with cN0 breast cancer (BC). Methods A health-economic decision-analytic model was developed to evaluate the utility of the NILS model in reducing the proportion of cN0 patients with low predicted risk undergoing SLNB. The model used information from a national registry and published studies, and three sensitivity/specificity scenarios of the NILS model were evaluated. Subgroup analysis explored the outcomes of breast-conserving surgery (BCS) or mastectomy. The results are presented as cost (€) and quality-adjusted life years (QALYs) per 1000 patients. Results All three scenarios of the NILS model reduced total costs (–€93,244 to –€398,941 per 1000 patients). The overall health benefit allowing for the impact of SLNB complications was a net health gain (7.0–26.9 QALYs per 1000 patients). Sensitivity analyses disregarding reduced quality of life from lymphedema showed a small loss in total health benefits (0.4–4.0 QALYs per 1000 patients) because of the reduction in total life years (0.6–6.5 life years per 1000 patients) after reduced adjuvant treatment. Subgroup analyses showed greater cost reductions and QALY gains in patients undergoing BCS. Conclusion Implementing the NILS model to identify patients with low risk for nodal metastases was associated with substantial cost reductions and likely overall health gains, especially in patients undergoing BCS. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-022-06636-x.
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Affiliation(s)
- Ida Skarping
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden. .,Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund, Sweden.
| | | | - Looket Dihge
- Division of Surgery, Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
| | | | - Mattias Ohlsson
- Division of Computational Biology and Biological Physics, Department of Astronomy and Theoretical Physics, Lund University, Lund, Sweden
| | - Linnea Huss
- Division of Surgery, Department of Clinical Sciences Helsingborg, Lund University, Lund, Sweden.,Department of Surgery, Helsingborg General Hospital, Helsingborg, Sweden
| | - Pär-Ola Bendahl
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Katarina Steen Carlsson
- The Swedish Institute for Health Economics, Lund, Sweden.,Department of Clinical Sciences, Health Economics, Lund University, Malmö, Lund, Sweden
| | - Lisa Rydén
- Division of Surgery, Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Surgery and Gastroenterology, Skåne University Hospital, Malmö, Sweden
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Cook JA, Sinha M, Lester M, Fisher CS, Sen CK, Hassanein AH. Immediate Lymphatic Reconstruction to Prevent Breast Cancer-Related Lymphedema: A Systematic Review. Adv Wound Care (New Rochelle) 2022; 11:382-391. [PMID: 34714158 DOI: 10.1089/wound.2021.0056] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Significance: Lymphedema is chronic limb swelling from lymphatic dysfunction. The condition affects up to 250 million people worldwide. In breast cancer patients, lymphedema occurs in 30% who undergo axillary lymph node dissection (ALND). Recent Advances: Immediate lymphatic reconstruction (ILR), also termed Lymphatic Microsurgical Preventing Healing Approach (LyMPHA), is a method to decrease the risk of lymphedema by performing prophylactic lymphovenous anastomoses at the time of ALND. The objective of this study is to assess the risk reduction of ILR in preventing lymphedema. Critical Issues: Lymphedema has significant effects on the quality of life and morbidity of patients. Several techniques have been described to manage lymphedema after development, but prophylactic treatment of lymphedema with ILR may decrease risk of development to 6.6%. Future Directions: Long-term studies that demonstrate efficacy of ILR may allow for prophylactic management of lymphedema in the patient undergoing lymph node dissection.
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Affiliation(s)
- Julia A. Cook
- Division of Plastic Surgery; Indianapolis, Indiana, USA
| | - Mithun Sinha
- Division of Plastic Surgery; Indianapolis, Indiana, USA
- Indiana Center for Regenerative Medicine, Department of Surgery; Indianapolis, Indiana, USA
| | - Mary Lester
- Division of Plastic Surgery; Indianapolis, Indiana, USA
| | - Carla S. Fisher
- Division of Surgical Oncology; Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Chandan K. Sen
- Division of Plastic Surgery; Indianapolis, Indiana, USA
- Indiana Center for Regenerative Medicine, Department of Surgery; Indianapolis, Indiana, USA
| | - Aladdin H. Hassanein
- Division of Plastic Surgery; Indianapolis, Indiana, USA
- Indiana Center for Regenerative Medicine, Department of Surgery; Indianapolis, Indiana, USA
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Virtual Reality Rehabilitation Systems for Cancer Survivors: A Narrative Review of the Literature. Cancers (Basel) 2022; 14:cancers14133163. [PMID: 35804933 PMCID: PMC9264833 DOI: 10.3390/cancers14133163] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022] Open
Abstract
Rehabilitation plays a crucial role in cancer care, as the functioning of cancer survivors is frequently compromised by impairments that can result from the disease itself but also from the long-term sequelae of the treatment. Nevertheless, the current literature shows that only a minority of patients receive physical and/or cognitive rehabilitation. This lack of rehabilitative care is a consequence of many factors, one of which includes the transportation issues linked to disability that limit the patient’s access to rehabilitation facilities. The recent COVID-19 pandemic has further shown the benefits of improving telemedicine and home-based rehabilitative interventions to facilitate the delivery of rehabilitation programs when attendance at healthcare facilities is an obstacle. In recent years, researchers have been investigating the benefits of the application of virtual reality to rehabilitation. Virtual reality is shown to improve adherence and training intensity through gamification, allow the replication of real-life scenarios, and stimulate patients in a multimodal manner. In our present work, we offer an overview of the present literature on virtual reality-implemented cancer rehabilitation. The existence of wide margins for technological development allows us to expect further improvements, but more randomized controlled trials are needed to confirm the hypothesis that VRR may improve adherence rates and facilitate telerehabilitation.
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Single-cell RNA sequencing of subcutaneous adipose tissues identifies therapeutic targets for cancer-associated lymphedema. Cell Discov 2022; 8:58. [PMID: 35725971 PMCID: PMC9209506 DOI: 10.1038/s41421-022-00402-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/09/2022] [Indexed: 12/14/2022] Open
Abstract
Cancer-associated lymphedema frequently occurs following lymph node resection for cancer treatment. However, we still lack effective targeted medical therapies for the treatment or prevention of this complication. An in-depth elucidation of the cellular alterations in subcutaneous adipose tissues of lymphedema is essential for medical development. We performed single-cell RNA sequencing of 70,209 cells of the stromal vascular fraction of adipose tissues from lymphedema patients and healthy donors. Four subpopulations of adipose-derived stromal cells (ASCs) were identified. Among them, the PRG4+/CLEC3B+ ASC subpopulation c3 was significantly expanded in lymphedema and related to adipose tissue fibrosis. Knockdown of CLEC3B in vitro could significantly attenuate the fibrogenesis of ASCs from patients. Adipose tissues of lymphedema displayed a striking depletion of LYVE+ anti-inflammatory macrophages and exhibited a pro-inflammatory microenvironment. Pharmacological blockage of Trem1, an immune receptor predominantly expressed by the pro-inflammatory macrophages, using murine LR12, a dodecapeptide, could significantly alleviate lymphedema in a mouse tail model. Cell–cell communication analysis uncovered a perivascular ligand-receptor interaction module among ASCs, macrophages, and vascular endothelial cells. We provided a comprehensive analysis of the lineage–specific changes in the adipose tissues from lymphedema patients at a single-cell resolution. CLEC3B was found to be a potential target for alleviating adipose tissue fibrosis. Pharmacological blockage of TREM1 using LR12 could serve as a promising medical therapy for treating lymphedema.
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Chen L, Chang K, Chen Y, Xu Z, Shen W. Does Autologous Transfusion Decrease Allogeneic Transfusion in Liposuction Surgery of Lymphedema Patients? Front Med (Lausanne) 2022; 9:778230. [PMID: 35479938 PMCID: PMC9037081 DOI: 10.3389/fmed.2022.778230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Objective Liposuction is an effective treatment for fat disposition in lymphedema. Blood transfusion has been seldom investigated in lymphedema liposuction surgery. The purpose of the study was to analyze clinical factors associated with blood transfusion in liposuction surgery of lymphedema patients and compare the autologous and allogeneic transfusion patterns. Methods A total of 1,187 cases of liposuction due to lymphedema were recruited. Demographic, laboratory tests and operation information were collected. Patients were divided into a transfusion and a non-transfusion group. Different transfusion patterns were compared and analyzed. Results Between the two groups, there is a significant difference in postoperative hemoglobin levels, and as well as gender, age, surgery duration, body weight change, intraoperative transfusion volume and blood loss, hospital length of stay, and surgical site distribution. There is a significant difference in the comparison of hospital stay length, autologous transfusion volume, combined allogeneic volume, operative blood loss, intraoperative transfusion volume, and change in hemoglobin levels between predonation and acute normovolemic hemodilution (ANH) transfusion. In comparison with the allogeneic transfusion-only patients, the mean allogeneic transfusion volume in either ANH group, predonated transfusion group, or mixed group is statistically lower. Allogeneic transfusion volume in the predonated-only group is significantly lower than that of either the ANH-only group or the mixing ANH with predonation group. Ordinary least squares regression analysis suggests that autologous transfusion in the ANH-only mode is statistically associated with allogeneic transfusion. Conclusions This study described the blood transfusion in lymphedema liposuction surgery and compared autologous and allogeneic transfusion patterns in these patients. Autologous transfusion can reduce the transfusion volume of allogeneic blood and might be a beneficial mode of transfusion in these patients.
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Affiliation(s)
- Linfeng Chen
- Department of Blood Transfusion, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Kun Chang
- Department of Lymph Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yan Chen
- Department of Blood Transfusion, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zhenhua Xu
- HealSci Technology Co. Ltd., Beijing, China
| | - Wenbin Shen
- Department of Lymph Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Stafford AP, Hoskin TL, Day CN, Sanders SB, Boughey JC. Contemporary Axillary Management in cT1-2N0 Breast Cancer with One or Two Positive Sentinel Lymph Nodes: Factors Associated with Completion Axillary Lymph Node Dissection Within the National Cancer Database. Ann Surg Oncol 2022; 29:4740-4749. [PMID: 35451727 DOI: 10.1245/s10434-022-11759-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/23/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Management of the axilla in patients with cT1-2N0 breast cancer with one or two positive (+) sentinel lymph nodes (SLNs) is often debated, especially in patients undergoing mastectomy. In 2018, the National Cancer Database (NCDB) began collecting the number of +SLNs, enabling identification of patients with one or two +SLNs for the first time. METHODS From the 2018 NCDB participant user file (PUF), all cT1-2N0M0 patients with one or two +SLNs were identified. The rates of completion axillary lymph node dissection (cALND) after breast-conserving surgery (BCS) and mastectomy were determined, and logistic regression was used to assess factors associated with cALND. RESULTS Of 10,531 patients with one or two +SLNs, cALND was performed in 807/6498 (12.4%) BCS patients and 1845/4033 (45.7%) mastectomy patients (p < 0.001). Factors associated with cALND in BCS were cT2 versus cT1 (16.0% versus 11.1%, p < 0.001), two versus one positive SLN (20.7% versus 10.8%, p < 0.001), and higher tumor grade (grade 3: 15.4% versus grade 1-2: 11.7%, p = 0.002). Factors associated with cALND among mastectomy were cT2 versus cT1 (48.2% versus 43.7%, p = 0.004), two versus one positive SLN (56.6% versus 42.8%, p < 0.001), younger age (age < 50 years: 49.0%, age 50+ years: 44.1%, p = 0.004), and Hispanic ethnicity (55.7% versus 45.1%, p = 0.001). After adjusting for pN category, adjuvant radiation was significantly less likely after mastectomy if cALND was performed (odds ratio (OR) 0.51, p < 0.001). CONCLUSIONS Omission of cALND with one or two +SLNs in BCS is common. Deescalation of axillary therapy in mastectomy is slower, with a cALND rate of 45.7% in 2018. With the recent updates to the National Cancer Care Network (NCCN) guidelines, we anticipate continued deescalation of axillary therapy in mastectomy patients.
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Affiliation(s)
- Arielle P Stafford
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Tanya L Hoskin
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Courtney N Day
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Stacy B Sanders
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Judy C Boughey
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
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Liu M, Liu S, Zhao Q, Cui Y, Chen J, Wang S. Using the Indocyanine Green (ICG) Lymphography to Screen Breast Cancer Patients at High Risk for Lymphedema. Diagnostics (Basel) 2022; 12:diagnostics12040983. [PMID: 35454031 PMCID: PMC9026904 DOI: 10.3390/diagnostics12040983] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/09/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Indocyanine green (ICG) lymphography is a newer technique for diagnosing lymphedema. Our study aimed to find whether the abnormality of ICG lymphography can predict the occurrence of early lymphedema and then select candidates at high risk of developing lymphedema. Methods: Postoperative breast cancer patients who visited the lymphedema clinic of Peking University People’s Hospital from December 2016 to September 2019 were consecutively enrolled and received ICG lymphography and circumference measurement. Data were collected on the patients’ characteristics and correlation between ICG lymphography and the occurrence of lymphedema. Results: The analysis included 179 patients. There were 91 patients in the lymphedema group and 88 patients in the non-lymphedema group. By multivariate analysis, age, axillary surgery, radiotherapy, and time since breast cancer surgery were regarded as risk factors for lymphedema (p < 0.05). According to the results of ICG lymphography, patients in the non-lymphedema group (n = 88) were divided into ICG-positive (n = 47) and ICG-negative (n = 41) groups. The incidence of lymphedema in the ICG-positive group was significantly higher than that in the ICG-negative group (19.1% vs. 2.4%, p = 0.027). Conclusion: Lymphatic disorder can be detected before circumference change using ICG lymphography. Abnormal ICG lymphography is an independent risk factor for lymphedema. Patients with abnormal dermal backflow patterns are considered to be a high-risk group for lymphedema and should undergo early interventions to prevent lymphedema.
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Affiliation(s)
| | | | | | | | | | - Shu Wang
- Correspondence: ; Tel.: +010-8832-4010
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Pinto M, Marotta N, Caracò C, Simeone E, Ammendolia A, de Sire A. Quality of Life Predictors in Patients With Melanoma: A Machine Learning Approach. Front Oncol 2022; 12:843611. [PMID: 35402230 PMCID: PMC8990304 DOI: 10.3389/fonc.2022.843611] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/25/2022] [Indexed: 12/20/2022] Open
Abstract
Health related quality of life (HRQoL) is an important recognized health outcome for cancer treatments, but also disease course with slower recovery and increased morbidity. These issues are of implication in melanoma, which maintains a risk of disease progression for many years after diagnosis. This study aimed to explore and weigh factors in the perception of the quality of life and possible relationships with demographic–clinical characteristics in people with melanoma via a machine learning approach. In this observational study, patients with melanoma, without metastatic disease, were recruited from January 2020 to December 2021 with a follow-up of at least one year. Demographic variables and clinics were collected, and the 12-Item Short-Form Health Survey (SF-12) was adopted as the physical and mental aspects of the Health-Related Quality of Life (HRQoL) measure. All the variables were processed in a random forest model to weigh at each node of each tree of this machine learning regression model, their actual weight in SF-12 score. We included 203 melanoma patients, mean aged 59.25 ± 15.1 years: 56 (27%) affecting the upper limbs and 147 (73%) affecting the trunk. The model of 142 patients with no missing value, generating 92 trees (MSE = 0.45, R2 of 0.78), reported that the lesion site was the most influencing variable on HRQoL based on the decrease in Gini impurity in variable weighing at each node intersection in forest generation. In this scenario, we built two distinct models for lesion sites and demonstrated that the variable that most influenced the quality of life in upper limb melanoma was lymphedema, while BMI was in the trunk. Given these results, random forest regressions could play a crucial role in the clinical and rehabilitation approach. The machine-learning model for detecting the HRQoL predictor in melanoma patients indicates that the experienced lymphedema and BMI may influence the HRQoL perception. This study suggests that the prevention and treatment of lymphedema and bodyweight reduction might improve the quality of life in melanoma.
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Affiliation(s)
- Monica Pinto
- Rehabilitation Medicine Unit, Strategic Health Services Department, Istituto Nazionale Tumori-Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-Fondazione G. Pascale, Naples, Italy
| | - Nicola Marotta
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Corrado Caracò
- Melanoma and Skin Cancer Surgery Unit, Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori-Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-Fondazione G. Pascale, Naples, Italy
| | - Ester Simeone
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori-Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-Fondazione G. Pascale, Naples, Italy
| | - Antonio Ammendolia
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Alessandro de Sire
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
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Dual-Energy Computed Tomography for Evaluation of Breast Cancer Follow-Ups: Comparison of Virtual Monoenergetic Images and Iodine-Map. Diagnostics (Basel) 2022; 12:diagnostics12040946. [PMID: 35453994 PMCID: PMC9028705 DOI: 10.3390/diagnostics12040946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/06/2022] [Accepted: 04/09/2022] [Indexed: 02/01/2023] Open
Abstract
Differentiating tumor tissue from dense breast tissue can be difficult. Dual-energy CT (DECT) could be suitable for making diagnoses at breast cancer follow-ups. This study investigated the contrast in DECT images and iodine maps for patients with breast cancer being followed-up. Chest CT images captured in 2019 were collected. Five cases of metastatic breast cancer in the lungs were analyzed; the contrast-to-noise ratio (for breast tissue and muscle: CNRb and CNRm, respectively), tumor-to-breast mammary gland ratio (T/B), and tumor-to-muscle ratio (T/M) were calculated. For 84 cases of no metastasis, monochromatic spectral and iodine maps were obtained to compare differences under various breast densities using the K-means algorithm. The optimal T/B, T/M, and CNRb (related to mammary glands) were achieved for the 40-keV image. Conversely, CNRm (related to lungs) was better for higher energy. The optimal balance was achieved at 80 keV. T/B, T/M, and CNR were excellent for iodine maps, particularly for density > 25%. In conclusion, energy of 80 keV is the parameter most suitable for observing the breast and lungs simultaneously by using monochromatic spectral images. Adding iodine mapping can be appropriate when a patient’s breast density is greater than 25%.
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Omura M, Saito W, Akita S, Yoshida K, Yamaguchi T. In Vivo Quantitative Ultrasound on Dermis and Hypodermis for Classifying Lymphedema Severity in Humans. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:646-662. [PMID: 35033402 DOI: 10.1016/j.ultrasmedbio.2021.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
This study investigated the ability of in vivo quantitative ultrasound (QUS) assessment to evaluate lymphedema severity compared with the gold standard method, the International Society of Lymphology (ISL) stage. Ultrasonic measurements were made around the middle thigh (n = 150). Radiofrequency data were acquired using a clinical scanner and 8-MHz linear probe. Envelope statistical analysis was performed using constant false alarm rate processing and homodyned K (HK) distribution. The attenuation coefficient was calculated using the spectral log-difference technique. The backscatter coefficient (BSC) was obtained by the reference phantom method with attenuation compensation according to the attenuation coefficients in the dermis and hypodermis, and then effective scatterer diameter (ESD) and effective acoustic concentration (EAC) were estimated with a Gaussian model. Receiver operating characteristic curves of QUS parameters were obtained using a linear regression model. A single QUS parameter with high area under the curve (AUC) differed between the dermis (ESD and EAC) and hypodermis (HK) parameters. The combinations with ESD and EAC in the dermis, HK parameters in the hypodermis and typical features (dermal thickness and echogenic regions in the hypodermis) improved classification performance between ISL stages 0 and ≥I (AUC = 0.90 with sensitivity of 75% and specificity of 91%) in comparison with ESD and EAC in the dermis (AUC = 0.82) and HK parameters in the hypodermis (AUC = 0.82). In vivo QUS assessment by BSC and envelope statistical analyses can be valuable for non-invasively classifying an extremely early stage of lymphedema, such as ISL stage I, and following its progression.
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Affiliation(s)
- Masaaki Omura
- Center for Frontier Medical Engineering, Chiba University, Chiba, Chiba, Japan; Faculty of Engineering, University of Toyama, Toyama, Toyama, Japan
| | - Wakana Saito
- Department of Medical Engineering, Graduate School of Science and Engineering, Chiba University, Chiba, Chiba, Japan
| | - Shinsuke Akita
- Department of Plastic, Reconstructive, and Aesthetic Surgery, School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Kenji Yoshida
- Center for Frontier Medical Engineering, Chiba University, Chiba, Chiba, Japan
| | - Tadashi Yamaguchi
- Center for Frontier Medical Engineering, Chiba University, Chiba, Chiba, Japan
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McNeely ML, Harris SR, Dolgoy ND, Al Onazi MM, Parkinson JF, Radke L, Kostaras X, Dennett L, Ryan JA, Dalzell MA, Kennedy A, Capozzi L, Towers A, Campbell KL, Binkley J, King K, Keast D. Update to the Canadian clinical practice guideline for best-practice management of breast cancer-related lymphedema: study protocol. CMAJ Open 2022; 10:E338-E347. [PMID: 35414596 PMCID: PMC9007443 DOI: 10.9778/cmajo.20210038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND One of the more frequent complications following treatment for breast cancer, lymphedema is a substantial swelling of the arm, breast and chest wall that occurs on the side where lymph nodes were removed. The aim of this work is to update recommendations on the prevention, diagnosis and management of lymphedema related to breast cancer. METHODS We present the protocol for an update of the 2001 clinical practice guideline on lymphedema from the Steering Committee for Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. We will use a patient-oriented research approach with a focus on self-management and the positive health model to inform the updated guideline development. The methods proposed will be undertaken with consideration of the standards outlined in the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. The literature will be appraised by evaluating existing guidelines from other countries, the evidence from systematic reviews and meta-analyses and direct evidence from clinical studies. We will manage competing interests according to Guidelines International Network principles. Recommendations will be presented using an actionable statement format and will be linked to the level of evidence along with any relevant considerations used in formulation. A draft of the guideline will be produced by the steering committee then sent out to international experts and stakeholder groups for feedback. INTERPRETATION The primary benefit of this clinical guideline will be to improve the quality of care of women with breast cancer-related lymphedema. Findings will be disseminated at national and international conferences and through webinars and educational videos hosted on the websites of the supporting organizations.
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Affiliation(s)
- Margaret Lynn McNeely
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont.
| | - Susan R Harris
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Naomi D Dolgoy
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Mona M Al Onazi
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Joanna F Parkinson
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Lori Radke
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Xanthoula Kostaras
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Liz Dennett
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Jean Ann Ryan
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Mary-Ann Dalzell
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Anna Kennedy
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Lauren Capozzi
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Anna Towers
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Kristin L Campbell
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Jill Binkley
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Karen King
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - David Keast
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
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Ramírez-Parada K, Lopez-Garzon M, Sanchez-Rojel C, Petric-Guajardo M, Alfaro-Barra M, Fernández-Verdejo R, Reyes-Ponce A, Merino-Pereira G, Cantarero-Villanueva I. Effect of Supervised Resistance Training on Arm Volume, Quality of Life and Physical Perfomance Among Women at High Risk for Breast Cancer-Related Lymphedema: A Study Protocol for a Randomized Controlled Trial (STRONG-B). Front Oncol 2022; 12:850564. [PMID: 35299753 PMCID: PMC8921986 DOI: 10.3389/fonc.2022.850564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/01/2022] [Indexed: 01/31/2023] Open
Abstract
Objectives To determine the preventive effects of supervised resistance training on arms volume, quality of life, physical performance, and handgrip strength in Chilean women at high risk for breast cancer-related lymphedema (BCRL) undergoing chemotherapy. Design Randomized control trial. Participants One hundred and six women at high risk for breast cancer-related lymphedema aged 18 to 70 years. Interventions Participants will be randomized into two groups: [a] intervention, who will receive 12 weeks of supervised resistance training (STRONG-B) during adjuvant chemotherapy; and [b] control, who will receive education to promote lymphatic and venous return, maintain range of motion, and promote physical activity. Main Outcome Measures The primary outcome will be arms volume measured with an optoelectric device (perometer NT1000). Secondary outcomes will be quality of life, handgrip strength, and physical performance. Primary and secondary outcomes will be measured at baseline, just after the intervention, and 3 and 6 months after. Statistical analysis will be performed following intention-to-treat and per-protocol approaches. The treatment effect will be calculated using linear mixed models. Discussion The STRONG-B will be a tailored supervised resistance training that attempts to prevent or mitigate BCRL in a population that, due to both intrinsic and extrinsic factors, will commonly suffer from BCRL. Clinical Trial Registration [https://clinicaltrials.gov/ct2/show/NCT04821609], identifier NCT04821609.
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Affiliation(s)
- Karol Ramírez-Parada
- Carrera de Kinesiología, Departamento Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maria Lopez-Garzon
- 'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
- Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Cesar Sanchez-Rojel
- Departamento de Hematología-Oncología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Militza Petric-Guajardo
- Department of Surgery Dr Sótero del Río Hospital, Santiago, Chile
- Department of Surgery Davila Clinic, Santiago, Chile
| | - Margarita Alfaro-Barra
- Centro de Cáncer, Red de Salud U- Christus, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Fernández-Verdejo
- Laboratorio de Fisiología del Ejercicio y Metabolismo (LABFEM), Escuela de Kinesiología, Facultad de Medicina, Universidad Finis Terrae, Santiago, Chile
| | - Alvaro Reyes-Ponce
- Escuela de Kinesiología, Facultad de Ciencias de la Rehabilitación, Universidad Andrés Bello, Viña del Mar, Chile
| | - Gina Merino-Pereira
- Departamento Manejo Integral del Cáncer y Otros Tumores, Subsecretaria de Salud Pública, Ministerio de Salud de Chile, Santiago, Chile
- Escuela de Medicina, Facultad de Ciencias, Universidad Mayor, Santiago, Chile
- Instituto de Investigación y Postgrado, Facultad de Ciencias de la Salud, Universidad Central de Chile, Santiago, Chile
| | - Irene Cantarero-Villanueva
- 'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
- Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
- Sport and Health Research Center (iMUDS), Granada, Spain
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Finkelstein ER, Ha M, Hanwright P, Ngaage LM, Yoon JS, Liang F, Nam AJ, Rasko YM. A Review of American Insurance Coverage and Criteria for the Conservative Management of Lymphedema. J Vasc Surg Venous Lymphat Disord 2022; 10:929-936. [DOI: 10.1016/j.jvsv.2022.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/01/2022] [Indexed: 11/15/2022]
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Risk Factors for Lower Extremity Lymphedema after Inguinal Lymphadenectomy in Melanoma Patients: A Retrospective Cohort Study. Surg Open Sci 2022; 8:33-39. [PMID: 35280121 PMCID: PMC8914217 DOI: 10.1016/j.sopen.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/26/2022] [Accepted: 02/04/2022] [Indexed: 01/25/2023] Open
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Pierazzi DM, Arleo S, Faini G. Distally Prophylactic Lymphaticovenular Anastomoses after Axillary or Inguinal Complete Lymph Node Dissection Followed by Radiotherapy: A Case Series. Medicina (B Aires) 2022; 58:medicina58020207. [PMID: 35208531 PMCID: PMC8880594 DOI: 10.3390/medicina58020207] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/29/2021] [Accepted: 01/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Lymphedema is an important and underestimated condition, and this progressive chronic disease has serious implications on patients’ quality of life. The main goal of research would be to prevent lymphedema, instead of curing it. Patients receiving radiotherapy after lymph node dissection have a significantly higher risk of developing lymphedema. Through the prophylactic use of microsurgical lymphaticovenular anastomoses in selected patients, we could prevent the development of lymphedema. Materials and Methods: Six patients who underwent prophylactic lymphaticovenular anastomoses in a distal site to the axillary or groin region after axillary or inguinal complete lymph node dissection followed by radiotherapy were analyzed. Patients characteristics, comorbidities, operative details, postoperative complications and follow-up assessments were recorded. Results: Neither early nor late generic surgical complications were reported. We observed no lymphedema development throughout the post-surgical follow-up. In particular, we observed no increase in limb diameter measured at 1, 3, 6 and 12 months postoperatively. Conclusion: In our experience, performing LVA after axillary or groin lymphadenectomy and after adjuvant radiotherapy, and distally to the irradiated area, allows us to ensure the long-term patency of anastomoses in order to obtain the best results in terms of reducing the risk of iatrogenic lymphedema. This preliminary report is encouraging, and the adoption of our approach should be considered in selected patients.
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Affiliation(s)
- Diletta Maria Pierazzi
- Department of Medicine, Surgery and Neuroscience, Division of Plastic and Reconstructive Surgery, “Santa Maria alle Scotte” Hospital, University of Siena, 53100 Siena, Italy
- Correspondence:
| | - Sergio Arleo
- Department of Plastic Surgery, ASST Spedali Civili di Brescia, 25121 Brescia, Italy;
| | - Gianpaolo Faini
- Operative Unit of Reconstructive Microsurgery, Department of Surgery, ASST Valle Camonica, 25040 Brescia, Italy;
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Rafn BS, Christensen J, Larsen A, Bloomquist K. Prospective Surveillance for Breast Cancer-Related Arm Lymphedema: A Systematic Review and Meta-Analysis. J Clin Oncol 2022; 40:1009-1026. [PMID: 35077194 DOI: 10.1200/jco.21.01681] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The call to integrate prospective surveillance for lymphedema into cancer care pathways is building momentum to enable early intervention and prevent the progression of the condition. We offer a critical evaluation of the literature on prospective surveillance and early management for cancer-related lymphedema and evaluate the effect of such programs in preventing chronic lymphedema (CRD42019137965). METHODS Five databases and two registries were searched for randomized controlled trials or observational studies that assessed the incidence or prevalence of lymphedema associated with participation in a prospective surveillance program, published until February 26, 2021. Numbers triggered for early lymphedema management, resolved, and chronic lymphedema were extracted. Pooled relative risk (trials) and pooled rate (cumulative incidence; observational studies) of chronic lymphedema was calculated. Subgroup analyses assessed the effect of study design, length of follow-up, and extent of axillary surgery. RESULTS Twenty-three studies were included, of which 21 studies evaluated breast cancer-related arm lymphedema (BCRaL). Participation in prospective surveillance with early management reduced the risk of chronic BCRaL versus usual care (relative risk 0.31; 95% CI, 0.10 to 0.95; two randomized controlled trials; N = 106). The pooled rate of chronic BCRaL was 4% (95% CI, 3 to 6; 15 observational studies; N = 3,545), and 6% (95% CI, 4 to 9) when restricted to participants with axillary lymph node dissection (12 studies; N = 1,527). CONCLUSION The findings suggest that participation in prospective surveillance with early management reduces the risk of chronic BCRaL. Only a minority of patients at high risk of lymphedema because of axillary surgery developed chronic lymphedema. More robust research is needed to determine whether prospective surveillance with early management can reduce the risk of chronic lymphedema, particularly among cancer survivors other than breast cancer.
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Affiliation(s)
- Bolette S Rafn
- Cancer Survivorship and Treatment Late Effects Research Unit (CASTLE), Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Jan Christensen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Anders Larsen
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Kira Bloomquist
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Denmark
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Zhang W, Li J, Liang J, Qi X, Tian J, Liu J. Coagulation in Lymphatic System. Front Cardiovasc Med 2021; 8:762648. [PMID: 34901222 PMCID: PMC8652051 DOI: 10.3389/fcvm.2021.762648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/28/2021] [Indexed: 12/20/2022] Open
Abstract
The lymphatic system maintains homeostasis of the internal environment between the cells in tissues and the blood circulation. The coagulation state of lymph is determined by conditions of coagulation factors and lymphatic vessels. Internal obliteration, external compression or abnormally increased lymphatic pressure may predispose to localized lymphatic coagulation. In physiological conditions, an imbalance of antithrombin and thrombokinase reduces lymphatic thrombosis. However, the release of factor X by lymphatic endothelium injury may trigger coagulation casacade, causing blockage of lymphatic vessels and lymphedema. Heterogeneity of lymphatic vessels in various tissues may lead to distinct levels and patterns of coagulation in specific lymphatic vessels. The quantitative and qualitative measurement of clotting characteristic reveals longer time for clotting to occur in the lymph than in the blood. Cancer, infections, amyloidosis and lymph node dissection may trigger thrombosis in the lymphatic vessels. In contrast to venous or arterial thrombosis, lymphatic thrombosis has rarely been reported, and its actual prevalence is likely underestimated. In this review, we summarize the mechanisms of coagulation in lymphatic system, and discuss the lymphatic thrombosis-related diseases.
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Affiliation(s)
- Wendi Zhang
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China.,Medical Research Center, Shandong Medicine and Health Key Laboratory of Microvascular Medicine, Institute of Microvascular Medicine, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China.,Graduate School, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jiang Li
- Qeeloo Medical College, Shandong University, Jinan, China
| | - Jiangjiu Liang
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Xiumei Qi
- Department of Education, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated With Shandong First Medical University, Jinan, China
| | - Jinghui Tian
- School of Public Health and Health Management, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Ju Liu
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China.,Medical Research Center, Shandong Medicine and Health Key Laboratory of Microvascular Medicine, Institute of Microvascular Medicine, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
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Suzuki Y, Nakajima Y, Nakatani T, Okuwa M, Sugama J. Comparison of normal hindlimb lymphatic systems in rats with detours present after lymphatic flow blockage. PLoS One 2021; 16:e0260404. [PMID: 34898636 PMCID: PMC8668128 DOI: 10.1371/journal.pone.0260404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 11/09/2021] [Indexed: 11/18/2022] Open
Abstract
In the present study, we aimed to identify the normal hindlimb lymphatic systems in rats and compare them with the detours after lymphatic flow blockage. The lymphatic systems of the hindlimbs of normal rats were investigated via lymphography using a near-infrared fluorescence imaging system. The lymphatic vessels were stained using Evans Blue. The lymphatic flow was blocked through lymphatic vessel ligation combined with inguinal and popliteal lymph node dissection. Detours that appeared after 30 days were visualized using lymphography and immunostaining with anti-podoplanin antibodies. Three main results were obtained in the present study. First, the deep medial system, the superficial medial system, a connection between the superficial and deep medial lymphatic systems, and the superficial lateral system, were elucidated. Second, three types of detours, namely the detour of the lateral abdomen, the detour to the lymphatic vessel near the midline of the abdomen, and the detour to the contralateral inguinal lymph node, were identified after lymphatic flow blockage. Lastly, detours were located in the fatty layer above the panniculus carnosus muscle and their lumina were wide. The histology suggested that the detour was a pre-collecting lymphatic vessel. Lymphatic routes in the rat hindlimbs after lymphatic flow blockage were different from those of the normal rat lymphatic system. It was suggested that the detour is a pre-collecting lymphatic vessel and that encouraging its development may be a new method of simple lymphatic drainage.
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Affiliation(s)
- Yuiko Suzuki
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Ishikawa, Japan
- Faculty of Health Sciences, Komatsu University, Ishikawa, Japan
| | - Yukari Nakajima
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
- * E-mail: (YN); (JS)
| | - Toshio Nakatani
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Mayumi Okuwa
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Junko Sugama
- Research Center for Implementation Nursing Science Initiative, School of Health Sciences, Fujita Health University, Aichi, Japan
- * E-mail: (YN); (JS)
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Laustsen-Kiel CM, Lauritzen E, Langhans L, Engberg Damsgaard T. Study protocol for a 10-year prospective observational study, examining lymphoedema and patient-reported outcome after breast reconstruction. BMJ Open 2021; 11:e052676. [PMID: 34873005 PMCID: PMC8650483 DOI: 10.1136/bmjopen-2021-052676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Over the last decades, treatment of breast cancer has become increasingly more effective. Consequently, an increasing number of women are living with late effects of breast cancer treatment, including disfiguring scars, deformity or asymmetry of the breast, secondary lymphoedema and other physical and psychosocial late effects. Data from this study will provide knowledge on how to guide breast reconstruction in the future towards outcomes with fewer complications, higher long-term quality of life (QoL) and satisfaction with the aesthetic outcome. The development of secondary lymphoedema, for which the effect of breast reconstruction has yet to be established, will be thoroughly examined. METHODS AND ANALYSIS Women receiving breast reconstruction (autologous and implant based) at the Department of Plastic Surgery and Burns Treatment, Rigshospitalet, will be invited to participate. The patients will be followed for 10 years postoperatively. Demographic, health-related, oncological characteristics and treatment data will be registered. Validated assessment tools, such as the BREAST-Q and Beck Depression Inventory, will be used to measure an extensive range of clinical outcomes, including QoL, life and aesthetic satisfaction and depression. Arm range of motion will be measured with a goniometer and lymphoedema by bioimpedance spectroscopy, compared with circular arm measurements. ETHICS AND DISSEMINATION This study will be conducted according to the 5th version of the Helsinki Declaration. The regional ethical committee for Capital Region Denmark did not find the study notifiable, according to the law of the committee § 1, part 4. All data will be anonymised before its publication. This study will be conducted according to the Danish data protection regulation and is catalogued and approved by the Capital Region Head of Knowledge Centre. According to the Danish health law § 46, part 2, this study does not need the Danish Patient Safety Authority's approval. The findings of this study will be submitted to international peer-reviewed journals.
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Affiliation(s)
| | - Elisabeth Lauritzen
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
| | - Linnea Langhans
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
| | - Tine Engberg Damsgaard
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
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