Hot of the Press May 2021
We have collated some great articles and material published over the last month. Click on the links below to read the abstract or download the full paper.
Anatomy / Physiology /Pathophysiology
Biology of Lymphedema
Prospective Validation of Indocyanine Green Lymphangiography Staging of Breast Cancer-Related Lymphedema
Lymphedema alters lipolytic, lipogenic, immune and angiogenic properties of adipose tissue: a hypothesis-generating study in breast cancer survivors
Prevalence and Risk Factors
Factors associated with melanoma-related limb lymphoedema - click for abstract
Factors associated with melanoma-related limb lymphoedema
BACKGROUND: Melanoma-related limb lymphoedema is a well-known late effect following sentinel node biopsy (SNB), and lymph node dissection (LND) in patients treated of melanoma. However, data on associated risk factors are sparse. This study aimed to investigate factors associated with melanoma-related limb lymphoedema.
METHODS: The present cross-sectional single-center clinical study included patients between 18 and 75 years with American Joint Committee on Cancer Stages I-III melanoma treated with wide local excision (WLE) and unilateral axillary or inguinal SNB and/or completion LND (CLND) or therapeutic LND (TLND). The diagnosis of secondary unilateral limb lymphoedema was based on the history, symptoms, and physical examination and staged according to the International Society of Lymphology (ISL). Data on factors associated with lymphoedema were analysed with binary logistic regression models.
RESULTS: In total, 642 patients were eligible, of which 435 (68%) patients participated in the study. Among these 431 patients, 109 (25%) had lymphoedema of which 48 (44%), and 61 (56%) were classified with ISL Stages I and II-III, respectively. Multivariate analyses identified primary tumour on the limb (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.17-4.56; p value .017), inguinal surgery (OR, 6.91; 95% CI, 3.49-14.11; p value <.0001), LND (OR, 6.45; 95% CI, 3.18-13.57; p value <.0001), and persistent pain at the site of lymph node surgery as factors associated with lymphoedema (OR, 3.52; 95% CI, 1.54-8.19; p value .003). Multivariable analysis of ISL Stage II-III lymphoedema further identified limb cellulitis to be associated with lymphoedema (OR 5.74; 95% CI, 2.11-15.99; p value .0006). CONCLUSIONS: Melanoma-related limb lymphoedema is associated with inguinal surgery, LND, primary tumour on the limb, persistent pain at the site of lymph node surgery, and cellulitis of the limb. This study highlights the importance of increasing awareness, improving prevention, and treatment of melanoma-related limb lymphoedema
Correlation of older age with severity of lymphedema in breast cancer survivors: A systematic review. - click for abstract
Correlation of older age with severity of lymphedema in breast cancer survivors: A systematic review
BACKGROUND: Breast cancer is the most frequent cause of secondary lymphedema. Besides being progressive and chronic, lymphedema is usually hard to treat. That’s why the clinicians are more focused on the prevention of its development and progression.
OBJECTIVE: The aim of this study is to evaluate the possible relationship between the age of patients and the severity of breast cancer-related lymphedema (BCRL).
METHODS: PubMed, Scopus, and Ovid MEDLINE databases were searched for articles, which described the relationship between aging and BCRL development. Two authors searched for and selected articles independently.
RESULTS: Out of 562 studies selected, 8 studies met the inclusion criteria. However, 2 papers had the same study population, so only 7 were included in the final analysis. The total number of those 7 studies was 3,904 patients. Five out of 7 studies included in our review depicted the association of more severe forms of BCRL with older age.
CONCLUSION: The final analysis showed that aging is related to the severity of BCRL. However, due to heterogeneity in study outcome reporting, the cause and effect relationship could not be determined.
Development and Validation of an Intraoperative Nomogram to Predict Breast Cancer-Related Lymphedema Based on the Arm Lymphatics Distribution - click for abstract
Development and Validation of an Intraoperative Nomogram to Predict Breast Cancer-Related Lymphedema Based on the Arm Lymphatics Distribution
The association of breast cancer-related lymphedema after unilateral mastectomy with shoulder girdle kinematics and upper extremity function - click for abstract
The association of breast cancer-related lymphedema after unilateral mastectomy with shoulder girdle kinematics and upper extremity function
Assessment
Quality-of-life outcomes after operative management of primary and secondary lymphoedema: a systematic review - click for abstract
Quality-of-life outcomes after operative management of primary and secondary lymphoedema: a systematic review
BACKGROUND: Lymphoedema is an incurable and progressive disease that affects not only physical function but overall quality of life. Surgical treatment options for the management of lymphoedema are being increasingly performed. This study aims to review post-operative health-related quality of life (HRQOL) following surgical treatment of lymphoedema.
METHODS: A systematic search of the PubMed and Medline databases was performed from the date of their inception until September 2018 to evaluate HRQOL following different surgical options for the treatment of lymphoedema.
RESULTS: One hundred and thirteen articles were identified. Twenty-one articles were included in the final review, comprising a total of 736 patients. HRQOL improvements appear to be sustained for at least 6-12 months post-operatively. In particular, major benefits were noted in the domains based around physical functioning. Patient satisfaction similarly mirrors HRQOL improvements, following an initial dip in the immediate post-operative period.
CONCLUSION: All surgical treatment modalities for the management of lymphoedema confer significant HRQOL improvements across a diverse range of health domains, with this critical outcome of surgery an important pre-operative consideration. Recommendations for ongoing research are suggested.
Real-time electronic patient evaluation of lymphedema symptoms, referral, and satisfaction: a cross-sectional study
It was just mind blowing to be honest: a qualitative phenomenological study exploring cancer survivor’s experiences of indocyanine green lymphography used to inform lymphedema therapy management - click for abstract
It was just mind blowing to be honest: a qualitative phenomenological study exploring cancer survivor’s experiences of indocyanine green lymphography used to inform lymphedema therapy management
PURPOSE: A diagnosis of secondary lymphedema following cancer treatment can necessitate lifelong therapy. Indocyanine green (ICG) lymphography is a technique for visualising lymphatics to enable individualised lymphedema diagnosis, staging and therapy prescription. The participant experience of undergoing the procedure and the impact of imaging findings on lymphedema management is unknown. This study aimed to explore participant’s experiences of ICG lymphography to inform cancer-related lymphedema therapy.
METHODS: A qualitative phenomenological study was conducted using semi-structured interviews with 17 adult participants who had undergone ICG lymphography for stage 0 to 2 upper or lower limb secondary cancer-related lymphedema (International Society of Lymphology, Lymphology 53(1):3-10, 2020).
RESULTS: Seventeen participants were included in the study ranging in age from 36 to 78 years (M = 53.8 years), the majority had a primary diagnosis of breast cancer (N = 7) or melanoma (N = 7). Three overarching themes emerged. Firstly, describing the experience of the ICG lymphography procedure. Secondly, the new knowledge explained symptoms and tailored treatment. Participants reflected on how seeing their lymphatic system helped in understanding about their lymphedema symptoms and guided changes towards more individualised lymphedema management. The final theme described the internal impact of self-knowledge, which included impacts of the new information on empowerment and motivation to self-manage participant’s condition as well as their feelings.
CONCLUSIONS: ICG lymphography had beneficial impacts on participant’s understanding of their lymphedema symptoms and often led to changes in management, positive outcomes in response to management changes and peace of mind about management plans, leading to feeling more empowered to self-manage their condition
Upper limb sensory evaluations and ultrasonographic skin measurements in breast cancer-related lymphedema receiving complex decongestive physiotherapy - click for abstract
Upper limb sensory evaluations and ultrasonographic skin measurements in breast cancer-related lymphedema receiving complex decongestive physiotherapy
Management Strategies
Rethinking decongestive lymphoedema treatment during the pandemic- click for abstract
Rethinking decongestive lymphoedema treatment during the pandemic
During the course of the COVID-19 pandemic, lymphoedema and community clinicians have had to modify how they implement intensive treatments for patients with lymphoedema and chronic oedema. Using novel approaches to treat and move patients towards self-management regimes has enabled patients to be in control of their condition, particularly if they are unable to attend normal clinic appointments. This article explores how using Haddenham easywrap instead of time- and resource-intensive bandaging regimes, alongside the Haddenham LymphFlow Advance, as part of self-management programmes, can benefit patients’ quality of life, reduce costs and resource use and enable patients to self-manage this long-term chronic condition more effectively.
Reducing Circumference and Volume in Upper Extremity Lipedema: The Role of Complex Decongestive Physiotherapy - click for abstract
Reducing Circumference and Volume in Upper Extremity Lipedema: The Role of Complex Decongestive Physiotherapy
Objective: The aim of this study is to investigate the effect of complex decongestive physiotherapy (CDP) plus intermittent pneumatic compression (IPC) applications on upper extremity circumference and volume in patients with lipedema.
Methods and Results: All participants included in the study were included in a treatment protocol consisting of CDP and IPC. The Perometer 400 NT was used in the measurement of upper extremity volume and circumference before and after treatment. The measurements were performed in four reference points. According to the Perometer results before and after CDP, statistically significant reduction was found in the circumference of 3 of the 4 points of measurements performed in each of the left and right upper extremities. When the volume assessments were compared, it was seen that statistically significant reduction was found in the volume of both limbs.
Conclusion: A treatment program consisting of CDP and IPC can be effective in reducing the circumference and volume of the arm in patients with upper extremity lipedema. So, CDP applications can help prevent the development of complications such as lipolymphedema, hypertension, and heart failure.
Lymphoedema after head and neck cancer treatment: an overview for clinical practice - click for abstract
Lymphoedema after head and neck cancer treatment: an overview for clinical practice
Lymphoedema is a disorder of the lymphatic system that presents as an atypical swelling and accumulation of protein-rich fluid within the interstitial spaces. Head and neck lymphoedema (HNL) is highly prevalent in patients who have been treated for head and neck cancer (HNC) and may manifest externally on the face and neck; internally within the oral cavity, pharynx or larynx; or as a combination of both. HNL is known to contribute to a wide range of physical, functional and psychological issues, and presents several unique challenges in terms of its management. This review article provides an overview of HNL for clinicians and aims to improve awareness of this condition and the impact it has on patients.
Lymphoedema and oedema in palliative care patients - click for abstract
Lymphoedema and oedema in palliative care patients
Long-Term Effectiveness of Combined Intermittent Pneumatic Compression Plus Low-Level Laser Therapy in Patients with Postmastectomy Lymphedema: A Randomized Controlled Trial - click for abstract
Long-Term Effectiveness of Combined Intermittent Pneumatic Compression Plus Low-Level Laser Therapy in Patients with Postmastectomy Lymphedema: A Randomized Controlled Trial
Study on the Design and Optimization of a Portable Monitoring and Auxiliary Treatment Device for Upper Extremity Lymphedema-Focus on the Rehabilitation Function of the Device - click for abstract
Study on the Design and Optimization of a Portable Monitoring and Auxiliary Treatment Device for Upper Extremity Lymphedema-Focus on the Rehabilitation Function of the Device
Treatment of breast cancer-related lymphedema using negative pressure massage: a pilot randomized controlled trial - click for abstract
Treatment of breast cancer-related lymphedema using negative pressure massage: a pilot randomized controlled trial
Effect of Aqua Therapy Exercises on Postmastectomy Lymphedema: A Prospective Randomized Controlled Trial - click for abstract
Effect of Aqua Therapy Exercises on Postmastectomy Lymphedema: A Prospective Randomized Controlled Trial
Development and Evaluation of a Satisfaction Questionnaire About Therapeutic Textile Devices Used for Breast Cancer-Related Lymphedema - click for abstract
Development and Evaluation of a Satisfaction Questionnaire About Therapeutic Textile Devices Used for Breast Cancer-Related Lymphedema
Postural differences in the immediate effects of active exercise with compression therapy on lower limb lymphedema - click for abstract
Postural differences in the immediate effects of active exercise with compression therapy on lower limb lymphedema