Subclinical Lymphedema After Treatment for Breast Cancer: Risk of Progression and Considerations for Early Intervention

Bucci, Loryn K; Brunelle, Cheryl L.; Bernstein, Madison C; Shui, Amy; Gillespie, Tessa C.; Roberts, Sacha A; Naoum, George E.; Taghian, Alphonse G.

doi:10.1245/s10434-021-10173-0

Cited by 25 publications

(14 citation statements)

References 41 publications

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“…Nevertheless, transient swelling during the first year after surgery has been found to be a strong predictor of chronic BCRaL, which is why prospective monitoring is warranted. 52,59 This is exemplified by the results from a recent cohort study by Bucci et al 52 estimating that half of the women who underwent ALND and experienced subclinical BCRaL (n 5 171, 5%-10% relative volume change), but who did not receive treatment, progressed to chronic BCRaL within 5 years.…”

Section: Discussionmentioning

confidence: 96%

Prospective Surveillance for Breast Cancer–Related Arm Lymphedema: A Systematic Review and Meta-Analysis

Rafn

Christensen

Larsen

et al. 2022

JCO

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PURPOSE The call to integrate prospective surveillance for lymphedema into cancer care pathways is building momentum to enable early intervention and prevent the progression of the condition. We offer a critical evaluation of the literature on prospective surveillance and early management for cancer-related lymphedema and evaluate the effect of such programs in preventing chronic lymphedema (CRD42019137965). METHODS Five databases and two registries were searched for randomized controlled trials or observational studies that assessed the incidence or prevalence of lymphedema associated with participation in a prospective surveillance program, published until February 26, 2021. Numbers triggered for early lymphedema management, resolved, and chronic lymphedema were extracted. Pooled relative risk (trials) and pooled rate (cumulative incidence; observational studies) of chronic lymphedema was calculated. Subgroup analyses assessed the effect of study design, length of follow-up, and extent of axillary surgery. RESULTS Twenty-three studies were included, of which 21 studies evaluated breast cancer–related arm lymphedema (BCRaL). Participation in prospective surveillance with early management reduced the risk of chronic BCRaL versus usual care (relative risk 0.31; 95% CI, 0.10 to 0.95; two randomized controlled trials; N = 106). The pooled rate of chronic BCRaL was 4% (95% CI, 3 to 6; 15 observational studies; N = 3,545), and 6% (95% CI, 4 to 9) when restricted to participants with axillary lymph node dissection (12 studies; N = 1,527). CONCLUSION The findings suggest that participation in prospective surveillance with early management reduces the risk of chronic BCRaL. Only a minority of patients at high risk of lymphedema because of axillary surgery developed chronic lymphedema. More robust research is needed to determine whether prospective surveillance with early management can reduce the risk of chronic lymphedema, particularly among cancer survivors other than breast cancer.

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Section: Discussionmentioning

confidence: 96%

Prospective Surveillance for Breast Cancer–Related Arm Lymphedema: A Systematic Review and Meta-Analysis

Rafn

Christensen

Larsen

et al. 2022

JCO

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“…However, what constitutes subclinical lymphedema and which threshold to be used to identify it are not clear. 31,41,42 In addition, lymphedema can develop between regular follow-up visits, 10,22,[43][44][45] which may lead to persistent tissue changes. These issues could be managed using effective preventative strategies such as the use of compression sleeves prophylactically in women at high risk of lymphedema.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic Use of Compression Sleeves Reduces the Incidence of Arm Swelling in Women at High Risk of Breast Cancer–Related Lymphedema: A Randomized Controlled Trial

Paramanandam

Dylke

Clark

et al. 2022

JCO

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PURPOSE To determine whether prophylactic use of compression sleeves prevents arm swelling in women who had undergone axillary lymph node dissection for breast cancer surgery. METHODS Women (n = 307) were randomly assigned to either a compression or control group. In addition to usual postoperative care, the compression group received two compression sleeves to wear postoperatively until 3 months after completing adjuvant treatments. Arm swelling was determined using bioimpedance spectroscopy (BIS) thresholds and relative arm volume increase (RAVI). Incidence and time free from arm swelling were compared using Kaplan-Meier analyses. Hazard ratios (HRs) were estimated from Cox regression models for BIS and RAVI thresholds independently. In addition, time to documentation of the first minimally important difference (MID) in four scales of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the breast cancer–specific (BR23) questionnaire was analyzed. RESULTS The HR for developing arm swelling in the compression group relative to the control group was 0.61 (95% CI, 0.43 to 0.85; P = .004) on the basis of BIS and 0.56 (95% CI, 0.33 to 0.96; P = .034) on the basis of RAVI. The estimated cumulative incidence of arm swelling at 1 year was lower in the compression group than the control group on the basis of BIS (42% v 52%) and RAVI (14% v 25%). HRs for time from baseline to the first change of the minimally important difference were not statistically significant for any of the four scales of EORTC QLQ-30 and BR23 questionnaires. CONCLUSION Prophylactic use of compression sleeves compared with the control group reduced and delayed the occurrence of arm swelling in women at high risk for lymphedema in the first year after surgery for breast cancer.

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“…Therefore, a good awareness of the importance of subclinical LE may prevent the progression of the disease. Furthermore, early and adequate treatment of subclinical LE allows for improving symptoms, upper extremity functioning, and quality of life because of its transitory property (Bucci et al, 2021).…”

Section: Resultsmentioning

confidence: 99%

Contribution of Self-Lymphatic Drainage to Subclinical Lymphedema After Treatment for Breast Cancer

Tastaban¹

2022

IJIASR

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Lymphedema is a significant complication of breast cancer treatment. Early treatment of subclinical lymphedema may prevent its related complications. We aimed to evaluate the contribution of applying self-lymphatic drainage (SLD) in subclinical LE patients.One hundred twenty-eight women diagnosed with subclinical lymphedema were enrolled in the study. Patients were allocated into control group 1 (n=64) and SLD group 2 (n=64). Excess volume; the Visual Analog Scale (VAS) for pain, stiffness, heaviness, and tightness; the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) for disability; handgrip strength; Beck Depression Inventory (BDI) for depression were recorded before and after therapy. Statistically significant improvements in the excess volume were observed in both groups; however, there was a substantial change in the SLD group. Also, only the VAS and BDI scores were assessed significantly lower in the SLD group than in the control group. In conclusion, SLD is useful in reducing lymphedema volume, sensations of pain, stiffness, heaviness, tightness, and depression in patients with subclinical LE.

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Subclinical Lymphedema After Treatment for Breast Cancer: Risk of Progression and Considerations for Early Intervention

Cited by 25 publications

References 41 publications

Prospective Surveillance for Breast Cancer–Related Arm Lymphedema: A Systematic Review and Meta-Analysis

Prospective Surveillance for Breast Cancer–Related Arm Lymphedema: A Systematic Review and Meta-Analysis

Prophylactic Use of Compression Sleeves Reduces the Incidence of Arm Swelling in Women at High Risk of Breast Cancer–Related Lymphedema: A Randomized Controlled Trial

Contribution of Self-Lymphatic Drainage to Subclinical Lymphedema After Treatment for Breast Cancer

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