Cancer-Related Lymphedema: Clinical and Epidemiological Features in Mexico

Background? There is a lack of clinical and epidemiological knowledge about cancer-related lymphedema in Mexico. The objective of this study is to present a broad and deep report of cancer-related lymphedema’s clinical characteristics and epidemiological features based on the analysis of CRL patients’ data, collected from a specialized rehabilitation clinic in Mexico. Methods? This is a cohort study based on the analysis of clinical data gathered between 2015 and 2022. The study was developed in a private clinic that specializes in oncological patients’ rehabilitation. Clinical assessments and interviews were performed to collect each case’s clinical history, considering diverse clinical characteristics and demographic information, classified in a matrix, and statistically evaluated. Results? Among 307 lymphedema patients, gender distribution was represented by 87.9% (270) female and 12.1% (37) male; mean age of 54.5 years (± 32.5); 79.8% of the patients corresponded to breast cancer diagnosis, the rest of them were associated with other 19 different types of cancer. 90.2% of patients underwent some lymph node removal procedure, 68.1% of patients received fractioned radiotherapy sessions, and 87.7% received some chemotherapy scheme treatment. 64% of patients had a diagnosis of lymphedema and had onset symptoms of lymphedema in the first 5 years after oncological interventions and/or cancer diagnosis, most of them during the first 2 years. The general distribution of clinical staging was: 23.7% in stage 0; 20.1% in stage I; 44.6% in stage II, and in stage III 11.4%. Regarding body mass index, it was found a mean of 26.7 BMI. 61.2% of patients ranged between overweight and obesity. 43.3% of patients with CRL reported a disability to perform one or more activities due to lymphedema. 80% of patients had no physical activity or performed under the minimal physical activity recommended for the population group they belong. Conclusion? This study reports broad epidemiological and clinical features of a group of cancer-related lymphedema patients in Mexico, it was possible to identify diverse potential factors and relations that influence the clinical features of CRL; it is necessary to explore all factors and the interactions among them for a better understanding of CRL patients in the country.

Lymphedema in Mexico: A Clinical and Epidemiological Overview

Background: There is insufficient clear epidemiological and clinical knowledge about lymphedema patient’s population in Mexico, this limits its investigation. The objective of this study is to present basic lymphedema epidemiological data and its clinical characteristics based on the analysis of lymphedema patients’ data collected from a specialized rehabilitation clinic in Mexico. Methods: This is a cohort study developed between 2015 and 2021. The study was carried ou in a private clinic specialized in oncological and peripheral vascular patients’ rehabilitation. Clinical assessments and interviews were performed to collect each case’s clinical history, considering its medical characteristics, physical activity and functionality and socio-demographic information, classified in a matrix, and later statistically evaluated. Results: Among 446 lymphedema patients, gender distribution was represented by 81% female and 19% male with a mean age of 50.5 years (±44.5). The population was categorized into the following three different study groups according to diagnosis: Cancer-Related Lymphedema (CRL), Non-Cancer-Related Secondary Lymphedema (NCRSL) and Primary Lymphedema. 60.08% of the patients had CRL; 25.11% had NCRSL and 14.79% had Primary Lymphedema. Among the patients with CRL, 81% of them corresponded to breast cancer diagnosis, the rest were associated to 19 different cancer diagnoses. The most prevalent diagnosis was breast CRL 48.6%; phlebolymphedema 19.4%; congenital and praecox lymphedema 14.1%; lipo-lymphedema 4.8%. The BMI of 64% of the patients ranged in overweight and obesity. 37.6% of patients reported that had experienced pain in limbs affected by lymphedema and 45% of all patients reported some disability to perform one or more activities associated to their limb volume or limb discomfort. 82% of patients had no physical activity or performed less physical activity than what is suggested to their population group’s recommendation. Conclusion: This study stablishes a precedent on reporting the broadest available epidemiological and clinical data of lymphedema in Mexico. Further studies are needed to report with a higher precision the epidemiological, clinical, and demographical data about each etiological group for a better understanding of lymphedema in Mexico and Latin America.

External application of traditional Chinese medicine on treatment of breast cancer related lymphedema: a systematic review / 中国实用护理杂志

Objective:To systematic review the efficacy and safety of external application of traditional Chinese medicine on treatment of breast cancer related lymphedema.Methods:CNKI, Wanfang Data, VIP, Sino-Med, The Cochrane Library, PubMed, Web of Science were searched for related randomized controlled trials, the retrieval time was from inception to May 25, 2020. Two researchers independently screened and evaluated the included studies. Meta-analysis was performed by RevMan 5.4 software.Results:A total of 16 studies involving 1 315 patients with breast cancer related lymphedema were included, and the methodological quality of the included studies was not high. Compared with conventional treatment, external application of traditional Chinese medicine combined with conventional treatment had advantages in improving the total efficiency( P<0.01) and quality of life( P<0.01), reducing pain( P<0.01) and improving upper limb function( P<0.01), without obvious adverse reactions( P>0.05), but there was no improvement in depression( P>0.05). Compared with conventional treatment, external application of traditional Chinese medicine could improve the total efficiency( P<0.01). Compared with placebo sticker combined with conventional treatment, external application of traditional Chinese medicine combined with conventional treatment can reduce circumference( P<0.05) and reduce pain( P<0.01), without obvious adverse reactions( P>0.05). Conclusions:Available evidence suggests that external application of traditional Chinese medicine may be a potential treatment method for breast cancer related lymphedema. Due to the poor methodological quality of the included studies, high-quality randomized controlled trials are still needed.

Association of postoperative radiotherapy and body mass index with the incidence of breast cancer related lymphedema in Chinese patients / 中国肿瘤临床

Objective: To investigate the correlation between body mass index (BMI) and the incidence of breast cancer (BC) related lymphedema (BCRL) in Chinese patients over the period following postoperative radiotherapy (RT). Methods: This study included 281 female patients with single-sided BC who were treated at The Fourth Hospital of Hebei Medical University between November 2013 and February 2015. The clinical data of these patients were collected prospectively and analyzed. Based on their BMI, the patients were classified into three subgroups: low BMI (BMI BMI>25, n=89), and high BMI (BMI≥28, n=98). The upper limb volume difference (ULVD) was compared between the diseased and healthy one. Univariate and multivariate generalized estimating equations (GEE) and linear logistic regression models were used to estimate the effects of RT and BMI on BCRL (defined as a ULVD ≥200 mL). In addition, these results were compared among the three BMI subgroups. Results: The mean ULVD before and after RT were 40.6 and 42.9 mL, respectively. The median ULVD before and after therapy remained constant at 30.0 mL; no significant difference was observed (P>0.05). Two and single patient respectively lacked one arm volume measurement before and after RT. The BCRL incidence rates in the low, middle, and high BMI subgroups before RT were 2.2% (2/93), 6.8% (6/88), and 13.3% (13/98); the corresponding rates after RT were 1% (1/93), 12.4% (11/89), and 12.2% (12/98), respectively. The GEE model indicated that RT did not cause an increase in the incidence rate of BCRL (P=0.529). Multivariable logistic regression for the middle and high BMI subgroups before RT (RR=4.199, P=0.693 and RR=10.999, P=0.002, respectively) and after RT (RR=13.287, P=0.047 and RR=14.308, P=0.029, respectively) indicated a significantly higher risk of BCRL in the high BMI subgroup . Similar results were obtained from the subgroup analyses of the middle BMI subgroup. Conclusions: The incidence and severity of BCRL do not decrease during the period following postoperative RT. Among Chinese BC patients, a lower threshold BMI of 28 kg/m2 appears to be associated with BCRL after RT. This is distinctly different from the commonly reported BMI threshold of 30 kg/m2 in most European and American studies.

Prevalência de linfedema após mastectomia em portadoras de câncer de mama: uma revisão sistemática acerca da influência da reconstrução imediata / Prevalence of lymphedema after mastectomy in women living with breast cancer: a systematic review of the influence of immediate reconstruction

Este estudo objetivou analisar, por meio de uma revisão sistemática da literatura, a influência da reconstrução imediata na prevalência de linfedema após mastectomia em pacientes portadoras de câncer de mama. Foram analisados os mais relevantes estudos publicados originalmente em qualquer idioma até agosto de 2018, indexados às bases de dados US National Library of Medicine, Cochrane Central Register of Controlled Trials, Web of Science e Scientific Electronic Library Online. A amostra foi composta por 10 publicações que se adequaram aos critérios de inclusão e exclusão estabelecidos, incluindo 2.425 pacientes submetidas a apenas mastectomia e 2.772 pacientes submetidas à mastectomia associada à reconstrução imediata da mama. A prevalência de linfedema foi 20,95% nas pacientes submetidas a apenas mastectomia (n = 508) e de 5,23% nas pacientes submetidas à mastectomia associada à reconstrução imediata (n = 145), havendo diferença estatisticamente significativa (p < 0,001). Concluiu-se que a mastectomia associada à reconstrução imediata influencia positivamente o prognóstico das pacientes portadoras de câncer de mama, proporcionando um índice significativamente menor de linfedema, quando comparada à realização de apenas mastectomia.

This study aimed to analyze, through systematic review of literature, the influence of immediate reconstruction on the prevalence of lymphedema after mastectomy, in women living with breast cancer. The analysis considered the most relevant studies originally published, in any language, up to August 2018, indexed on the databases of the US National Library of Medicine, Cochrane Central Register of Controlled Trials, Web of Science, and Scientific Electronic Library Online. The sample comprised 10 publications that met the established criteria for inclusion and exclusion, including 2,425 patients who were subjected to mastectomy alone, and 2,772 patients who were subjected to mastectomy associated with immediate reconstruction of the breast. The prevalence of lymphedema was 20.95% in patients who had been subjected to mastectomy alone (n = 508), and 5.23% among those patients who were subjected to mastectomy associated with immediate reconstruction of the breast (n = 145), the difference being statistically significant (p < 0.001). We concluded that mastectomy, when associated with immediate breast reconstruction, has a positive influence on the prognosis of patients living with breast cancer, thereby providing a much lower rate of lymphedema when compared with mastectomy alone.

Consistency between Arm Circumference and Water Drainage Volume in Measurements of Breast Cancer Related Lymphedema / 中国康复理论与实践

Objective:To compare arm circumference (AC) and upper limb volume (ULV) in assessment of breast cancer related lymphedema (BCRL). Methods:From November, 2013 to February, 2015, 281 women with one-sided breast cancer accepting radiotherapy were consecutively enrolled. AC was measured as the means of circumference 10 cm above and 5 cm below the most eminent midpoint of olecranon. ULV was measured as the water displacement volume when the water surface reached at 15 cm above the midpoint of olecranon. Univariate and multivariable linear regressions were used between AC and ULV. Results:All the correlated coefficients between AC and In(ULV) were above 0.959 (P < 0.001). For linear equations, the R2 > 0.90. The consistency of diagnoses of BCRL with AC and ULV were above 90% (Kappa > 0.492, P < 0.001). Conclusions:AC and ULV are consistent in measurement of BCRL. AC is reliable and easier.

Diagnostic Significance of Fibrin Degradation Products and D-Dimer in Patients With Breast Cancer-Related Lymphedema

OBJECTIVE: To find out whether levels of fibrin degradation products (FDP) and D-dimer are increased in breast cancer-related lymphedema (BCRL) as in many vascular diseases. FDP and D-dimer have been used in blood tests to help differentiate deep vein thrombosis in the diagnosis of lymphedema. Levels of FDP and D-dimer are often elevated in patients with BCRL. METHODS: Patients with BCRL (group I), non-lymphedema after breast cancer treatment (group II), and deep venous thrombosis (group III) from January 2012 to December 2016 were enrolled. Levels of FDP and D-dimer were measured in all groups and compared among groups. RESULTS: Mean values of FDP and D-dimer of group I were 5.614±12.387 and 1.179±2.408 μg/μL, respectively. These were significantly higher than their upper normal limits set in our institution. Levels of FDP or D-dimer were not significantly different between group I and group II. However, values of FDP and D-dimer in group III were significantly higher than those in group I. CONCLUSION: Values of FDP and D-dimer were much higher in patients with thrombotic disease than those in patients with lymphedema. Thus, FDP and D-dimer can be used to differentiate between DVT and lymphedema. However, elevated levels of FDP or D-dimer cannot indicate the occurrence of lymphedema.

Diagnostic and Therapeutical Progress of Breast Cancer Related Lymphedema / 中国微创外科杂志

[Summary] With the development of diagnosis and treatment levels and the improvement of survival rates of breast cancer , related lymphedema has received increasing attention .In a long term, it is regarded as the primary complication after the breast cancer therapy , which affects the quality of life of patients .Due to lack of consensus in many aspects worldwide , it continues to be a challenge to diagnose and treat the disease .This article aimed to summarize the diagnosis and therapeutics of breast cancer related lymphedema .

Prediction of Treatment Outcome with Bioimpedance Measurements in Breast Cancer Related Lymphedema Patients

OBJECTIVE: To investigate the usefulness of bioimpedance measurement for predicting the treatment outcome in breast cancer related lymphedema (BCRL) patients. METHOD: Unilateral BCRL patients who received complex decongestive therapy (CDT) for 2 weeks (5 days per week) were enrolled in this study. We measured the ratio of extracellular fluid (ECF) volume by using bioelectrical impedance spectroscopy (BIS), and single frequency bioimpedance analysis (SFBIA) at a 5 kHz frequency before treatment. Arm circumferences were measured at 10 cm above and below the elbow before and after treatment. We also investigated whether there is correlation between ECF ratio and SFBIA ratio with the change of arm circumference after CDT. RESULTS: A total of 73 patients were enrolled in this study. The higher ECF ratio was significantly correlated with higher reduction of arm circumference at both above and below the elbow after treatment, but the higher SFBIA ratio was correlated only with the higher reduction of arm circumference below the elbow. CONCLUSION: These results show that ECF volume measurements and SFBIA before treatment are useful tools for predicting the outcome of patients with lymphedema. We concluded that ECF volume measure can be used as a screening tool for predicting treatment outcome of BCRL patients.