Hot off the Press July 2023

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

A rare truncal collateral lymph drainage pathway seen on indocyanine green lymphography in patients with secondary lower limb lymphedema

Solji Roh, Isao Koshima, Toshiro Mese, Hirofumi Imai, Shuhei Yoshida, Shuji Yamashita. J Vasc Surg Cases Innov Tech. 2023 Feb 14

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Prevalence and Risk Factors

Quantifying radiation in the axillary bed at the site of lymphedema surgical prevention - click for abstract

Quantifying radiation in the axillary bed at the site of lymphedema surgical prevention

Rosie Friedman, Daphna Y. Spiegel, JacqueLyn Kinney, Julia Willcox, Abram Recht, Dhruv Singhal. Breast Cancer Res Treat. 2023 Jun 29.

PURPOSE: Immediate lymphatic reconstruction (ILR) is a procedure known to reduce the risk of lymphedema in patients undergoing axillary lymph node dissection (ALND). However, patients who receive adjuvant radiotherapy are at increased risk of lymphedema. The aim of this study was to quantify the extent of radiation at the site of surgical prevention.

METHODS: We recently began deploying clips at the site of ILR to identify the site during radiation planning. A retrospective review was performed to identify breast cancer patients who underwent ILR with clip deployment and adjuvant radiation therapy from October 2020 to April 2022. Patients were excluded if they had not completed radiotherapy. The exposure and dose of radiation received by the site was determined and recorded.

RESULTS: In a cohort of 11 patients, the site fell within the radiation field in 7 patients (64%) and received a median dose of 4280 cGy. Among these 7 patients, 3 had sites located within tissue considered at risk of oncologic recurrence and the remaining 4 sites received radiation from a tangential field treating the breast or chest wall. The median dose to the ILR site for the 4 patients whose sites were outside the radiation fields was 233 cGy.

CONCLUSION: Our findings suggest that even when the site of surgical prevention was not within the targeted radiation field during treatment planning, it remains susceptible to radiation. Strategies for limiting radiation at this site are needed.

Effect of illness perception on predicting breast cancer-related lymphedema risk management behaviours among breast cancer patients: A comparison between dimensions and profiles - click for abstract

Effect of illness perception on predicting breast cancer-related lymphedema risk management behaviours among breast cancer patients: A comparison between dimensions and profiles

Jing Chen, Ying Wang, Xia Luo, Yue Zhang, Xiaomin Zhang, Mingfang Li, Chenxia Xiong, Zijun Guo, Meng Zhao, Jun Yan. Int J Nurs Pract. 2023 Jul.

AIM: This study aimed to explore the utility of latent profile analysis of illness perception, in comparison to treating illness perception as several dimensions, to predict breast cancer-related lymphedema risk management behaviours among Chinese breast cancer patients.
METHODS: This is a 3-month longitudinal study. From August 2019 to January 2021, patients who recently underwent breast cancer surgery including axillary lymphadenectomy were recruited. Illness perception and risk management behaviours were measured by breast cancer-related lymphedema specific questionnaires before discharge following surgery (n = 268) and at 3 months postsurgery (n = 213), respectively.
RESULTS: Treating illness perception as several dimensions, ‘illness coherence’ and ‘timeline (cyclical)’ dimensions were found to be significantly associated with breast cancer-related lymphedema risk management behaviours. Using the latent profile analysis, two illness perception profiles were identified and significant differences were revealed in breast cancer-related lymphedema risk management behaviours between them. Overall, illness perception profiles explained smaller amounts of variability in breast cancer-related lymphedema risk management behaviours than illness perception dimensions.
CONCLUSION: Future studies could combine these two different perspectives of illness perception regarding breast cancer-related lymphedema into the design of interventions to improve breast cancer-related lymphedema risk management behaviours

Biomechanical alterations in lower limb lymphedema: Implications for walking ability and rehabilitation - click for abstract

Biomechanical alterations in lower limb lymphedema: Implications for walking ability and rehabilitation

Roberto Tedeschi. Phlebology. 2023 Jul.

BACKGROUND: Lymphedema is a chronic progressive disease that results in interstitial edema in the limbs, and to a lesser extent in the genitals and face, due to damage to the lymphatic system.
METHODS: Research was conducted between July 2022 and September 2022 in biomedical databases: PubMed, Cochrane Central Register of Controlled Trials (Cochrane Library), and PEDro.
RESULTS: Two studies showed that lymphedema alters gait parameters by affecting mainly kinematic parameters, although kinetic parameters were found to be significantly altered, especially in patients with severe lymphedema. In other studies, using methods such as videos and questionnaires, difficulties in walking were found in the presence of lymphedema. The most common abnormality was antalgic gait.
CONCLUSIONS: Poor mobility can worsen the edema, which, in turn, can compromise joint range of motion. Gait analysis is an essential tool to evaluate and follow

Assessment

Evaluation of incontinence and lymphedema in gynecological cancer patients along with their impact on the quality of life - click for abstract

Evaluation of incontinence and lymphedema in gynecological cancer patients along with their impact on the quality of life

Cevriye Mülkoğlu, Emine Merve Ersever, Burcu Duyur Çakıt. Support Care Cancer. 2023 Jul 3.

PURPOSE: The aim of this study is to evaluate the patients who developed both urinary incontinence and lymphedema in gynecological cancer survivors and to investigate the impact of these conditions on the quality of life among these patients.

METHODS: Our study included 56 patients who have lymphedema and urinary incontinence which started within first 2 years after surgery for gynecological cancer. We evaluated the presence of urinary incontinence by Overactive Bladder Assessment Tool (OABT) and Urogenital Distress Inventory (UDI). Incontinence Impact Questionnaire (IIQ-7) was used to assess the quality of life.

RESULTS: OABT and UDI scores were found to be statistically significantly increased in patients with grade 3 lymphedema (respectively p: 0.006, p: 0.008). A statistically significant difference was found between lymphedema grade patients in terms of IIQ-7 (p:0.002). The difference was statistically significant between the grade 1-3 (p:0.001) and grade 2-3 (p:0.013) groups. We did not find any correlation between age, type of cancer, radiotherapy, and urinary incontinence. There was a statistically significant positive correlation between BMI and OABT, UDI scores (respectively, r = 0.43, p = 0.001; r = 0.38, p = 0.003).

CONCLUSION: It was concluded that there was a relationship between urinary incontinence and grade 3 lymphedema in gynecological cancer survivors. Grade 3 lymphedema increases urinary incontinence and worsens daily living functions in these patients

Exploring women’s experiences of breast or trunk lymphoedema following treatment for breast cancer

Janet Ulman, Laura Serrant, Margaret Dunham, Heidi Probst. J Psychosoc Oncol. 2023 Jun 2

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Management Strategies

Early Intervention with a Compression Sleeve in Mild Breast Cancer-Related Arm Lymphedema: A 12-Month Prospective Observational Study - click for abstract

Early Intervention with a Compression Sleeve in Mild Breast Cancer-Related Arm Lymphedema: A 12-Month Prospective Observational Study

Karin Johansson, Katarina Blom, Lena Nilsson-Wikmar, Christina Brogårdh Cancers (Basel). 2023 May 9.

BACKGROUND: In our previous randomized controlled trial (RCT), the progression/no progression of mild breast cancer-related arm lymphedema (BCRL) was examined among women randomized to a compression group (CG) with a compression sleeve (compression class (ccl) 1) or not (NCG) for 6 months. In the present prospective study, BCRL in the CG and NCG was followed for 12 months.

METHODS: At the end of the RCT, 33 women with mild BCRL were eligible in the CG and 37 in the NCG. The proportional differences in no progression/progression of BCRL were defined as a >.% increase from start of RCT or exceeding 10% in the lymphedema relative volume as measured by the water displacement method. In addition, changes in the lymphedema relative volume and tissue dielectric constant ratio, which measures local tissue water, were examined. At the end of the RCT (i.e., after 6 months), a one-month break of the compression treatment was made in the CG. If the lymphedema relative volume progressed by definition, the compression treatment was resumed and continued, with follow-up of all women at 9 and 12 months.

RESULTS: A larger proportion of women in the NCG showed progression (57%, 61%, 67%) compared to the CG (16%, 22%, 31%) at 6, 9, and 12 months (p < 0.001, 0.005, 0.012), respectively. Twelve (33%) women in the NCG did not progress at all. No changes of the lymphedema relative volume and local tissue water were found over time at any follow-ups, but were stable on a low level.

CONCLUSIONS: To avoid the progression of mild BCRL into a chronic issue in the long-term, compression sleeve ccl 1 may be applied immediately after early diagnosis of mild BCRL

Predicting lymphedema self-management behaviours in breast cancer patients: A structural equation model with the Integrated Theory of Health Behaviour Change - click for abstract

Predicting lymphedema self-management behaviours in breast cancer patients: A structural equation model with the Integrated Theory of Health Behaviour Change

Aomei Shen, Peipei Wu, Wanmin Qiang, Xin Fu, Fangfang Wang, Fei Zhu, Lisha Pang, Lichuan Zhang, Qian Lu. J Adv Nurs. 2023 Jun 26.

AIMS: To explore predictors of lymphedema self-management behaviours among Chinese breast cancer survivors based on the Integrated Theory of Health Behaviour Change, and to clarify the interrelationship among these variables.

DESIGN: Further analysis of a multicentre cross-sectional and survey-based study.

METHODS: A total of 586 participants with breast cancer were recruited from December 2021 to April 2022 in different cities in China. We used self-reported questionnaires to collect data. Descriptive analysis, bivariate analysis and structural equation model were performed.

RESULTS: The Integrated Theory of Health Behaviour Change is suitable for predicting lymphedema self-management behaviours. The final structural model showed good model fit. Social support, self-efficacy and lymphedema knowledge positively affected lymphedema self-management behaviours, directly and indirectly. Self-regulation acted as a crucial mediator between these variables and self-management. The direct path between social support and self-regulation was not significant. Lymphedema knowledge and social support also influenced self-management via illness perception, self-efficacy and self-regulation, sequentially. These variables explained 55.9% of the variance in lymphedema self-management behaviours.

CONCLUSIONS: The modified model based on the Integrated Theory of Health Behaviour Change fitted well in predicting lymphedema self-management behaviours among breast cancer patients. Lymphedema knowledge, illness perception, self-efficacy, social support and self-regulation directly and indirectly influenced lymphedema self-management behaviours.

IMPACT: This study provides a theoretical basis for the assessment and interventions of lymphedema self-management behaviours in breast cancer patients. Lymphedema self-management behaviours should be assessed regularly and comprehensively, taking these predictors into consideration to identify potential barriers. Further research is needed to explore effective interventions integrating these significant predictors.

REPORTING METHOD: This study was reported following Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contributed to the design or conduct of the study, analysis or interpretation of the data, or in the preparation of the manuscript.

WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: This study focused on identifying and predicting mechanism of self-management based on a theory of behaviour change. The results can be applied among patients with other chronic diseases or high-risk populations, and inspire the assessment and interventions facilitating self-management behaviours.

STUDY REGISTRATION: This study was registered as an observational study at Chinese Clinical Trial Registry: http://www.chictr.org.cn (ChiCTR2200057084).

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: For breast cancer patients with poor lymphedema self-management behaviour, attention should be raised among nurses and involved healthcare staffs that lymphedema self-management is multi-faced. Strategies targeted at improving social support, self-regulation, knowledge, self-efficacy and illness perception should be also addressed in lymphedema self-management programs, to facilitate more effective improvement of lymphedema self-management behaviours

The Future of Lymphedema: Potential Therapeutic Targets for Treatment

Stav Brown, Adana C. Campbell, Kevin Kuonqui, Ananta Sarker, Hyeung Ju Park, Jinyeon Shin, Raghu P. Kataru, Michelle Coriddi, Joseph H. Dayan, Babak J. Mehrara. Curr Breast Cancer Rep. 2023 Jun.

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Data on the effects of The-Optimal-Lymph-Flow program on lymphedema symptoms in breast cancer survivors

Mei Rosemary Fu, Xinwen Du, Yuan Li, Lan Fu, Huaying Chen, Xiaoxia Zhang, Yuping Shui, Aihua Zhang, Xianqiong Feng. Data Brief. 2023 May 28.

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Effectiveness of physical exercise programmes in reducing complications associated with secondary lymphoedema to breast cancer: a protocol for an overview of systematic reviews

Raúl Alberto Aguilera-Eguía, Ruvistay Gutiérrez-Arias, Carlos Zaror, Pamela Seron. BMJ Open. 2023 Jul 10. 

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