Hot off the Press November 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

Etiology and treatment of cancer-related secondary lymphedema - click for abstract

Etiology and treatment of cancer-related secondary lymphedema

Michael J. Bernas, Sara Al-Ghadban, Saskia R. J. Thiadens, Karen Ashforth, Walter C. Lin, Bauback Safa, Rudolf Buntic, Michael Paukshto, Alexandra Rovnaya, Margaret McNeely. Clin Exp Metastasis. 2023 Sep 30.

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

A 3D biomimetic model of lymphatics reveals cell-cell junction tightening and lymphedema via a cytokine-induced ROCK2/JAM-A complex - click for abstract

A 3D biomimetic model of lymphatics reveals cell-cell junction tightening and lymphedema via a cytokine-induced ROCK2/JAM-A complex

Esak Lee, Siu-Lung Chan, Yang Lee, William J. Polacheck, Sukyoung Kwak, Aiyun Wen, Duc-Huy T. Nguyen, Matthew L. Kutys, Stella Alimperti, Anna M. Kolarzyk, Tae Joon Kwak, Jeroen Eyckmans, Diane R. Bielenberg, Hong Chen, Christopher S. Chen. Proc Natl Acad Sci U S A. 2023 Oct 10. Epub 2023 Oct 2.

Impaired lymphatic drainage and lymphedema are major morbidities whose mechanisms have remained obscure. To study lymphatic drainage and its impairment, we engineered a microfluidic culture model of lymphatic vessels draining interstitial fluid. This lymphatic drainage-on-chip revealed that inflammatory cytokines that are known to disrupt blood vessel junctions instead tightened lymphatic cell-cell junctions and impeded lymphatic drainage. This opposing response was further demonstrated when inhibition of rho-associated protein kinase (ROCK) was found to normalize fluid drainage under cytokine challenge by simultaneously loosening lymphatic junctions and tightening blood vessel junctions. Studies also revealed a previously undescribed shift in ROCK isoforms in lymphatic endothelial cells, wherein a ROCK2/junctional adhesion molecule-A (JAM-A) complex emerges that is responsible for the cytokine-induced lymphatic junction zippering. To validate these in vitro findings, we further demonstrated in a genetic mouse model that lymphatic-specific knockout of ROCK2 reversed lymphedema in vivo. These studies provide a unique platform to generate interstitial fluid pressure and measure the drainage of interstitial fluid into lymphatics and reveal a previously unappreciated ROCK2-mediated mechanism in regulating lymphatic drainage.:10.1073

Prevalence and Risk Factors

Is it the Type of Axillary Surgery or the Number of Removed Lymph Nodes That Increases the Risk of Breast Cancer Related Lymphedema (BCRL)? Results from a Prospective Screening Trial- click for abstract

Is it the Type of Axillary Surgery or the Number of Removed Lymph Nodes That Increases the Risk of Breast Cancer Related Lymphedema (BCRL)? Results from a Prospective Screening Trial

G.E. Naoum, B Juhel, H Ababneh, A.M. Shui, L Bucci, A Jung, C.L. Brunelle, A.G. Taghian. Int J Radiat Oncol Biol Phys. 2023 Oct 1

 PURPOSE/ OBJECTIVE(S): Axillary surgery has been identified as the main risk factor for BCRL regardless the delivery of regional nodal radiation (RLNR). Yet it remains unknown if it is the type of axillary surgery or the number of removed lymph nodes (LN) that increases BCRL risks.

MATERIALS/ METHODS: Between 2008 and 20., 3,350 patients (pts) who received surgery for breast cancer were enrolled in a lymphedema screening trial. Patients with bilateral breast cancer or without axillary surgery were excluded. Perometry was used to assess limb volume preoperatively in all patients. BCRL was defined as a ≥10% relative arm-volume increase arising >3 months postoperatively. The cohort was divided by axillary surgery type: axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB). Radiation was delivered using 3D conformal technique and RLNR was defined as the usage of anterior supraclavicular field. No hypofractionation was used and doses ranged between 50 and 50.4 Gy in 25-28 fractions. Multivariable Cox proportional hazard models compared the cumulative incidence of BCRL and local failure between different patient groups.

RESULTS: After applying inclusion criteria, 2,623 pts were available with overall median follow-up s of 6.1 years. Of the entire cohort, 709 (27%) had ALND with a median of 16 LN removed, while 1,914 (73%) received SLNB only with a median of 2 LN removed. The median number of malignant LN and patients receiving RLNR was higher in ALND group compared to SLNB only group. Frequency distribution analysis showed that the main overlap between ALND and SLNB only groups happen in the range of 3-11 LN removed. Therefore, the primary analysis focused only on pts with 3-11 LN across both groups (n = 690: ALND n = 140, SLNB n = 550). The multivariable model adjusted for BMI, RLNR, age and breast surgery showed that in this group with 3-11 LN removed in both cohorts, ALND remained significantly associated with BCRL (HR: 4.2, p<0.0001). Separate analyses for the entire SLNB only group and ALND groups were conducted to evaluate if the BCRL risk increases per each removed LN within the same axillary surgery group. The multivariable analysis for SLNB only pts(N = 1,914) showed that for each LN removed the risk of BCRL did not increase significantly (HR:1.06, p = 0.3), similarly for ALND group (N = 709) for each LN removed (HR:1.02, p = 0.08). For pts with pathologic disease and clinical node negative without neoadjuvant chemotherapy receiving ALND, the number of LN removed did not significantly improve neither Local control (HR:1.02, p = 0.8) nor distant disease survival (HR:1.01, p = 0.6). CONCLUSION: ALND procedure per se is the main risk factor for BCRL not the number of LNs removed. For high-risk pts with >N2 disease, aggressive ALND did not improve tumor outcome. De-escalation with targeted axillary sampling followed by RLNR should be evaluated. Future lymphedema research should account for type of axillary surgery instead of number of LNs removed as a factor.

Identification and Dosimetric Analysis of Axillary Substructures Associated with Breast Cancer Related Lymphedema- click for abstract

Identification and Dosimetric Analysis of Axillary Substructures Associated with Breast Cancer Related Lymphedema

J.Q. Huang, S.Y. Zheng, L Cao, J.Y. Chen. Int J Radiat Oncol Biol Phys. 2023 Oct 1.S):S177.

PURPOSE/ OBJECTIVE(S): It has been hypothesized that substructures in the axillary region may be involved in the development of upper limb lymphedema in breast cancer patients. We aimed to compare dosimetric parameters of different substructures to identify risk regions and dose indicators related to the development of lymphedema.
MATERIALS/ METHODS: A total of 486 patients with breast cancer treated with axillary node dissection (ALND) and regional node irradiation (RNI) between 2017 and 20. were analyzed. Ten axillary substructures were retrospectively contoured, and dose-volume histogram (DVH) parameters (maximum dose [Dmax], Dmean, Dmin, V5 Gy, V10 Gy, V15 Gy, V20 Gy, V25 Gy, V30 Gy, V35 Gy, V40 Gy, V45 Gy and V50 Gy) were evaluated. EQD2 using α/β = 3 was applied for hypofractionation.
RESULTS: The cumulative incidence of lymphedema was 32.5% during the median follow-up of 25 month (IQR 15-35). Higher BMI (≥21.77 kg/m2, hazard ratio [HR]1.6, 95% CI 1.1-2.3, p = 0.019) and higher number of dissected lymph nodes (≥13, HR 1.8, 95% CI 1.1-3.0, p = 0.026) were baseline risk factors associated with breast cancer related lymphedema (BCRL). A cohort of 196 patients was obtained by propensity score matching based on the above two factors (154 treated with 50 Gy/25 fractions [Fx] and 42 with 40.05 Gy/15Fx). The optimal metric was axillary-lateral thoracic vessel juncture (ALTJ) Dmean ≥36.84 Gy (HR 3.7, 95% CI 1.6-8.6, p = 0.002). Other significant risk factors are Medial of Axillary Nodes level I(ALN-I-M) Dmin <9.19 Gy (HR 2.3, 95% CI 1.4-3.7, p = 0.001) and Posterior of Axillary Nodes level II(ALN-II-P) Dmax <52.75 Gy (HR 2.0, 95% CI 1.2-3.5, p = 0.015). A nomogram incorporated the above three parameters was created to predict the risk of lymphedema with reasonable accuracy confirmed by both self-training (area under curve [AUC], 0.76; 95% CI, 0.67-0.84) and internal validation (AUC 0.66; 95% CI, 0.50-0.80).
CONCLUSION: A mean dose of 36.84 Gy of ALTJ may be a suggested dose limit for patients indicated RNI after ALND, especially when patients with higher BMI and higher dissected nodes. Ideally, avoidance of ALTJ may be realized without compromising dose coverage to high-risk nodal region. Confirmation of this finding in future prospective studies is needed.:10.1016/j.ijrobp.2023.06.648

Incidence, Radiologic and Dosimetric Parameters Associated with Radiation Induced Breast Lymphedema - click for abstract

Incidence, Radiologic and Dosimetric Parameters Associated with Radiation Induced Breast Lymphedema

L Hasnain, H Kang, F Vaince, K Ganesh, K Gomez, V Gahtan, W Small, T Refaat. Int J Radiat Oncol Biol Phys. 2023 Oct 1.S):.

PURPOSE/ OBJECTIVE(S): Radiation induced breast lymphedema (BL) is an underreported but common finding. This study aimed to report the incidence of clinical BL and investigate the radiologic and dosimetric parameters associated with higher risk of BL.
MATERIALS/ METHODS: This IRB approved study included women with breast cancer who underwent breast conservative surgery followed by adjuvant radiation therapy between 2019 and 20. at our institution. We reviewed the eligible patients’ charts for incidence of clinical BL resulting in symptoms and requiring physical therapy referral. Thickness of the skin at defined center and bottom points of the breast was measured for patient’ baseline and follow up mammograms. Dosimetric parameters were imported from patients’ radiation plans including mean, maximum doses, and volumes receiving 20, 30, 40, & 50 Gy (V20, V30, V40, & V50), of the whole breast (WB), breast_eval (BE), and breast skin (BS) (defined as the superficial 5 mm of the skin). A chi-square test was used to test the association between clinical BL and radiation treatment regimens and beam energies and the association of skin thicknesses between those who had clinical BL and those who did not. A Wilcoxon rank sum test was used to test the association of the dosimetric parameters with clinical BL.
RESULTS: We identified 268 patients who were eligible for the study. After chart and radiologic review, 119 patients had complete records available and were included in this study. Twenty-nine patients (24.4%) of the patients presented with symptomatic BL. Most patients (68%) received hypofractionated (42.56 Gy with or without 10 Gy boost), while 25% received conventional and 7% received ultra-hypofractionated radiotherapy. There was no association between the fractionation and incidence of BL (p = 0.4). There was no association between breast size and BL (mean 1065 cc vs 1232 cc, p = 0.35). There was significant association between BL and BS V30 (142cc vs 162 cc, p = 0.02), and BS V40 (82 cc vs 102 cc, p = 0.02), and a trend towards significant association with BS V20 (172cc vs. 193cc, p = 0.08), BS V50 (8 cc vs. 16 cc, p = 0.06). There was no significant association between BL and BS mean dose (36.9 Gy vs 39 Gy p = 0.11), or BS max dose (53.9 Gy vs 54.1 Gy, p = 0.21). None of the dosimetric parameters of WB and BE had significant association with clinical BL. Utilizing ROC analysis, there was significant association between clinical BL and the change of baseline mammogram breast skin thickness and skin thickness at 6 months follow up mammograms (+13 mm center point p = 0.04, +9 mm bottom point p<0.5), and at 12 months mammograms (+15 mm center point p<0.5, +11 mm bottom point p<0.5).
CONCLUSION: Almost 1 in 4 women experienced radiation induced BL in our cohort. BS V30 & V40 are significantly associated with higher risk of BL. There was significant association between increased skin thickening in 6- and 12-months follow up mammograms and BL. Further analysis will follow to assess the association between surgical and clinical characteristics and BL

Analysis of the Risk Factors of Breast Cancer-Related Lymphedema and Construction and Evaluation of a Prediction Model - click for abstract

Analysis of the Risk Factors of Breast Cancer-Related Lymphedema and Construction and Evaluation of a Prediction Model

Hui Li, Wei-Bo Li, Zeng-Xin Sun, Jing Yu, Pei-Yuan Lv, Chun-Xiao Li, Xiao Liang, Yin Yu, Zhen-Biao Zhao, Lymphat Res Biol. 2023 Sep 28.

Objective: The occurrence of breast cancer-related lymphedema (BCRL) in postoperative breast cancer survivors is described and the independent risk factors of BCRL are analyzed. A BCRL nomogram prediction model is constructed, and its effectiveness is evaluated to screen out high-risk patients with BCRL.
Methods: A univariate analysis was carried out to determine the risk factors possibly related to BCRL, and a logistic regression analysis was utilized to determine the independent risk factors related to BCRL. A BCRL nomogram prediction model was built, and a nomogram was drawn by R software v4.1.0. The area under the curve (AUC) of the receiver operating characteristic (ROC) and the Hosmer-Lemeshow test were used to evaluate the efficacy of the constructed model to assess its clinical application value.
Results: The risk factors independently associated with BCRL were body mass index (BMI), handedness on the operation side, no BCRL-related rehabilitation plan, axillary lymph node dissection (ALND), taxane-based chemotherapy, and radiotherapy (all p < 0.05). The BCRL nomogram prediction model was built on this basis, and the results of the efficacy evaluation showed a good fit: AUC = 0.952 (95% confidence interval: 0.930-0.973) for the ROC and χ2 = 6.963, p = 0.540 for the Hosmer-Lemeshow test.
Conclusions: The risk factors for BCRL included higher BMI, handedness on the operation side, no BCRL-related rehabilitation plan, ALND, taxane-based chemotherapy, and radiotherapy. In addition, the BCRL nomogram prediction model accurately calculated the risk of possible BCRL among breast cancer survivors and effectively screened for high-risk patients with BCRL. Therefore, this prediction model can provide a basis for rehabilitation physicians and therapists to formulate early and individualized prevention and treatment programs

The role of aromatase inhibitors in slim women with breast cancer-related lymphoedema: a reflective case series - click for abstract

The role of aromatase inhibitors in slim women with breast cancer-related lymphoedema: a reflective case series

Clare Anvar. Br J Community Nurs. 2023 Oct 1.Sup10):.

BACKGROUND: This case series follows the reflective processes undertaken, when five slim women presented with reactive oedemas of the forearm and hand, that did not respond to usual therapy.
AIM: To raise awareness about Aromatase Inhibitor (AI), Letrozole.
METHODS: Possible causes, including Cyclin-Dependent Kinase 4 and 6 (CDK4/6) inhibitors, Ribociclib and Axillary Web Syndrome, were explored and reviewed, and potential effective treatment options were then sought. New cases presented, which discounted each theory, until Letrozole was suspected.
RESULTS: Inflammatory oedemas were explained by the mechanisms-of-action relating to Aromatase Inhibitor Associated Musculoskeletal Syndrome (AIMSS), the severity of which, especially for slim women with oestrogen deprivation, causes almost 50% of women to cease treatment within 6 months; risking disease reoccurrence.
CONCLUSION: Permissions were gained, a table was collated and sent to referring consultants, requesting risk/benefit analysis of Letrozole with a medication review. If non-responsive, inflammatory oedemas present in clinic, AIs should be considered as a trigger.

Axillary Treatment and Chronic Breast Cancer-Related Lymphedema: Implications for Prospective Surveillance and Intervention From a Randomized Controlled Trial - click for abstract

Axillary Treatment and Chronic Breast Cancer-Related Lymphedema: Implications for Prospective Surveillance and Intervention From a Randomized Controlled Trial

John Boyages, Frank A. Vicini, Behnaz Azimi Manavi, Richelle L. Gaw, Louise A. Koelmeyer, Sheila H. Ridner, Chirag Shah. JCO Oncol Pract. 2023 Oct 10.

PURPOSE: The PREVENT randomized trial assessed progression to chronic breast cancer-related lymphedema (cBCRL) after intervention triggered by bioimpedance spectroscopy (BIS) or tape measurement (TM). This secondary analysis identifies cBCRL risk factors on the basis of axillary treatment.

METHODS: Between June 2014 and September 2018, 881 patients received sentinel node biopsy (SNB; n = 651), SNB + regional node irradiation (RNI; n = 58), axillary lymph node dissection (ALND; n = 85), or ALND + RNI (n = 87). The primary outcome was the 3-year cBCRL rate requiring complex decongestive physiotherapy (CDP).

RESULTS: After a median follow-up of 32.8 months (IQR, 21-34.3), 69 of 881 patients (7.8%) developed cBCRL. For TM, 43 of 438 (9.8%) developed cBCRL versus 26 of 443 (5.9%) for BIS (P = .028). The 3-year actuarial risk of cBCRL was 4.4% (95% CI, 2.7 to 6.1), 4.2% (95% CI, 0 to 9.8), 25.8% (95% CI, 15.8 to 35.8), and 26% (95% CI, 15.3 to 36.7). Rural residence increased the risk in all groups. For SNB, neither RNI (SNB, 4.1% v SNB + RNI, 3.4%) nor taxane (4.4%) increased cBCRL, but risk was higher for patients with a BMI of ≥30 (6.3%). For SNB + RNI, taxane use (5.7%) or supraclavicular fossa (SCF) radiation (5.0%) increased cBCRL. For ALND patients, BMI ≥25 or chemotherapy increased cBCRL. For ALND + RNI, most patients received SCF radiation and taxanes, so no additional risk factors emerged.

CONCLUSION: The extent of axillary treatment is a significant risk factor for cBCRL. Increasing BMI, rurality, SCF radiation, and taxane chemotherapy also increase risk. These results have implications for a proposed risk-based lymphedema screening, early intervention, and treatment program.:10.1200.00060

Obesity and Taxanes are Independent Risk Factors for Postmastectomy Lymphedema: A TriNetX Based Analysis

Eldaly, Abdullah; Torres-Guzman, Ricardo MD; Maita, Karla MD; Borna, Sahar MD; De Sario Velasquez, Gioacchino MD; Forte, Antonio MD, PhD, MS; Ho, Olivia MD, MMSc, MPH, FRCSC, FACS. Plastic and Reconstructive Surgery – Global Open 11(10S):p 28, October 2023.

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Effects of Body Positioning When Assessing Lymphedema of the Lower Limb Using Bioimpedance Spectroscopy - click for abstract

Effects of Body Positioning When Assessing Lymphedema of the Lower Limb Using Bioimpedance Spectroscopy

Louise A. Koelmeyer, Katrina Gaitatzis, Belinda Thompson, Leigh C. Ward. Lymphat Res Biol. 2023 Oct 17.

Background: Bioimpedance spectroscopy (BIS) measurements are conventionally performed in supine position with a lead device attached to gel-backed electrodes, and more recently, with a stand-on device that uses fixed stainless-steel electrodes under the hands and feet. The aim of this study was to assess and compare BIS measurements made in supine, sitting, and standing positions using lead and stand-on impedance devices in participants with and without unilateral leg lymphedema.
Materials and Methods: Participants with self-ascribed unilateral leg lymphedema (n = 24) and healthy controls (n = 71) were recruited using a cross-sectional study design. Triplicate BIS measurements were taken for each device in each position.
Results: Impedance measurements with either device were reliable with coefficient of variation of 0.6% or lower. The magnitude of mean differences in absolute impedance values between devices were between 1% and 6% dependent on condition. L-Dex scores between the two devices were highly correlated (r = 0.82) and ∼70% of participants in the lymphedema group were classified as having lymphedema using the recommended cut-off with either device. There was no significant interleg difference of controls using the lead device; however, small, but significant differences (p = 0.0001) were found when using the stand-on device.
Conclusion: The findings demonstrate that reliable impedance measurements of the legs can be made with either device in lying, sitting, or standing positions. However, data between the devices were not directly interchangeable. Although the risk of misidentification was small, reference ranges appropriate to the device and measurement position should be used when converting data to L-Dex scores.:10.1089.0108

Indocyanine Green Lymphography in Conservative Lymphedema Therapy: A Scoping Review - click for abstract

Indocyanine Green Lymphography in Conservative Lymphedema Therapy: A Scoping Review

Trevethan, Megan BOccThy1; Patterson, Freyr BOccThy, PhD, MPH2; Doig, Emmah BOccThy(Hons), PhD3; Pigott, Amanda BOccThy(Hons), PhD4. Rehabilitation Oncology 41(4):p 180-190, October 2023.


There is great potential but seemingly limited use of indocyanine green (ICG) lymphography to influence conservative lymphedema therapy clinical practice. This scoping review aimed to map existing evidence for ICG lymphography relating to conservative lymphedema therapy.


A 6-staged scoping review framework of Arksey and O’Malley was used to guide the study. Protocol development included key stakeholder consultation. Searches were conducted in 5 databases with specialist librarian support. A 2-phase selection process undertaken by 2 researchers identified studies for inclusion. Conflicts were resolved by consensus. A subsequent 3-phase data extraction and quality appraisal process occurred. Key findings were presented in a descriptive numerical summary.


A total of 6316 records were identified, yielding 162 articles for inclusion. Categorization was made according to article type and purpose of ICG lymphography including lymphedema assessment (diagnosis and staging) and/or conservative therapy. Seventy-six empirical research articles with detailed reference to ICG lymphography were explored further.


Current published research about ICG lymphography in conservative lymphedema therapy describes support for its use in lymphedema diagnosis, and proposes staging systems for lymphedema severity. Despite existing work, further exploration of effect on conservative therapy planning, clinical, and patient outcomes is necessary to consider future translation to clinical practice.

Barriers and facilitators to implementation of APTA’s breast cancer-related lymphedema diagnosis and intervention clinical practice guidelines - click for abstract

Barriers and facilitators to implementation of APTA’s breast cancer-related lymphedema diagnosis and intervention clinical practice guidelines

Elizabeth Campione, Meredith Wampler, Charlotte A. Bolch, Joseph J. Krzak. J Cancer Surviv. 2023 Oct 18.

PURPOSE: The purpose of this study was to identify barriers and facilitators influencing implementation of the diagnosis and intervention clinical practice guidelines (CPGs) related to the management of patients with breast cancer-related lymphedema (BCRL).
METHODS: A descriptive, cross-sectional web-based survey was conducted. Participants included physical therapists and assistants who were members of the APTA’s Academy of Oncologic Physical Therapy and Lymphology Association of North America. Desriptive statisitcs were computed for all demographic and barriers and facilitators data. Individual exploratory factor analyses (EFA) were performed on survey items for both CPGs to identify themes of barriers and facilitators to implementation.
RESULTS: A total of 180 respondents completed the survey. 34.9% of respondents read the diagnosis CPG and 22.4% read the intervention CPG. A total of 77.8% reported that they did not have issues in changing their clinical routines and 69.5% did not have resistance working according to CPGs. The EFA resulted in 3 themes for each CPG, accounting for 46% of the variance for the diagnostic CPG and 54% of the variance for the intervention CPG. The 3 themes, clinician characteristics, patient demographics, therapist practice setting and beliefs/values, were weighted differently for each EFA.
CONCLUSION: Most respondents did not read either CPG, however, report a willingness to make changes to clinical practice and utilization of CPGs. For those who have attempted to implement the CPGs, this study was the first to identify the barriers and facilitators impacting the implementation of the CPGs related to the management of BCRL.
IMPLICATIONS FOR CANCER SURVIVORS: The results will inform the development of targeted implementation strategies to improve access to and adherence to recommendations from the CPGs ultimately improving the efficiency and efficacy of care delivery to patients.:10.1007

Suffering of patients developing lymphedema following gynecological cancer surgery

Keiko Seki, Ayako Okutsu. J Rural Med. 2023 Oct 18.-214. Epub 2023 Oct 1.

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Test-Retest Reliability of a Protocol for Assessment of Local Tissue Water in the Head and Neck Area

CR Arends, L van der Molen, MWM van den Brekel, MM Stuiver.  Lymphatic Research and Biology, 2023

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Management Strategies

Overcoming lymphorrhoea: a step to achieve a better life with lymphoedema - click for abstract

Overcoming lymphorrhoea: a step to achieve a better life with lymphoedema

Francesca Ramadan. Br J Community Nurs. 2023 Oct 1.Sup10)

Lymphorrhoea-otherwise known as ‘wet’ or ‘leaky’ legs-is an increasingly common condition that many community nurses will encounter in their daily practice; however, until relatively recently, evidence-based literature on its management was limited, and treatment modalities only tackled the symptoms instead of addressing the cause. In this article, Francesca Ramadan highlights the devastating impact of this condition, and the resources available to community practitioners to assist their patients to live well with lymphoedema.:10.12968.28.Sup10.S7

Effectiveness of manual lymphatic drainage and intermittent pneumatic compression in lymphedema maintenance therapy - click for abstract

Effectiveness of manual lymphatic drainage and intermittent pneumatic compression in lymphedema maintenance therapy

Erika Mendoza, Felix Amsler. Vasa. 2023 Oct 16.

Background: To compare the effectiveness of intermittent pneumatic compression (IPC) and/or manual lymphatic drainage (MLD) associated to compression stockings in the maintenance treatment of lymphedema. Patients and methods: Patients in the maintenance phase of lymphedema therapy with MLD and compression since more than a year with stable values for weight and circumferences of ankle and calf were asked to participate in a study: Compression had to be worn daily, (1) 4 weeks IPC+MLD, (2) 4 weeks MLD alone, (3) 4 Weeks IPC alone (Order 1 and 3 was randomized). At the beginning and after each 4 weeks, circumference measurements (by hand and by machine: BT600®, Bauerfeind) were documented, pain and discomfort were assessed, and quality-of-life questionnaires were completed. Results: Of 20 participants, 18 (14 female, 4 male), mean age 59.6 years (48-89) could be evaluated. 11 subjects had bilateral, 7 unilateral, 5 primary, 13 secondary lymphedema since 2-20 years (mean 7.7), the subjects had received MLD and compression for 2-14 years (mean 6.4), 1-3 times per week (mean 1.5). The BMI ranged between 21 and 47 (mean 33.7). No differences between any phases were found for: Calf and thigh volume, circumference of calf. Only the ankle circumference was significant less (-0.22 cm) when using “both” (IPC+MLD). Compared to before the study, quality of life was better in all three phases, but with a significantly higher improvement in the phases with IPC than in the phases without. Conclusions: There were no differences in objective measurement between MLD alone, IPC alone or both, excepting the minimal significant difference in ankle circumference after IPC+MLD. QOL favored IPC application. Considering the economic consequences of these results, a change of maintenance therapy with MLD weekly over years in favor of permanent care with IPC and few appointments of MLD per year should be considered and further investigated

Effect of Conservative Rehabilitation Interventions on Health-Related Quality of Life in Women with Upper Limb Lymphedema Secondary to Breast Cancer: A Systematic Review

María Nieves Muñoz-Alcaraz, Antonio José Jiménez-Vílchez, Luis Ángel Pérula-de Torres, Jesús Serrano-Merino, Álvaro García-Bustillo, Rocío Pardo-Hernández, Jerónimo Javier González-Bernal, Josefa González-Santos. Healthcare (Basel). 2023 Sep 17..3390/healthcar

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Strategies in activating lymphatic system on symptom distress and health-related quality of life in patients with heart failure: secondary analysis of a pilot randomized controlled trial

Ruixia Liu, Jinbo Fang, Mei Rosemary Fu, Qingtong Meng, Minlu Li, Xiaoxia Zhang, Sarah R. Allred, Yuan Li. Front Cardiovasc Med. 2023 Sep 19

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Effect of Physical Therapy on Circumference Measurement and Extremity Volume in Patients Suffering from Lipedema with Secondary Lymphedema
Murat Esmer and Franz Josef Schingale. Lymphatic Research and Biology 223

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Application of Complete Decongestive Therapy in Patients with Secondary Bilateral Lower Limb Lymphedema after Comprehensive Treatment of Gynecological Malignant Tumor
Yuanli Zeng, Gaoming Liu, Zheng Peng, Jin Hu, and Anhui Zhang. Lymphatic Research and Biology 2023

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