Risk factors for breast cancer–related lymphedema in patients undergoing 3 years of prospective surveillance with intervention

Abstract

Background To evaluate risk factors (treatment‐related, comorbidities, and lifestyle) for breast cancer–related lymphedema (BCRL) within the context of a Prospective Surveillance and Early Intervention (PSEI) model of care for subclinical BCRL. Methods The parent randomized clinical trial assigned patients newly diagnosed with breast cancer to PSEI with either bioimpedance spectroscopy (BIS) or tape measurement (TM). Surgical, systemic and radiation treatments, comorbidities, and lifestyle factors were recorded. Detection of subclinical BCRL (change from baseline of either BIS L‐Dex ≥6.5 or tape volume ≥ 5% and < 10%) triggered an intervention with compression therapy. Volume change from baseline ≥10% indicated progression to chronic lymphedema and need for complex decongestive physiotherapy. In this secondary analysis, multinomial logistic regressions including main and interaction effects of the study group and risk factors were used to test for factor associations with outcomes (no lymphedema, subclinical lymphedema, progression to chronic lymphedema after intervention, progression to chronic lymphedema without intervention). Post hoc tests of significant interaction effects were conducted using Bonferroni‐corrected alphas of .008; otherwise, an alpha of .05 was used for statistical significance. Results The sample (n = 918; TM = 457; BIS = 461) was female with a median age of 58.4 years. Factors associated with BCRL risk included axillary lymph node dissection (ALND) (p < .001), taxane‐based chemotherapy (p < .001), regional nodal irradiation (RNI) (p ≤ .001), body mass index >30 (p = .002), and rurality (p = .037). Mastectomy, age, hypertension, diabetes, seroma, smoking, and air travel were not associated with BCRL risk. Conclusions Within the context of 3 years of PSEI for subclinical lymphedema, variables of ALND, taxane‐based chemotherapy, RNI, body mass index >30, and rurality increased risk.

Preventive strategies for breast cancer–related lymphedema: Working toward optimal patient selection

“…The present study by Koelmeyer et al contributes greatly to the body of BCRL literature because it describes individual patient risk factors for BCRL development in an international, prospective cohort of BCS 3 . The study authors corroborate known risk factors for BCRL, such as axillary lymph node dissection (ALND), 4 taxane‐based chemotherapy, 5 regional nodal irradiation, 4 and obesity 6 .…”

“…These findings not only suggest that compression sleeve therapy may be inadequate for some patients, but also indicate that implementing BCRL prevention within the postsurgery setting alone may be insufficient. Although the study authors suggest more intensive follow‐up as one solution, 3 other preventive BCRL measures should also be considered.…”

“…Consequently, there is a need to better understand preoperative risk factors for BCRL to optimize patient selection. By adding valuable information to the literature regarding individual patient risk factors for BCRL development, the study by Koelmeyer et al helps to further refine clinical decision‐making in this area 3 …”

“…Postoperative infections have previously been associated with BCRL risk, 13 and certain complications such as cellulitis and tissue expander infection were also unavailable. 3 As such, generalizing BCRL risk from this study population may be limited.…”

“…6 They present novel data regarding increased BCRL risk for patients residing in rural settings and no increased BCRL risk from air travel. 3 The study also provides valuable context for BCRL risk factors postsurgery by prospectively measuring the severity and timing of lymphedema onset, both with and without nonsurgical compression sleeve therapy. Together, these data characterize which patients are at greatest risk of BCRL; in turn, clinicians may be able to set more informed expectations with patients who exhibit these risk factors and continue to refine optimal patient selection for BCRL preventive strategies.…”