Arm Edema in Breast Cancer Patients

Abstract

The improvement in the life expectancy of women with breast cancer raises important questions about how to improve the quality of life for women sustaining complications of breast cancer treatment. In particular, attention to common problems, such as arm edema, is of critical importance. We reviewed published breast cancer guidelines and literature identified via MEDLINE(R) searches in an effort to summarize the research literature pertinent to management of breast cancer-related arm edema, including incidence, prevalence, and timing; risk factors; morbidity; prevention; diagnosis; and efficacy of nonpharmacologic and pharmacologic interventions. We found that arm edema is a common complication of breast cancer therapy that can result in substantial functional impairment and psychological morbidity. The risk of arm edema increases when axillary dissection and axillary radiation therapy are used. Recommendations for preventive measures, such as avoidance of trauma, are available, but these measures have not been well studied. Nonpharmacologic treatments, such as massage and exercise, have been shown to be effective therapies for lymphedema, but the effect of pharmacologic interventions remains uncertain. Comparing results across studies is complicated by the fact that the definitions of interventions and measures of outcomes and risk stratification vary substantially among studies. As arm edema becomes more prevalent with the increasing survival of breast cancer patients, further research is needed to evaluate the efficacy of preventive strategies and therapeutic interventions.

Lymphedema beyond breast cancer

“…55 These findings are concordant with the primary risk factors for lymphedema identified in breast cancer survivors. Specifically, the surgical treatment for breast cancer, which often includes axillary lymph node dissection and/ or mastectomy, is considered a major risk factor for lymphedema 7,56 The extent of lymph node dissection and tumor burden has also been shown to increase the risk of lymphedema. 56 Over the past decade, less invasive surgical techniques such as sentinel lymph node biopsy and breast-conserving surgery have reduced the overall incidence of lymphedema; however, conservative estimates for incidence after sentinel lymph node biopsy are still in the range of 7%.…”

“…57,58 For high-risk patients treated with adjuvant radiation to a dissected axilla, the risk of subsequent lymphedema is greatly increased, with reported rates close to 45%. 7 Other breast cancer-related lymphedema risk factors for which data were not available in this systematic review of nonbreast cancer lymphedema studies include patient age, obesity, tumor factors, lymph node status, the presence of postoperative seroma or infection, and the presence of venous obstruction. It is likely that these risk factors do not account for the entire atrisk population.…”

“…Only 1 study in this group used objective measurement methods (circumference), whereas the remainder assessed lymphedema subjectively. The length of follow-up ranged from 9 to 115 months, and the median quality score for these studies was 5 (range, [3][4][5][6][7][8][9].…”

“…In this population, extent of surgery, tumor burden, and adjunctive treatments (eg, radiation therapy) have been identified as primary risk factors for breast cancer-related lymphedema. 7 The adoption of sentinel lymph node biopsy in the pathologic staging of breast cancer, along with other malignancies, has drastically reduced the number of patients undergoing elective lymph node dissection; by allowing surgeons to avoid lymph node dissections in patients with lymph nodes that do not harbor metastases, the risk of developing lymphedema in lymph node-negative patients has likely decreased. However, secondary lymphedema has been shown to occur after even simple operations, such as wide local excision or sentinel lymph node biopsy.…”

Decongestive lymphatic therapy for patients with breast carcinoma‐associated lymphedema

“…1 In general, without regard to the individual surgical approach or the elapsed time since treatment, approximately one in four women develops arm edema after treatment for breast carcinoma. 2 Once it is established, lymphedema has an inexorable tendency to progress. 3 Although the risk of developing lymphedema after therapy for breast carcinoma has been associated with anatomic risk factors, such as the extent of axillary lymph node dissection and the patient's exposure to axillary radiation, this awareness has reduced, but not eliminated, the problem of breast carcinoma-associated lymphedema.…”