Hot of the Press November 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
Stewart-Treves Syndrome: A Rare But Aggressive Complication of Breast Cancer-Related Lymphedema - click for abstract
Stewart-Treves Syndrome: A Rare But Aggressive Complication of Breast Cancer-Related Lymphedema
Stewart-Treves syndrome (STS) is an angiosarcoma that usually develop in an extremity with longstanding lymphedema. Most affected patients have a history of breast cancer treated with radical mastectomy. Here, we report a case of STS with breast cancer-related lymphedema (BCRL) for a period of seven years. A 56-year-old woman presented with chronic lymphedema of the left arm. Nine years previously she had modified radical mastectomy for grade 2, invasive, ductal breast cancer. Upon physical examination, a tender, purplish lesion on the medial half of the affected arm was observed. The lesion spread rapidly with different-sized, scattered, purple-colored lesions in the affected area. A prompt skin biopsy was reported as STS. An immediate arm amputation was performed. However, a few months later she presented with new lesions on the anterior thorax and subsequent local recurrence around the scar. She received radiation-therapy. However, six months later the angiosarcoma had spread to the pelvic and upper limb area with scattered skin lesions. She had several problems during the chemotherapy and radiation-therapy, although she survived beyond 20 months. In conclusion, STS is a rare but aggressive and important complication of BCRL. Awareness of rapidly progressing skin lesions and detailed investigation, as well as prompt surgery is necessary for patients with BCRL in order to relatively increase the survival time.
Primary lymphoedema - click for abstract
Primary lymphoedema
Lymphoedema is the swelling of one or several parts of the body owing to lymph accumulation in the extracellular space. It is often chronic, worsens if untreated, predisposes to infections and causes an important reduction in quality of life. (PLE) is thought to result from abnormal development and/or functioning of the lymphatic system, can present in isolation or as part of a syndrome, and can be present at birth or develop later in life. Mutations in numerous genes involved in the initial formation of lymphatic vessels (including valves) as well as in the growth and expansion of the lymphatic system and associated pathways have been identified in syndromic and non-syndromic forms of PLE. Thus, the current hypothesis is that most cases of PLE have a genetic origin, although a causative mutation is identified in only about one-third of affected individuals. Diagnosis relies on clinical presentation, imaging of the structure and functionality of the lymphatics, and in genetic analyses. Management aims at reducing or preventing swelling by compression therapy (with manual drainage, exercise and compressive garments) and, in carefully selected cases, by various surgical techniques. Individuals with PLE often have a reduced quality of life owing to the psychosocial and lifelong management burden associated with their chronic condition. Improved understanding of the underlying genetic origins of PLE will translate into more accurate diagnosis and prognosis and personalized treatment.
Prevalence and Risk Factors
Dosimetric Analysis for Predicting Secondary Lymphedema After Radiation for Head and Neck Cancer - click for abstract
Dosimetric Analysis for Predicting Secondary Lymphedema After Radiation for Head and Neck Cancer
PURPOSE/OBJECTIVE(S): Secondary lymphedema (SL) following radiation (RT) for head and neck (H&N) cancer occurs commonly with multiple adverse consequences1. Primary location, RT dose, months since treatment, and increasing treatment modalities are associated with SL1. We sought to define structures within anatomically relevant compartments and correlate dosimetric parameters of these structures with SL. We hypothesized that SL patients would have received different doses to these structures as compared to patients without SL.
MATERIALS/METHODS: This single-institution retrospective study was IRB approved. We identified 23 H&N patients referred to Occupational Therapy (OT) for SL management from 2017 – 2019 after completing H&N RT (SL patients). These patients were matched 1:2 to patients having received H&N RT without OT referral (non-SL patients). Matching was based on primary site, treatment paradigm, RT dose, unilateral vs bilateral neck RT, and RT year. For all 69 patients, we contoured 3 structures: anterior neck soft tissue superficial to larynx from the caudal mandible or cranial hyoid inferiorly to C7, soft tissue superficial to the spinous processes from C1-C7, and subcutaneous tissue superficial to bilateral trapezius muscles. Wilcoxon rank-sum tests were used to compare the following dosimetric parameters of Anterior Neck, Spinous Process, and Trapezius structures between SL (n = 23) vs non-SL (n = 46) patients: mean dose, D0.1 cc [Gy], D100% [Gy], and V15 Gy [%] to V50 Gy [%] in 5 Gy increments. Given this exploratory analysis, we did not adjust for multiple comparisons.
RESULTS: SL and non-SL patients were balanced for age, BMI, smoking, steroid use during RT, primary site, disease stage, treatment paradigm, bilateral vs unilateral neck dissection, radiation dose and unilateral vs bilateral neck RT (all P > 0.2). Vascular comorbidities were imbalanced with SL patients more commonly having both diabetes and hypertension (17%) vs non-SL patients (2%), and non-SL patients more commonly having HTN (41% vs 17%, P = 0.03). Oropharynx was the most common site (61%) followed by oral cavity (20%), larynx (13%), salivary (4%), and cutaneous (1%). Anterior Neck, mean dose (P = 0.03), V15 Gy [%] (P = 0.01), V20 Gy [%] (P < 0.01), V25 Gy [%] (P < 0.01), V30 Gy [%] (P = 0.02), V35 Gy [%] (P = 0.02), and V40 Gy [%] (P = 0.04) were significantly higher in patients with SL. Anterior Neck D100% [Gy] (P = 0.07), Spinous Process D100% [Gy] (P = 0.052), and Trapezius V15 Gy [%] (P = 0.06) trended towards significance.
CONCLUSION: To our knowledge, this is the first investigation of dosimetric parameters associated with SL following H&N RT. Our findings suggest that higher volume of low-mid RT dose within the anterior neck is associated with developing SL. This may be related to circumferential neck dose and/or the role of superficial lymphatics within level VI after H&N RT. These findings warrant prospective validation in a larger cohort, but may be considered in the context of RT treatment planning to minimize SL after RT.
Risk factors for lymphedema and method of assessment in endometrial cancer: a prospective longitudinal multicenter study - click for abstract
Risk factors for lymphedema and method of assessment in endometrial cancer: a prospective longitudinal multicenter study
OBJECTIVE: The aim of the study was to determine risk factors for lymphedema of the lower limbs, assessed by four methods, 1 year after surgery for endometrial cancer.
METHODS: A prospective longitudinal multicenter study was conducted in 14 Swedish hospitals. 235 women with endometrial cancer were included; 116 underwent surgery including lymphadenectomy, and 119 had surgery without lymphadenectomy. Lymphedema was assessed preoperatively and 1 year postoperatively objectively by systematic circumferential measurements of the legs, enabling volume estimation addressed as (1) crude volume and (2) body mass index-standardized volume, or (3) clinical grading, and (4) subjectively by patient-reported perception of leg swelling. In volume estimation, lymphedema was defined as a volume increase ≥10%. Risk factors were analyzed using forward stepwise logistic regression models and presented as adjusted odds ratio (aOR) and 95% confidence interval (95% CI).
RESULTS: Risk factors varied substantially, depending on the method of determining lymphedema. Lymphadenectomy was a risk factor for lymphedema when assessed by body mass index-standardized volume (aOR 14.42, 95% CI 3.49 to 59.62), clinical grading (aOR 2.11, 95% CI 1.04 to 4.29), and patient-perceived swelling (aOR 2.51, 95% CI 1.33 to 4.73), but not when evaluated by crude volume. Adjuvant radiotherapy was only a risk factor for lymphedema when assessed by body mass index-standardized volume (aOR 15.02, 95% CI 2.34 to 96.57). Aging was a risk factor for lymphedema when assessed by body mass index-standardized volume (aOR 1.07, 95% CI 1.00 to 1.15) and patient-perceived swelling (aOR 1.06, 95% CI 1.02 to 1.10), but not when assessed by crude volume or clinical grading. Increase in body mass index was a risk factor for lymphedema when estimated by crude volume (aOR 1.92, 95% CI 1.36 to 2.71) and patient-perceived swelling (aOR 1.36, 95% CI 1.11 to 1.66), but not by body mass index-standardized volume or clinical grading. The extent of lymphadenectomy was strongly predictive for the development of lymphedema when assessed by body mass index-standardized volume and patient-perceived swelling, but not by crude volume or clinical grading.
CONCLUSION: Apparent risk factors for lymphedema differed considerably depending on the method used to determine lymphedema. This highlights the need for a ‘gold standard’ method when addressing lymphedema for determining risk factors
Comparison of upper extremity lymphedema after sentinel lymph node biopsy and axillary lymph node dissection: patient-reported outcomes in 3044 patients - click for abstract
Comparison of upper extremity lymphedema after sentinel lymph node biopsy and axillary lymph node dissection: patient-reported outcomes in 3044 patients
PURPOSE: A limited number of studies have examined the impact of type of axillary lymph node surgery on breast cancer-related lymphedema (BCRL) from the patient’s perspective. The objective of this study was to assess the impact of sentinel lymph node dissection (SLND) and axillary lymph node dissection (ALND) on the health-related quality of life (HRQOL) in women diagnosed with BCRL using a condition specific patient-reported outcome measure (PROM), the LYMPH-Q upper extremity (UE) module.
METHODS: Adult women diagnosed with BCRL were identified from the Danish National Health Data Authority database for the period 2008 to 2020 and were sent an online REDCap survey with the LYMPH-Q UE module. Information pertaining to axillary surgery was obtained from an online pathology repository. Multivariable linear regression was used to examine differences in the SLND and ALND groups on the LYMPH-Q UE scale scores.
RESULTS: Three thousand and fourty four women with BCRL were included in the analysis. The mean follow-up duration was 8.6 ± 5.15 years (range, 0-36 years). The majority of participants underwent ALND (n = 2805, 92.1%) and only 7.9% (n = 239) received SLND. The mean number of lymph nodes removed in the SLND group was 2.2 ± 1.4. No statistically significant difference was found in the two groups on the LYMPH-Q UE scale scores.
CONCLUSION: There is no difference in women with upper extremity lymphedema after SLND or ALND on the LYMPH-Q UE module scales measuring arm symptoms, function, distress, and appearance.
Quantifying Risk of Ipsilateral Arm Lymphedema Causing Functional Impairment in Breast Cancer Patients: Results From a Prospective, Multi-Centre International Study of Treatment Toxicity - click for abstract
Quantifying Risk of Ipsilateral Arm Lymphedema Causing Functional Impairment in Breast Cancer Patients: Results From a Prospective, Multi-Centre International Study of Treatment Toxicity
PURPOSE/OBJECTIVE(S): Breast cancer related lymphedema (BCRL) of the ipsilateral arm remains a highly morbid long-term side effect of breast cancer treatment, one which can lead to functional impairment. We sought to independently examine clinical and treatment related risk factors for the development of lymphedema-associated functional impairment.
MATERIALS/METHODS: The REQUITE Consortium is a multi-center cohort study of patients with breast cancer treated at 26 hospitals in 8 countries from 2014-2017 who were prospectively evaluated for treatment toxicity. All patients received lumpectomy and adjuvant radiotherapy (RT) with or without chemotherapy at the discretion of their treating physician, and were enrolled prior to beginning RT. Arm circumference measurements and patient reported outcome (PRO) toxicity assessments were obtained before RT and annually after RT for a minimum of two years. Lymphedema-associated functional impairment was determined by PRO lymphedema that constrains activity and self-care. Grade 2+ BCRL was defined as ≥10% discrepancy in ipsilateral arm circumference compared to the contralateral arm. Cumulative incidence curves were stratified by the extent of axillary surgery and RT. Multivariable Cox models adjusted for axillary surgery, radiation, body mass index, and chemotherapy.
RESULTS: The cohort included 1921 patients followed for a median of 27 months: 1345 received sentinel node biopsy (SLNBx) alone, 90 received SLNBx and regional lymph node RT (RLNR), 136 received axillary node dissection (ALND) alone, 200 received ALND+RLNR, and 150 received no axillary treatment. Invasive breast cancer was present in 1678 (87%) patients, while 591 (30.7%) received chemotherapy. Among the whole cohort, four times as many patients reported functional impairment than Grade 2+ BCRL (4.6% vs 1.1%). On multivariable analysis, taxane-based chemotherapy resulted in a significantly higher risk of functional impairment (hazard ratio [HR] 1.90, P = 0.01), as did ALND (HR 11.92, P = 0.02) and higher BMI (HR 1.06, P < 0.001). Although RLNR and SLNBx did not confer significantly higher risk on multivariable analysis when evaluated individually, the SLNBx+RLNR treatment group demonstrated a trend towards significantly higher risk of functional impairment compared to no axillary treatment (HR 8.21, P = 0.05). The risk of functional impairment was highest in those receiving ALND+RLNR (HR 15.52, P = 0.008) and ALND alone (HR 14.58, P = 0.01), with a 3-year cumulative incidence rate of 21% in both groups.
CONCLUSION: Patients treated with taxane-based chemotherapy and those receiving more extensive axillary surgery are at significantly higher risk of developing ipsilateral arm lymphedema causing functional impairment. Additional variation in this toxicity may be due to genetic predisposition, which is under investigation in REQUITE. Lymphedema-associated functional impairment occurred substantially more often than Grade 2+ BCRL, highlighting the importance of capturing
Weight Gain and Lymphedema After Breast Cancer Treatment: Avoiding the Catch-22? - click for abstract
Weight Gain and Lymphedema After Breast Cancer Treatment: Avoiding the Catch-22?
Overweight and obesity are strongly implicated in breast cancer (BC) development and are also a risk factor for BC-related lymphedema (BCRL). Materials and Methods: An online cross-sectional survey was conducted between November 2017 and January 2018. Analyses were restricted to women with localized BC, who provided information about BCRL (n = 238). Most women were not experiencing BCRL (55.46%). Results: Mean self-reported weight at diagnosis was 68.55 kg for women without BCRL and 74.43 kg for women with BCRL (p = 0.0021). In this study, 50.9% with BCRL were overweight/obese at diagnosis (body mass index [BMI] ≥25) compared with 36.4% of women without BCRL (p = 0.003). For women without BCRL, 12.12% were classified as obese (BMI ≥30) versus 20.75% with BCRL. Women with BCRL were more likely to have gained >5% of body weight (p = 0.03), be currently overweight or obese (p = 0.004), and less active (48.11%) than they were at diagnosis than women without BCRL (33.33%) (p = 0.042). Having a structured exercise program, following a prescribed diet, and being accountable to someone else were identified as the main facilitators to successful weight loss and weight maintenance. Conclusions: Clinicians should consider obesity when personalizing axillary treatment and encourage lifestyle interventions and lymphedema screening after BC treatment.
Breast cancer-related lymphedema rates after modern axillary treatments: How accurate are our estimates?- click for abstract
Breast cancer-related lymphedema rates after modern axillary treatments: How accurate are our estimates?
BACKGROUND: Clinical trials have demonstrated methods to minimize the risk of breast cancer-related lymphedema while preserving regional control. We sought to determine the percent lifetime-risk of breast cancer-related lymphedema that surgeons and radiation oncologists discuss with patients before axillary interventions.
METHODS: A nationwide survey of surgeons and radiation oncologists was performed from July to August 2020. Participants were asked to identify what number they discuss with patients when estimating the percent lifetime-risk of breast cancer-related lymphedema after different axillary interventions.
RESULTS: Six hundred and eighty surgeons and 324 radiation oncologists responded (14% response rate). While the estimated rate after sentinel lymph node biopsy was clinically similar between surgeons and radiation oncologists, statistically surgeons quoted a higher percent lifetime-risk (5.7% vs 5.0%, P = .03). Surgeons estimated significantly higher rates of breast cancer-related lymphedema compared with radiation oncologists (P < .001) for axillary lymph node dissection (21.8% vs 17.5%), sentinel lymph node biopsy with regional nodal irradiation (14.1% vs 11.2%), and axillary lymph node dissection with regional nodal irradiation (34.8% vs 26.2%).
CONCLUSION: There is variability in the estimated rates of breast cancer-related lymphedema providers discuss with patients. These findings highlight the need for physician education on the current evidence of percent lifetime-risk of breast cancer-related lymphedema to provide patients with accurate estimates before axillary interventions.
Assessment
Upper Quadrant Edema Patient-Reported Outcome Measure Was Reliable, Valid, and Efficient for Patients with Lymphatic and Venous Disorders - click for abstract
Upper Quadrant Edema Patient-Reported Outcome Measure Was Reliable, Valid, and Efficient for Patients with Lymphatic and Venous Disorders
OBJECTIVE: The main aims of this study were to (1) create a patient-reported outcome measure (PROM) item bank for measuring the impact of upper quadrant edema (UQE) on physical function by calibrating responses to newly developed items; and (2) assess reliability, validity, and administration efficiency of scores based on computerized adaptive test (CAT) and 10-item short-form (SF) administration modes.
METHODS: A retrospective study including data from patients treated in outpatient rehabilitation clinics for UQE that responded to all 27 candidate items at intake. Item response theory model assumptions of unidimensionality, local item independence, item fit, and presence of differential item functioning were evaluated. UQE-CAT and UQE-SF generated scores were assessed for reliability, validity, and administration efficiency.
RESULTS: Total cohort included 3486 patients (mean age = 61 [SD = 13]; range = 14-89). After removing 2 items, a 25-item solution was supported for its unidimensionality and fit to the item response theory model with reliability estimates of >0.93 for scores based on both CAT and SF administration modes. No items demonstrated differential item functioning. Scores discriminated among multiple patient groups in clinically logical ways and were moderately responsive to change with negligible floor and acceptable ceiling effects. CAT scores were generated using an average of 5.6 items (median = 5).
CONCLUSIONS: Scores on the UQE PROM were reliable, valid, and efficient for assessing perceived physical function of patients with upper quadrant edema; thus, the measure is suitable for research and routine clinical administration. IMPACT: The newly developed UQE PROM was reliable and valid and offers efficient administration modes for assessing perceived physical function of patients with UQE caused by lymphatic and venous disorders, both for research and routine clinical care in busy outpatient rehabilitation settings. As an item response theory-based measure, the UQE PROM allows administration of condition-specific functional questions with low response burden for patients. This study supports a transition to PROMs that are based on modern measurement approaches to achieve high accuracy and efficiency.
Indocyanine green lymphangiography is superior to clinical staging in breast cancer-related lymphedema - click for abstract
Indocyanine green lymphangiography is superior to clinical staging in breast cancer-related lymphedema
Sci Rep. 2021 Oct 26;11(1):21103. doi: 10.1038/s41598-021-00396-2.
Precise staging of breast cancer-related lymphedema (BCRL) is important to guide treatment-decision making. Recent studies have suggested staging of BCRL using indocyanine green lymphangiography (ICG-L) based on the extent of lymphatic injury and dermal backflow patterns. Currently, the benefits of ICG-L compared to conventional clinical staging are unknown. For this study, we included 200 patients with unilateral BCRL. All BCRL patients were staged using ICG-L and clinical exam. The amounts of excess arm volume, fat mass and lean mass were compared between stages using Dual Energy X-Ray Absorptiometry. Multivariate regression models were used to adjust for confounders. For each increase in the patient’s ICG-L stage, the excess arm volume, fat mass and lean mass was increased by 8, 12 and 6.5 percentage points respectively (P < 0.001). For each increase in the patient's clinical ISL stage, the volume was increased by 3.5 percentage points (P < 0.05), however no statistically significant difference in the lean and fat mass content of the arm was observed for ascending stages. However, the residual plots showed a high degree of variance for both ICG-L and clinical staging. This study found that ICG-L staging of BCRL was superior to clinical staging in forecasting BCRL excess arm volume, fat mass, and lean mass. However, there was a high degree of variance in excess arm volume, fat mass, and lean mass within each staging system, and neither the ICG-L nor clinical staging forecasted perfectly.
Lymphoscintigraphy as an Outcome Measurement for Conservative Upper Limb Lymphedema Treatments: A Systematic Review - click for abstract
Lymphoscintigraphy as an Outcome Measurement for Conservative Upper Limb Lymphedema Treatments: A Systematic Review
The impact of conservative interventions on lymphatic function and the relationship to clinical outcomes is currently unknown. A systematic review was undertaken to evaluate studies that used lymphoscintigraphy to measure outcomes from conservative intervention for secondary arm lymphedema and to explore the relationship between changes in the lymphoscintigraphy and clinical outcomes. Methods and Results: Five databases were systematically searched using the selection criteria: randomized controlled trials (RCTs); quasi-RCTs; pre/post and cohort studies; upper limb secondary lymphedema; use of lymphoscintigraphy as an outcome measure; and conservative intervention. Seven articles met the inclusion criteria. Compression, exercise, hyperbaric oxygen therapy, and pharmacological interventions were evaluated using lymphoscintigraphy. There was heterogeneity with all aspects of the lymphoscintigraphy techniques, including radioisotope used, injection location, use of exercise, and imaging sequence between the studies as well as the outcome analysis. Also most studies did not show a relationship between the clinical and lymphoscintigraphy outcomes measured. Conclusions: Lymphoscintigraphy has not been used regularly or recently to evaluate conservative upper limb lymphedema treatment outcomes. Lack of standardization of lymphoscintigraphy protocols and lack of consensus and understanding of the lymphoscintigraphy analyses used to measure the outcomes of diverse conservative lymphedema interventions currently limit the use of lymphoscintigraphy as an outcome measure. Further research adopting recent guidelines to standardize lymphoscintigraphy and use of reliable analysis techniques that measure the physiological impact of the chosen conservative lymphedema intervention is recommended to evaluate the impact of conservative interventions on lymphatic function.
The effect of upper limb lymphedema in posture of patients after breast cancer surgery - click for abstract
The effect of upper limb lymphedema in posture of patients after breast cancer surgery
BACKGROUND: Upper limb lymphedema is one of the complications following breast cancer-related surgery. It is a fact that there are alterations in posture of the trunk following surgery, however, there is not much data on whether upper limb lymphedema has any effect on body posture.
OBJECTIVES: The main purpose of the study was to investigate the effect of upper limb lymphedema in the trunk posture and spine mobility of patients following breast cancer surgery.
METHODS: Twenty-seven women with lymphedema and 29 women without lymphedema with mastectomy or breast-conserving surgery participated in the study. Posture was evaluated by the New York Posture Rating Chart and spinal stability and thoracic mobility were evaluated by the Spinal Mouse device.
RESULTS: Posture and spine posture scores were significantly higher in the without lymphedema group (p= 0.004; 0.041; respectively). There was a significant difference between the groups in terms of lateral (p< 0.001) and posterior (p< 0.001) view of shoulders, spine (p= 0.027), upper (p< 0.001) and lower back (p= 0.009), and trunk postures (p= 0.001).
CONCLUSIONS: Body posture and spine are more affected due to upper limb lymphedema following breast cancer surgery. Alterations of posture mainly occur on shoulders, spine, upper and lower back, and trunk, but not on head and neck postures.
Management Strategies
Nighttime compression supports improved self-management of breast cancer-related lymphedema: A multicenter randomized controlled trial - click for abstract
Nighttime compression supports improved self-management of breast cancer-related lymphedema: A multicenter randomized controlled trial
Cancer. 2021 Oct 6.
BACKGROUND: Lymphedema is a prevalent long-term effect of breast cancer treatment associated with reduced quality of life. This study examined the efficacy of nighttime compression as a self-management strategy for women with chronic breast cancer-related lymphedema.
METHODS: Th authors conducted a parallel 3-arm, multicenter, randomized trial. Women were recruited from 3 centers in Canada and randomized to group 1 (daytime compression garment alone [standard care]), group 2 (daytime compression garment plus nighttime compression bandaging), or group 3 (daytime compression garment plus the use of a nighttime compression system garment). The primary outcome was the change in excess arm volume from the baseline to 12 weeks. Participants from all groups used a nighttime compression system garment from weeks 13 to 24.
RESULTS: One hundred twenty women were enrolled, 118 completed the randomized trial, and 114 completed the 24-week follow-up. The rates of adherence to nighttime compression were 95% ± 15% and 96% ± 11% in the compression bandaging and nighttime compression system groups, respectively. After the intervention, the addition of nighttime compression was found to be superior to standard care for both absolute milliliter reductions (P = .006) and percentage reductions (P = .002) in excess arm lymphedema volume. Significant within-group changes were seen for quality of life across all groups; however, no between-group differences were found (P > .05).
CONCLUSIONS: The trial demonstrated a significant improvement in arm lymphedema volume from the addition of nighttime compression whether through the application of compression bandaging or through the use of a nighttime compression system garment.
LAY SUMMARY: Lymphedema is swelling that occurs in the arm on the side of the surgery for breast cancer. Lymphedema occurs in approximately 21% of women. Lymphedema tends to worsen over time and can result in recurrent infections in the arm, functional impairment, and pain. Currently, treatment consists of intensive treatments to reduce the swelling followed by regular use of a compression sleeve during the day. This study examined and found a benefit from the addition of nighttime compression (whether through self-applied compression bandaging or through the use of a nighttime compression system garment) to the use of a daytime compression sleeve.
Physical Therapy in Women with Early Stage Lipedema: Potential Impact of Multimodal Manual Therapy, Compression, Exercise, and Education Interventions - click for abstract
Physical Therapy in Women with Early Stage Lipedema: Potential Impact of Multimodal Manual Therapy, Compression, Exercise, and Education Interventions
Lipedema is a distinct adipose disorder from obesity necessitating awareness as well as different management approaches to address pain and optimize quality of life (QoL). The purpose of this proof-of-principle study is to evaluate the therapeutic potential of physical therapy interventions in women with lipedema. Methods and Results: Participants with Stage 1-2 lipedema and early Stage 0-1 lymphedema (n = 5, age = 38.4 ± 13.4 years, body mass index = 27.2 ± 4.3 kg/m2) underwent nine visits of physical therapy in 6 weeks for management of symptoms impacting functional mobility and QoL. Pre- and post-therapy, participants were scanned with 3 Tesla sodium and water magnetic resonance imaging (MRI), underwent biophysical measurements, and completed questionnaires measuring function and QoL (patient-specific functional scale, PSFS, and RAND-36). Pain was measured at each visit using the 0-10 visual analog scale (VAS). Treatment effect was calculated for all study variables. The primary symptomatology measures of pain and function revealed clinically significant post-treatment improvements and large treatment effects (Cohen’s d for pain VAS = -2.5 and PSFS = 4.4). The primary sodium MRI measures, leg skin sodium, and subcutaneous adipose tissue (SAT) sodium, reduced following treatment and revealed large treatment effects (Cohen’s d for skin sodium = -1.2 and SAT sodium = -0.9). Conclusions: This proof-of-principle study provides support that persons with lipedema can benefit from physical therapy to manage characteristic symptoms of leg pain and improve QoL. Objective MRI measurement of reduced tissue sodium in the skin and SAT regions indicates reduced inflammation in the treated limbs. Further research is warranted to optimize the conservative therapy approach in lipedema, a condition for which curative and disease-modifying treatments are unavailable
Adding Pneumatic Compression Therapy in Lower Extremity Lymphedema Increases Compliance of Treatment, While Decreasing the Infection Rate- click for abstract
Adding Pneumatic Compression Therapy in Lower Extremity Lymphedema Increases Compliance of Treatment, While Decreasing the Infection Rate
Lymphedema (LE) is a chronic condition that requires lifelong treatment. Although pneumatic compression therapy (PCT) is one treatment option, current algorithms consider it as an adjunct to standard LE. The purpose of this study is to evaluate the importance of adapting PCT for lower extremity LE (LEL) in relation to patient compliance and rate of infection. Materials and Methods: Patients diagnosed with LEL were followed prospectively. Patient demographics, comorbidities, treatment modality, compliance, infection due to LE, and hospitalization were recorded. LEL patients with no-PCT were also recorded in the same time period to evaluate the treatment compliance and the need for physical therapy visits. The no-PCT group received the standard LE care, whereas the PCT group received the standard LE care plus a new-generation pneumatic compression device. Results: A total of 69 patients were enrolled in this study. The PCT group had 50 patients and no-PCT group had 19 patients. The PCT group had median 58.5 months of LE symptoms, while non-PCT patients had median 23 months of LE symptoms (p = 0.11). Infection rates decreased by 32% and hospitalizations due to infection decreased by 14% after PCT treatment had been initiated. Physical therapy needs decreased by 24% after PCT use. At median 18 months, follow-up compliance for PCT was 84%, but compliance for manual lymphatic drainage was almost half (53%) in no-PCT group. Conclusions: PCT leads to a decrease in infection rate, hospital admissions, and physical therapy (PT) visits in clinically significant LEL. Although there is no cost calculation in this study, it can be correlated to significant cost savings due to a reduction of infection and hospitalization and the need for PT visits. Adoption of PCT offers a superior value proposition to not only patients but also the health care system. Cost analysis should be followed.
Using the Functional Resonance Analysis Method to explore how elastic compression therapy is organised and could be improved from a multistakeholder perspective
Self-management Strategies for Risk Reduction of Subclinical and Mild Stage of Breast Cancer-Related Lymphedema: A Longitudinal, Quasi-experimental Study
