Invited Commentary from the Authors of: Kuruvilla AS, et al. Risk Factors Associated With Postmastectomy Breast Cancer Lymphedema: Amulticenter Retrospective Analysis

Abstract

To the Editor:I read with great interest the article by Kuruvilla et al, 1 in which they evaluated the risk factors predictive of lymphedema-related events within 2 years of mastectomy in breast cancer patients. The predictive risk factors included higher Elixhauser score, prolonged hospitalization for mastectomy, more recent mastectomy procedure, obesity, younger age, non-Asian race, Medicaid insurance, and hypertension (all P < 0.01). Detailed information about chemotherapy schedules was not described in this article. The association of taxanes with the development of peripheral edema was evaluated previously. Taxanes may cause systemic disruption, which could have a longer-term effect on lymphatic function leading to lymphedema in breast cancer patients. Cariati and colleagues 2 in their hypothesis-generating study investigated risk factors for lymphedema with a specific focus on the potential impact of chemotherapy. They found that patients who received adjuvant taxanes were nearly 3 times more likely to develop lymphedema than patients who did not. Therefore, adjuvant taxane use might be one of the predictive factors for postmastectomy breast cancer lymphedema.

‘Social compliance decoupling cascades’ in global supply chains: A review of the implementation of labour codes

“…Decoupling occurs when actors either comply with standards symbolically to gain legitimacy with external stakeholders, without substantive integration with core organizational goals, practices or processes (i.e., policy-practice decoupling), or comply with these standards inappropriately, in ways such that the intended goals are not achieved (i.e., means-ends decoupling) (Bromley & Powell, 2012;Wijen, 2014). Indeed, a primary critique of labour codes by several scholars is that their implementation in supplier facilities may often be decoupled from core business or production practices, thereby constraining improvements in working conditions (Egels-Zandén, 2007;Eriksson & Svensson, 2016;Huq & Stevenson, 2020;Kuruvilla et al, 2020). Tilcsik (2010Tilcsik ( , p. 1474 argues, however, that 'decoupling-the creation of gaps between formal policies and actual practices-is ubiquitous in organizations'.…”

“…Conflicting interests Third-party audit personnel may collude with the supplier and be complicit in the supplier's concealment of non-compliance. Kuruvilla et al (2020); Short et al (2016); Welford and Frost (2006) Because auditors' income is dependent on the number of audits they do, they often conduct as many audits as possible with little emphasis on the quality of audits, follow-ups and proof of remediation.…”

“…Kim (2013) provides an example in which a buyer imposed a fine of only $1250 on a supplier that had saved $187 500 by not providing social insurance for workers. Furthermore, prior work suggests that buyers are rarely willing to contribute to the costs of improving working conditions in alignment with the labour code that they enforce, or share in the costs of contracting a third-party auditor to evaluate code compliance (e.g., Alghababsheh & Gallear, 2021; Egels-Zandén, 2014; Kuruvilla et al, 2020).…”

“…A primary documented reason for these failures in the use of labour codes in global supply chains is the inconsistent, weak, symbolic implementation of the code's criteria on labour standards by some supply chain actors, without substantively incorporating these criteria into core practices and behaviours (e.g., Bartley & Egels-Zandén, 2015;Kuruvilla et al, 2020). Management and organization scholars have referred to this phenomenon as 'decoupling', describing a failure to align actual practices and behaviours with a formally adopted or legitimizing standard, policy or stance, such that it is not substantively implemented or does not achieve the intended goals (Bromley & Powell, 2012;Meyer & Rowan, 1977;Wijen, 2014).…”

“…To move the needle forward, we conducted a comprehensive review of all empirical evidence to date-both published/unpublished and qualitative/quantitative-on the relationship between labour code implementation by actors at any stage of the supply chain (e.g., buyer, supplier, supplier workers and worker unions, third-party social auditors) and the working conditions and rights of supplier workers. Evidence of decoupling in labour codes is rarely explicitly concluded or inferred in prior research, leaving aside a few notable exceptions (e.g., Bartley & Egels-Zandén, 2015;Bird et al, 2019;Huq & Stevenson, 2020;Kuruvilla et al, 2020). Because decoupling is described by a failure in the translation of a labour code's impact as intended, our search for prior empirical evidence casts a broader net that is not limited to studies that explicitly conclude evidence of decoupling, but also includes studies on labour code implementation where anything less than full compliance with the code offers evidence from which decoupling may be inferred.…”