Hand Edema in Patients at Risk of Breast Cancer‐Related Lymphedema: Health Professionals Should Take Notice

Background. There is little research on hand edema in the population at risk for breast cancer‐related lymphedema (BCRL). Objectives. Study aims included reporting potential importance of hand edema (HE) as a risk factor for progression of edema in patients treated for breast cancer at risk for BCRL, reporting risk factors for BCRL, and reporting treatment of HE. Design/Methods. This was a retrospective analysis of 9 patients treated for breast cancer in Massachusetts General Hospital's lymphedema screening program who presented with isolated HE. Limb volumes via perometry, BCRL risk factors, and HE treatment are reported. Results. Edema was mostly isolated to the hand. Three patients had arm edema >5% on perometry; and 2 of these had edema outside the hand on clinical examination. Patients were at high risk of BCRL with an average of 2.9/5 known risk factors. Arm edema progressed to >10% in 2 high‐risk patients. Treatment resulted in an average hand volume reduction of 10.2% via perometry and improvement upon clinical examination. Limitations. The small sample size and lack of validated measures of subjective data were limitations. Conclusions. In this cohort, patients with HE carried significant risk factors for BCRL. Two out of 9 (22%), both carrying ≥4/5 risk factors, progressed to edema >10%. Isolated HE may be a prognostic factor for edema progression in patients treated for breast cancer at risk for BCRL. Further research is warranted.

[1]  L. Gerber,et al.  A prospective surveillance model for rehabilitation for women with breast cancer , 2012, Cancer.

[2]  S. O'Sullivan,et al.  Physical Rehabilitation: Assessment and Treatment , 1980 .

[3]  W. Svensson,et al.  Differences in lymph drainage between swollen and non-swollen regions in arms with breast-cancer-related lymphoedema. , 2001, Clinical science.

[4]  F. Ansaldi,et al.  Prospective evaluation of a prevention protocol for lymphedema following surgery for breast cancer. , 2009, Lymphology.

[5]  W. Svensson,et al.  A quantitative lymphoscintigraphic evaluation of lymphatic function in the swollen hands of women with lymphoedema following breast cancer treatment. , 2006, Clinical science.

[6]  J. Studdiford,et al.  Evaluating edema of the hands , 2009 .

[7]  Cynthia L. Miller,et al.  Risk of lymphedema after mastectomy: potential benefit of applying ACOSOG Z0011 protocol to mastectomy patients , 2014, Breast Cancer Research and Treatment.

[8]  Cynthia L. Miller,et al.  The need for preoperative baseline arm measurement to accurately quantify breast cancer-related lymphedema , 2016, Breast Cancer Research and Treatment.

[9]  S. Czerniec,et al.  Reliability and concurrent validity of the perometer for measuring hand volume in women with and without lymphedema. , 2011, Lymphatic research and biology.

[10]  Ruy Freitas Reis,et al.  A personalized computational model of edema formation in myocarditis based on long-axis biventricular MRI images , 2019, BMC Bioinformatics.

[11]  L. Salama,et al.  Diagnostic Methods, Risk Factors, Prevention, and Management of Breast Cancer-Related Lymphedema: Past, Present, and Future Directions , 2017, Current Breast Cancer Reports.

[12]  Fangdi Sun,et al.  Perometry versus simulated circumferential tape measurement for the detection of breast cancer-related lymphedema , 2018, Breast Cancer Research and Treatment.

[13]  H. Mayrovitz,et al.  Hand volume estimates based on a geometric algorithm in comparison to water displacement. , 2006, Lymphology.

[14]  Consensus Document,et al.  The Diagnosis and Treatment of Peripheral Lymphedema: 2016 Consensus Document of the International Society of Lymphology. , 2016, Lymphology.

[15]  Cynthia L. Miller,et al.  Defining a threshold for intervention in breast cancer-related lymphedema: what level of arm volume increase predicts progression? , 2013, Breast Cancer Research and Treatment.

[16]  Alphonse G. Taghian,et al.  Establishing and Sustaining a Prospective Screening Program for Breast Cancer-Related Lymphedema at the Massachusetts General Hospital: Lessons Learned , 2015, Journal of personalized medicine.

[17]  M. Specht,et al.  A novel, validated method to quantify breast cancer-related lymphedema (BCRL) following bilateral breast surgery. , 2013, Lymphology.

[18]  L. Gerber,et al.  Breast Cancer–Related Lymphedema: Comparing Direct Costs of a Prospective Surveillance Model and a Traditional Model of Care , 2011, Physical Therapy.

[19]  Cynthia L. Miller,et al.  The impact of radiation therapy on the risk of lymphedema after treatment for breast cancer: a prospective cohort study. , 2014, International journal of radiation oncology, biology, physics.

[20]  M. Irwin ACSM's Guide to Exercise and Cancer Survivorship , 2011 .

[21]  Cynthia L. Miller,et al.  Impact of body mass index and weight fluctuation on lymphedema risk in patients treated for breast cancer , 2013, Breast Cancer Research and Treatment.

[22]  B. Newman,et al.  Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. , 2013, The Lancet. Oncology.

[23]  S. Mclaughlin,et al.  Considerations for Clinicians in the Diagnosis, Prevention, and Treatment of Breast Cancer-Related Lymphedema: Recommendations from a Multidisciplinary Expert ASBrS Panel , 2017, Annals of Surgical Oncology.

[24]  Barbara L. Smith,et al.  Standardized method for quantification of developing lymphedema in patients treated for breast cancer. , 2011, International journal of radiation oncology, biology, physics.

[25]  L. Gerber,et al.  Segmental Limb Volume Change as a Predictor of the Onset of Lymphedema in Women With Early Breast Cancer , 2011, PM & R : the journal of injury, function, and rehabilitation.

[26]  Cynthia L. Miller,et al.  Factors associated with fear of lymphedema after treatment for breast cancer. , 2014, Oncology nursing forum.

[27]  J. Armer,et al.  Prospective Lymphedema Surveillance in a Clinic Setting , 2015, Journal of personalized medicine.

[28]  L. Ward,et al.  Use of impedance ratios to assess hand swelling in lymphoedema , 2014, Phlebology.