Hand Edema in Patients at Risk of Breast Cancer–Related Lymphedema: Health Professionals Should Take Notice

Cheryl L. Brunelle, Meyha N. Swaroop, Melissa N. Skolny, Maria S. Asdourian, Hoda E. Sayegh, Alphonse G. Taghian. Physical Therapy Volume 98 Number 6 June 2018

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Hand Edema in Patients at Risk of Breast Cancer–Related Lymphedema: Health Professionals Should Take Notice

Cheryl L. Brunelle, Meyha N. Swaroop, Melissa N. Skolny, Maria S. Asdourian,  Hoda E. Sayegh, Alphonse G. Taghian. Physical Therapy Volume 98 Number 6 June 2018

Background. There is little research on hand edema in the population at risk for breast cancer–related lymphedema (BCRL).

Objectives. Study aims included reporting potential importance of hand edema (HE) as a risk factor for progression of edema in patients treated for breast cancer at risk for BCRL, reporting risk factors for BCRL, and reporting treatment of HE.

Design/Methods. This was a retrospective analysis of 9 patients treated for breast cancer in Massachusetts General Hospital’s lymphedema screening program who presented with isolated HE. Limb volumes via perometry, BCRL risk factors, and HE treatment are reported.

Results. Edema was mostly isolated to the hand. Three patients had arm edema >5% on perometry; and 2 of these had edema outside the hand on clinical examination. Patients were at high risk of BCRL with an average of 2.9/5 known risk factors. Arm edema progressed to >10% in 2 high-risk patients. Treatment resulted in an average hand volume reduction of 10.2% via perometry and improvement upon clinical examination.

Limitations. The small sample size and lack of validated measures of subjective data were limitations.

Conclusions. In this cohort, patients with HE carried significant risk factors for BCRL. Two out of 9 (22%), both carrying ≥4/5 risk factors, progressed to edema >10%. Isolated HE may be a prognostic factor for edema progression in patients treated for breast cancer at risk for BCRL. Further research is warranted.

Main findings

  • Small sample size of 9.
  • Hand oedema was quantified via Perometry. In terms of clinical examination, integumentary integrity, circulation (pulses, capillary refill, color, temperature), and sensory integrity (light touch) of bilateral upper extremities were examined in terms of norms and affected to non-affected limb symmetry. Stemmer’s sign, quantification of pain, anatomical location of oedema, and quantification of pitting oedema were examined.
  • Treatment included a combination of the following: a Class I glove, a quilted night glove, a Class I sleeve, multiple-layer bandaging of the hand ± forearm, quilted pad for the dorsum of the hand, kinesiotaping, and exercise.
  • The compression glove or sleeve was worn during the day, and a night glove or wrapping was used at night. The dorsal pad was used in conjunction with the day glove, and the kinesiotape was used in lieu of a day glove at times. A latex-free medical glove was recommended over compression for activities of daily living.
  • There is some evidence that segmental differences in surviving lymphatic function result in uneven distribution of swelling along the arm in BCRL, and that the pathophysiology of BCRL is more complex than axillary lymphatic obstruction alone. The hand is spared in some patients with BCRL because local lymph flow is increased and diverted along collateral dermal routes, whereas other patients with BCRL experience hand oedema.
  • Hand oedema may be a potential risk factor for progression of oedema in patients treated for breast cancer who are at risk of BCRL. Further research is warranted to definitively establish whether or not hand oedema is a risk factor for progression of oedema, and to ensure accurate measurement and effective treatment of hand oedema in the at-risk population.