Hot off the Press October 2022

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

Physiological, Pathological, and Circadian Factors Impacting Skin Hydration

Jose V Camilion, Siya Khanna, Sheela Anasseri, Coral Laney, Harvey N. Mayrovitz
Cureus. 2022 Aug 4;14(8)

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A prospective observational cohort study examining the development of head and neck lymphedema from the time of diagnosis

Amanda Pigott, Bena Brown, Nicole White, Steven McPhail, Sandro Porceddu, Howard Liu, Claire Jeans, Ben Panizza, Jodie Nixon. Asia Pac J Clin Oncol. 2022 Sep 13.

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Prevalence and Risk Factors

Correlation between Lymphatic Surgery Outcome and Lymphatic Image-Staging or Clinical Severity in Patients with Lymphedema

Hirofumi Imai, Shuhei Yoshida, Toshiro Mese, Solji Roh, Asuka Fujita, Ayano Sasaki, Shogo Nagamatsu, Isao Koshima. J Clin Med. 2022 Aug 25;11(17):4979.

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Five-year results after total knee arthroplasty in lymphoedema and lipoedema: encouraging functional and clinical outcomes and low rates of infection

Luke Granger, Scott M Bolam, Avtar Sur, Philip Mitchell, Jonathan Hutt, Nemandra A Sandiford. Int Orthop. 2022 Sep 8.
BACKGROUND: The aim of this study was to define outcomes after total knee arthroplasty (TKA) in lymphoedema and lipoedema patients managed by a multidisciplinary team and daily compression bandaging.
METHODS: A retrospective study was performed in a single centre. Between 2007 and 2018, 36 TKA procedures were performed on 28 consecutive patients with a diagnosis of lymphoedema and lipoedema. Oxford Knee Scores (OKS), EuroQol-5D (EQ-5D) scores, satisfaction scores, radiographs, and complications were obtained at the final follow-up. Patients were admitted to the hospital up to two weeks prior to surgery and remained on the ward for daily compression bandaging by the specialist lymphoedema team.
RESULTS: Over the study period, 36 TKAs were performed on 28 patients (5 males, 23 females) with a mean age of 71 years (range 54-90). Of these, 30 TKAs were in patients with lymphoedema, five with lipoedema, and one with a dual diagnosis. Overall, 28 TKAs (21 patients) were available at the final follow-up with a mean follow-up time of 61 months (range 9-138). The mean BMI was 38.5 kg/m2. The mean pre-operative and post-operative Oxford Knee Score increased from 18 (range 2-38) to 29 (range 10-54); p < 0.001. EQ-5D score increased from 0.48 (range 0.15-0.80) to 0.74 (0.34-1.00) (p < 0.001). Mean post-operative satisfaction was 7.6/10 (range 2-10), with 89.3% TKAs satisfied. Complications were one (4%, 1/28) deep vein thrombosis, one superficial wound infection, one prosthetic joint infection, one stiff knee requiring manipulation, and one intra-operative femoral fracture.
CONCLUSIONS: Lymphoedema and lipoedema should not be seen as barriers to TKA if adopting a multidisciplinary approach.

Analysis of the factors and moderating role of self-care ability among patients with breast cancer-related lymphedema

Wenting Jiang, Lijun Chen. J Clin Nurs. 2022 Sep 13.
AIMS AND OBJECTIVES: To analyse the status quo and influencing factors of self-care ability in breast cancer-related lymphedema (BCRL) patients and explore the moderating role of social support between self-efficacy and self-care ability, to provide references for clinical intervention.
BACKGROUND: The ‘gold standard’ for the treatment of lymphedema is two-stage Complete Decongestion Therapy (CDT). Due to the high frequency of patients seeking treatment and CDT is not covered by medical insurance, resulting the medical cost is high, and a set integrated course of edema treatment cannot be completed. Nevertheless, with sufficient self-care ability, patients can reduce the frequency of outpatient and inpatient treatments, and initiate detumescence procedures with affordable home care. Accordingly, it is necessary to pay attention to the self-care ability of BCRL patients.
DESIGN: A descriptive and cross-sectional study following the STROBE guideline checklist.
METHODS: From June 2021 to January 2022, 156 BCRL patients were selected as convenience samples. Questionnaires were administered to the patients using the sociodemographic information questionnaire, the exercise of self-care agency scale, Chinese version of strategies used by people to promote health, and social support rating scale. Spearman rank correlation was used to analyse the relationship among the three, and univariate and multiple linear regression were used for factor analysis and process to explore the moderating role of social support.
RESULTS: The total score of self-care ability of BCRL patients was 41.00 (32.50, 51.00). The self-efficacy and social support of BCRL patients were positively correlated with the total score and its dimensions of self-care ability. Disease duration, severity and difficulty raising limbs were negative correlation factors influencing the self-care ability of BCRL patients, and self-efficacy and social support were positive correlation factors, which could explain 77.8% of the total variation. The moderating role of social support between self-efficacy and self-care ability was significant, and its moderating role boundary value was 15.70.
CONCLUSIONS: The self-care ability of BCRL patients is at a low level. The longer duration of lymphedema, the more serious degree of edema, the more difficulty raising limbs, the lower self-efficacy and the less social support, the poorer self-care ability of BCRL patients. Self-efficacy has a greater impact on the self-care ability of patients with high levels of social support.
RELEVANCE TO CLINICAL PRACTICE: Factors and moderator-based models are the first to identify predictors of self-care ability and the moderating role of social support in Chinese BCRL patients, which may facilitate healthcare practitioners to develop appropriate interventions to manage self-care ability.

Assessment

Outcomes of lipectomy in patients with advanced unilateral upper extremity lymphedema with regard to the difference in time required for indocyanine green to reach the axilla: A retrospective cohort study in a single center

Ryuck Seong Kim, Changryul Claud Yi, Jae Woo Lee, Jin A Yoon, Seungbeom Lee, Joo Hyoung Kim. Medicine (Baltimore). 2022 Sep 16;101(37)

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Bioelectrical impedance analysis for early screening of upper limb subclinical lymphedema: A case-control study

Linli Zhuang, Huaying Chen, Xuemei Zheng, Shaoyong Wu, Youhui Yu, Lu Lan, Liang Xu, Jumei Xu, Hongying Fan. PLoS One. 2022 Sep 19;17(9)

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A Pilot Study of Determining the Reliability of a New Three-Dimensional Scanning System for Measuring Truncal Thickness After Breast Cancer Surgery

Fumiya Hisano, Sachiyo Watanabe, Shiori Niwa, Keisuke Nakanishi, Ayana Mawaki, Yukari Takeno, Kaoru Murota, Ikumi Honda, Etsuko Fujimoto, Chika Oshima. Lymphat Res Biol. 2022 Sep 16
 

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Reliability and Measurement Error of Breast Volume Calculation Using Three-Dimensional Surface Imaging

Nicola Fearn, Farid Meybodi, Sharon Kilbreath, Elizabeth Dylke, Catalina Llanos, Carmen Swanton, Kirsty Stuart. Lymphat Res Biol. 2022 Sep 26.
Breast lymphedema after breast cancer is challenging to quantify. Three-dimensional (3D) surface imaging is one available technique to measure breast volume, however, the measurement properties of available software programs have not been fully determined. The aim of this study was to determine equivalency of measurements with two software programs as well as reliability, standard error of measurement (SEM), and smallest detectable change (SDC). Methods and Results: Retrospective three-dimensional surface imaging (3D-SI) of 100 breasts taken before or after breast conserving surgery for breast cancer were retrieved for reliability analysis. Three assessors followed a standardized measurement technique using two software programs, Vectra® 3D Analysis Module (VAM) and Breast Sculptor®. Mean breast volume was 489.9 ± 206 cc using VAM and 480.1 ± 229.1 cc using Breast Sculptor. Lin’s concordance showed poor agreement between programs (0.81-0.88). Measurements using VAM had excellent intra- and inter-rater reliability with SEM = 4.1% for one assessor and 8.7% for multiple assessors. Breast Sculptor also had excellent intra-rater and substantial inter-rater reliability but the SEM was much larger at 14.5% (intra-rater) and 19.1% (inter-rater). The SDC value was lowest for VAM and a single rater with 56 cc indicating a meaningful change beyond measurement error. Conclusion: Breast volume measurements captured with 3D-SI using VECTRA-XT are highly reliable, but the volumes, SEM, and SDC varied between the two software programs. Measurement error was lowest with VAM software. Although the usefulness of VECTRA-XT and VAM software to detect change in breast volume is promising, further solutions to reduce measurement error are required to improve clinical utility to measure breast lymphedema.

Management Strategies

Effectiveness of Mobiderm® bandages in the treatment of cancer-related secondary lymphedema: A pilot study

Sung Cheol Cho, Sang Gyu Kwak, Hee Kyung Cho. Medicine (Baltimore). 2022 Sep 2;101(35):e30198.
 

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

Mary S Dietrich, Katrina Gaitatzis, Louise Koelmeyer, John Boyages, Vandana G Abramson, Sarah A McLaughlin, Nicholas Ngui, Elisabeth Elder, James French, Jeremy Hsu, T Michael Hughes, Deonni P Stolldorf, Chirag Shah, Sheila H Ridner. Lymphat Res Biol. 2022 Sep 20. 

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Effectiveness of six-step complex decongestive therapy for treating upper limb lymphedema after breast cancer surgery

Hui-Zhen Zhang, Qiao-Ling Zhong, Hui-Ting Zhang, Qing-Hua Luo, Hai-Lin Tang, Li-Juan Zhang. World J Clin Cases. 2022 Sep 6;10(25):8827-8836

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Multidisciplinary preventive intervention for breast cancer-related lymphedema: An international consensus

Patricia Martínez-Jaimez, Pilar Fuster Linares, Neil B. Piller, Jaume Masia, Takumi Yamamoto, Luis López-Montoya, Cristina Monforte-Royo. Eur J Cancer Care (Engl). 2022 Sep 1

OBJECTIVE: To establish a consensus regarding the multidisciplinary prevention of breast cancer-related lymphedema (BCRL), taking into account the expert opinion of professional groups from across the world involved in the identification and treatment of breast cancers.

METHODS: International consensus study involving a modified nominal group and Delphi process. A total of 50 preventive strategies representing those used by a range of health disciplines involved in breast cancer care were identified by the nominal group. These strategies were categorised into four subgroups (general recommendations, therapeutic approach, rehabilitation medicine and physiotherapy and dietary recommendations) and presented in survey format to a multidisciplinary panel of experts in a two-round Delphi process. Eleven specialist areas and 15 countries were represented on the panel.

RESULTS: Twenty-seven experts responded to both Delphi rounds, and the mean overall agreement after Round 2 was 85.7%. Of the 50 proposed strategies for preventing BCRL, 48 yielded consensus among experts.

CONCLUSION: We report an international consensus for the multidisciplinary prevention of BCRL, setting out recommendations aimed at systematising the care of women with breast cancer. The consensus could provide a platform for the development of standardised clinical guidelines.

Cancer Optimal Care PathwayHot off the Press November 2022