Neel S. Iyer; Brenda Cartmel; Louis Friedman; Fangyong Li; Yang Zhou; Elizabeth Ercolano; Maura Harrigan; Linda Gottlieb; Ruth McCorkle; Peter E; and Melinda L. Irwin. Cancer 2018

Main findings

• The assessments tools were:
  • Self report questionnaire – Norman Lymphedema Questionnaire
  • Optoelectronic perometer
  • Lymphoedema specialist assessment including
    • History
    • Palpation
    • Visual assessment

• The exercise intervention consisted of a 6-month homebased moderate-intensity aerobic exercise program facilitated by weekly telephone calls. Women in the exercise arm were asked to participate in moderate-intensity aerobic exercise, mainly brisk walking, for 150 min/wk. They were asked to record their activity in a daily activity log and to include the type, duration, and intensity (from study-provided heart rate monitors) of their physical activity. The trainer provided weekly counselling and support via telephone to motivate participants using a 26-chapter book developed for the study (1 chapter per week of intervention).
• The control arm received weekly phone calls from a staff member along with a 26 chapter book containing only information related to ovarian cancer survivorship. One chapter was discussed during each weekly call.
• An exploratory evaluation of predictors of LLL was performed. When it was controlled for demographic and treatment factors and used an LLL diagnosis by any method, the BMI was found to be significantly lower in the women who did not have LLL at the baseline (27.8 6 5.8 kg/m2) versus those who did have LLL (31.7 6 7.7 kg/m2; P < .01). No other patient characteristics were found to be significantly different between the 2 groups.
• The prevalence of LLL in ovarian cancer survivors ranged from 21% to 38%, and it was dependent on the diagnostic method used. Individually, the 3 diagnostic methods evaluated—the self-report questionnaire, the optoelectronic perometer, and the lymphedema specialist evaluation—each indicated a prevalence of LLL of 21% to 27%, but when they were used collectively, the prevalence was 38%. The self-report questionnaire had strong agreement with the gold-standard evaluation by a trained lymphedema specialist, whereas there was no agreement between the optoelectronic perometer and the trained specialist evaluation.
• The perometer is severely limited by the fact that it is unable to diagnose lymphedema in women who are experiencing LLL in both legs.
• The lymphedema specialist evaluation remains the gold standard because it takes both subjective factors, such as a patient-reported history of swelling and changes in the range of motion, and objective factors, such as induration and pitting, into consideration for the diagnosis of LLL. However, the evaluation is a time-intensive process. The reasonably high agreement of the self-report questionnaire with the lymphedema specialist indicates that with further validation, the self-report questionnaire could be a useful tool in preliminarily diagnosing LLL.