Hot off the Press October 2024

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.

Prevalence and Risk Factors

Incidence of lymphedema related to various cancers

Marie-Eve Letellier, Marize Ibrahim, Anna Towers, Genevieve Chaput. Med Oncol. 2024 Sep 17.

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Characterizing early postoperative changes in body composition in patients with secondary lymphedema after breast cancer surgery: potential screening indicators for preventive intervention

Aya Okamichi, Miyoko Watanabe, Kazuo Kurosawa. J Phys Ther Sci. 2024 Oct 36.-676. Epub 2024 Oct 1

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Current evidence on patient precautions for reducing breast cancer-related lymphedema manifestation and progression risks

Julie Hunley, David A. Doubblestein, Elizabeth Campione. Med Oncol. 2024 Oct 17. 

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Consensus statement on non-cancer-related risk factors for development of secondary lymphedema

Nicole L. Stout, Marize IbrahimJane M. Armer, Mary Vargo, Julia R. Rodrick, Jeanne Nourse, Brandy McKeown, Jessica C. Griffin, Melissa B. Aldrich. Med Oncol. 2024 Oct 14. 

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Predictive models for breast cancer-related lymphedema after mastectomy

Zhong, Chunchang ; Xiao, Hong ; Chen, Birong ; Lan, Yan ; Liu, Haiying ; Zhang, Wenxia
American journal of translational research, 2024-01, Vol.16 (9), p.4623-4632

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The influence of non-cancer-related risk factors on the development of cancer-related lymphedema: a rapid review

Nicole L. Stout, McKinzey Dierkes, Jill M. Oliveri, Stanley G. RocksonElectra D. Paskett

Med Oncol. 2024 Oct 14. Extensive research supports an evidence-base for cancer treatment-related risk factors, including extent of lymph node dissection and use of radiotherapy, as contributing to secondary lymphedema. Additionally, comorbidities, such as higher body mass index, and vascular-related conditions are identified to further augment risk. While social determinants of health (SDOH) and socioeconomic factors are widely regarded as influencing an individual’s healthcare outcomes, including cancer risk and survival, these factors have not been explored as risk factors for developing secondary lymphedema. A rapid literature review explored the current evidence for SDOH as risk factors for lymphedema. Studies that were published over the last 10 years and that specifically analyzed social factors as variables associated with lymphedema were included. Studies that only characterized the social determinants of the study population were not included. Forty-nine studies were identified through a rapid literature review, and 13 studies that expressly analyzed social determinants as risk factors for secondary lymphedema were reviewed and extracted. All studies were conducted in patients with breast cancer-related lymphedema. Social risk factors included race, educational level, insurance type, and income level. These are consistent with the socioeconomic inequalities related to cancer survival. SDOH may influence the risk of developing cancer treatment-related health conditions like secondary lymphedema. Research trials studying cancer treatment-related conditions should collect consistent and robust data across social, behavioral, environmental, and economic domains and should analyze these variables to understand their contribution to study endpoints. Risk prediction modeling could be a future pathway to better incorporate social determinants, along with medical and co-morbidity data, to holistically understand lymphedema risk.:10.1007

Is axillary web syndrome a risk factor for breast cancer-related lymphedema of the upper extremity? A systematic review and meta-analysis

Cheryl L. Brunelle, Angela Serig. Breast Cancer Res Treat. 2024 Oct 16.

PURPOSE: To systematically review the available literature to determine if axillary web syndrome (AWS) is a risk factor for breast cancer-related lymphedema (BCRL) of the upper extremity.
METHODS: The study is Prospero-registered (ID CRD42024508169) and follows PRISMA guidelines. Ovid MEDLINE, PubMED, CINAHL, Embase, clinicaltrials.gov and the WHO International Clinical Trials Registry Platform were searched February 24, 2024. Original studies including a cohort of females > 18 years of age diagnosed with AWS after breast cancer surgery and assessing BCRL outcome were included. Scoping, mapping, systematic or qualitative reviews, dissertations without peer-review and conference abstracts were excluded. Methodological quality was assessed using the Modified Downs and Black Checklist and overall certainty in the body of evidence was assessed using Cochrane’s GRADE criteria (Grading of Recommendations Assessment, Development and Evaluation).
RESULTS: Nine cohort studies representing 3218 participants were included. The median incidence of AWS and BCRL was 31.79% (IQR 8.90%) and 14.29% (IQR 19.01%), respectively, across all studies. Pooled analysis indicated an odds ratio of 1.19 (95% confidence interval 0.60,2.37), with substantial heterogeneity across studies (Chi2 p < 0.0001, I2 = 82%). Methodological quality of the included studies was poor to fair, and there was very low certainty evidence indicating no difference in AWS for BCRL risk. The strongest study included, found that AWS more than doubles BCRL risk in the upper extremity.
CONCLUSION: The available evidence base cannot definitively determine whether AWS imparts risk of BCRL. AWS should be considered a potential risk factor for BCRL, until definitive conclusions from future research are available.:10.1007

Assessment

Analysis and relationship between the volume of upper limb lymphoedema and pressure pain threshold, neural range of motion, pain intensity, kinesiophobia, pain hypervigilance and catastrophizing in breast cancer survivors

Isabel Almagro-Céspedes, Rosa M. Tapia-Haro, Antonio M. Mesa-Ruiz, Natalia Fernández-Sánchez, Patrocinio Ariza-Vega, María E. Aguilar-Ferrándiz. Eur J Phys Rehabil Med. 2024 Sep 18.

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Reliability of L-Dex Scores for Assessment of Unilateral Breast Cancer-Related Lymphedema

Leigh C. Ward, Katrina Gaitatzis, Belinda Thompson, Vincent Singh Paramanandam, Louise A. Koelmeyer. Eur J Breast Health. 2024 Sep 26.-257. 

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Patient-reported outcome measures and physical function following head and neck lymphedema – a systematic review

Katrina Gaitatzis, Belinda Thompson, Fiona Tisdall Blake, Louise Koelmeyer. J Cancer Surviv. 2024 Sep 26

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Lymphatic pain in breast cancer survivors: An overview of the current evidence and recommendations

Jeanna Mary Qiu, Mei Rosemary Fu, Catherine S. Finlayson, Charles P. Tilley, Rubén Martín Payo, Stephanie Korth, Howard L. Kremer, Cynthia L. Russell Lippincott. Women Child Nurs. 2024 Sep 7.

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Mild symptoms matter: Results from a prospective, longitudinal study on the relationship between symptoms, lymphedema and health-related outcomes post-gynecological cancer

Melanie L. Plinsinga, Sheree Rye, Tamara Jones, Dimitrios Vagenas, Leigh Ward, Monika Janda, Andreas Obermair, Sandra C. Hayes. Gynecol Oncol. 2024 Oct 17.-164.

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Diagnosis of Lymphedema and Subjective Symptoms in the Lower Abdomen and Genital Region

Hisako Hara, Makoto Mihara. Lymphat Res Biol. 2024 Sep 24.

Background: Lymphedema in the lower abdomen and genitals is unnoticeable and has no established diagnostic methods. In this study, we evaluated it using four examinations.
Methods: We evaluated 25 patients with lymphedema in the legs, dividing the abdomen and genitals in four areas (right and left, upper and lower). The mean age was 58.6 years. In lymphoscintigraphy and indocyanine green (ICG) lymphography, we diagnosed lymphedema when dermal backflow was observed. ICG lymphography was performed in 13 patients. In ultrasonography, we determined the presence of edema when cobblestone pattern was observed. Subcutaneous fat thickness was also measured. The patients’ subjective symptoms were identified on an interview. We compared the results among the examinations.
Results: The positivity rates for lymphedema based on lymphoscintigraphy, ICG lymphography, ultrasonography, and subjective symptoms were 45.0%, 42.3%, 8.0%, and 34.0%, respectively. Two of the 13 patients who underwent all examinations complained of subjective symptoms of edema in areas that showed no abnormalities in the examinations. In contrast, 14 of the 25 patients had areas where they had no subjective symptoms despite having abnormalities in at least one of the tests. Those with subjective symptoms of edema tended to have thinner abdominal fat in both the upper and lower abdomen, but no significant difference was observed.
Conclusion: Large differences were observed in the positive rate of edema in subjective symptoms and examinations of lymphedema in the lower abdomen and genitals. It is not important to determine which examination is best but rather to combine multiple examinations.:10.1089.0032

Management Strategies

Essential components of the maintenance phase of complex decongestive therapy

Margaret McNeely, Mona M. Al Onazi, Mike Bond, Andrea Brennan, Heather Ferguson, Deborah A. Gross, Fedor Lurie, Linda Menzies, Steve NortonYuanlu Sun, Alaina Newell. Med Oncol. 2024 Oct 17.

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Expert-consensus on lymphedema surgeries: candidacy, prehabilitation, and postoperative care

Justin Sacks, Breanne Riley, David A. Doubblestein, John P. Kirby, Anna Towers, Kathy Weatherly. Med Oncol. 2024 Oct 14

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The effect of compression therapies and therapeutic modalities on lymphedema secondary to cancer: a rapid review and evidence map

Margaret McNeelyShirin Shallwani, M.M. Al Onazi, F Lurie. Med Oncol. 2024 Oct 17. 

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Leg ulceration in venous and arteriovenous insufficiency: assessment and management with compression therapy as part of a holistic wound‑healing strategy

Harikrishna Kr Nair, Giovanni Mosti, Leanne Atkin, Rebecca Aburn, Nizam Ali Hussin, Naresh Govindarajanthran, Sriram Narayanan, Georgina Ritchie, Ray Samuriwo, Kylie Sandy-Hodgetts, Hiske Smart, Geoff Sussman, Suzie Ehmann, John Lantis, Christine Moffatt, Liezl Naude, Sebastian Probst, Wendy White. J Wound Care. 2024 Oct 14.:10.12968/jowc.2024.33.Sup10b.S1