Risk Factors for Developing Upper Limb Cellulitis After Breast Cancer Treatment

Abstract

Cellulitis is one of the most important troubling complications of breast cancer treatment. Therefore, elucidating the risk factors for cellulitis in patients that have undergone breast cancer treatment is crucial. This is a retrospective medical record study among 523 patients who had received breast cancer treatment and were referred to the Lymphedema Clinic. Data on age, height, weight, BMI (body mass index), education level, arm dominance, history of previous surgery, axillary lymph node dissection, radiotherapy, and chemotherapy were noted. The time between operation and onset of lymphedema, duration of lymphedema, history of cellulitis, and number of cellulitis attacks were recorded. Circumference measurements were taken at four points on the upper limb. Univariate analysis showed that longer duration of lymphedema, larger circumference of the unaffected arm and larger circumference of the arm with lymphedema were associated with higher risk of cellulitis (p=0.008, p=0.007, p< 0.001, respectively). The incidence of cellulitis was higher in patients with lymphedema than patients who had no lymphedema (p< 0.001). Moreover, the frequency of cellulitis was higher in patients with lower education level (p=0.015). It was deter-mined that patients with cellulitis needed more compression garments (p< 0.001) and multi-layered bandage therapy (p< 0.001) than those without. Regression analysis revealed that presence of lymphedema (p=0.036), duration of lymphedema (p=0.048), radiotherapy (p=0.01) and educational level (0.019) are significantly associated with developing upper extremity cellulitis. It is important to consider these risk factors for the prevention and management of cellulitis in patients who undergo treatment for breast cancer. Early detection and treatment of lymphedema also remains essential for these patients.

Effect of Manual Lymphatic Drainage on Breast Cancer–Related Postmastectomy Lymphedema

“…7,13 Manual lymphatic drainage may not have a positive effect on reducing pain in the upper limbs. There was no significant reduction in pain according to Tambour et al 7 and Bergmann et al 14 (SMD, −0.09; 95% CI, −0.43 to 0.25; P = .61; Figure 3).…”

“…In the ≤2 weeks' duration of the MLD group, 3,11,13 there was no significant difference between the MLD group and the no-MLD treatment group (SMD, 2.03; 95% CI, −0.39 to 4.44; P = .10; I 2 = 96%; Figure 4B). In the >2 weeks' duration of MLD group, 7,14,[16][17][18] there was a significant difference between the 2 groups (SMD, 0.23; 95% CI, −0.02 to 0.44; P = .03; I 2 = 0%; Figure 4B).…”

“…We conducted multiple subgroup analyses to examine the relative efficacy of MLD treatment compared with the no-MLD treatment group, for example, the treatment session (<20 or ≥20 sessions) and the duration of intervention (≤2 or >2 weeks). In the group with <20 MLD sessions, 4,7,[13][14][15] there was no significant difference between the MLD group and the no-MLD treatment group (SMD, 0.82; 95% CI, −0.17 to 1.82; P = .11; Figure 4A). In contrast, for patients in the group with ≥20 sessions, [16][17][18] there was a significant difference compared with the no-MLD treatment group (SMD, 0.31; 95% CI, 0.03 to 0.58; P = .03; Figure 4A).…”

“…Recently, some studies have attested to the efficacy of adding MLD to bandage treatment 15,17 and MLD to standard therapy. 7,13,14 Perhaps comprehensive treatment may be more effective than MLD alone, but it is more complicated and timeconsuming. Therefore, we intend to explore additional methods to enhance the effectiveness of MLD and further investigate whether there are other benefits of MLD to the heaviness, pain, and mobility of the upper extremity.…”

Rest/Stress Intradermal Lymphoscintigraphy for the Functional Imaging of the Lymphatic System

“…33,34 We recommend this test to evaluate the effects of prolonged muscular activity on patients at risk of developing a secondary lymphedema following cancer treatments. [35][36][37] Along these lines, we selected several patients who could safely perform an exercise plan as a first-line treatment, under the supervision of a physiotherapist. A preclinical diagnosis allows for an early initiation of a complete decongestive therapy program and avoid lymphedema progression.…”