Predictive Factors of Response to Decongestive Therapy in Patients with Breast-Cancer-Related Lymphedema
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Many studies have reported the benefits of Decongestive treatment in patients with breast-cancer-related lymphedema (BCRL) but few have study what are the predictive factors of response.
We performed a prospective, multicenter controlled cohort study of 171 patients with BCRL to identify independent predictive factors of response to decongestive treatment (CDT). Demographic data and clinical and lymphedema characteristics were collected prospectively. The end point was the “percentage reduction in excess volume (PREV).” Volumes were measured prior and at the end of CDT. Factors associated with response (PREV) were tested in univariate and multivariate analyses using linear regression techniques.
Median age was 60.4 years (range 32–84); mean lymphedema chronicity 4 years [95% confidence interval (95% CI): 3.1–5.0]; mean baseline excess volume (EV) was 936 mL (95% CI: 846–1026), and mean percentage EV was 35.3% (95% CI: 32.0–38.7); compliance to bandages was good in 81.3% of patients. PREV was 71.7% (95% CI: 65.2–78.2). After univariate screening, 11 variables were found to be associated with PREV but only 4 variables were independent predictive factors of response to CDT in the multivariate analysis: Venous insufficiency, percentage of EV (the higher the EV, the lower the reduction with CDT); compliance to bandages (a good compliance improved PREV in 25%), and treatment in autumn (better results than during the rest of the year).
This study shows that compliance to bandages during CDT is one of the most important predictors of response. Moreover, data support the idea that more severe lymphedemas have a worse response to treatment, and it should be recommended in early stages. The association between the season of treatment and response was also very strong, so weather conditions are an additional factor that must be taken into account in further studies.
- Földi E, Földi M. Lymphostatic diseases. In: Földi M, editors. Textbook of lymphology for physicians and lymphedema therapists. Munich: Urban & Fisher; 2003. p. 231–319.
- Ji RC. Lymphatic endothelial cells, lymphedematous lymphangiogenesis, and molecular control of edema formation. Lymphat Res Biol. 2008;6:123–37. CrossRef
- Petrek JA, Heelan MC. Incidence of breast carcinoma-related lymphedema. Cancer. 1998;83:2776–81. CrossRef
- Hinrichs CS, Watroba NL, Rezaishiraz H, Giese W, Hurd T, Fassl KA, et al. Lymphedema secondary to postmastectomy radiation: incidence and risk factors. Ann Surg Oncol. 2004;11:573–8. CrossRef
- Shih YC, Xu Y, Cormier JN, Giordano S, Ridner SH, Buchholz TA, et al. Incidence, treatment costs, and complications of lymphedema after breast cancer among women of working age: a 2-year follow-up study. J Clin Oncol. 2009;27:2007–14. CrossRef
- Norman SA, Localio AR, Potashnik SL, Simoes Torpey HA, Kallan MJ, et al. Lymphedema in breast cancer survivors: incidence, degree, time course, treatment, and symptoms. J Clin Oncol. 2009;27:390–7. CrossRef
- Hayes SC, Janda M, Cornish B, Battistutta D, Newman B. Lymphedema after breast cancer: incidence, risk factors, and effect on upper body function. J Clin Oncol. 2008;26:3536–42. CrossRef
- Paskett ED, Naughton MJ, McCoy TP, Case LD, Abbott JM. The epidemiology of arm and hand swelling in premenopausal breast cancer survivors. Cancer Epidemiol Biomarkers Prev. 2007;16:775–82. CrossRef
- Yen TW, Fan X, Sparapani R, Laud PW, Walker AP, Nattinger AB. A contemporary, population-based study of lymphedema risk factors in older women with breast cancer. Ann Surg Oncol. 2009;16:979–88. CrossRef
- Lee TS, Kilbreath SL, Refshauge KM, Herbert RD, Beith JM. Prognosis of the upper limb following surgery and radiation for breast cancer. Breast Cancer Res Treat. 2008;110:19–37. CrossRef
- Chachaj A, Małyszczak K, Pyszel K, Lukas J, Tarkowski R, Pudelko M, et al. (2009) Physical and psychological impairments of women with upper limb lymphedema following breast cancer treatment. Psychooncology. 2009; Apr 27. http://www3.interscience.wiley.com/journal/5807 [Epub ahead of print].
- Ahmed RL, Prizment A, Lazovich D, Schmitz KH, Folsom AR. Lymphedema and quality of life in breast cancer survivors: the Iowa Women’s Health Study. J Clin Oncol. 2008;26:5689–96. CrossRef
- Kwan W, Jackson J, Weir LM, Dingee C, McGregor G, Olivotto IA. Chronic arm morbidity after curative breast cancer treatment: prevalence and impact on quality of life. J Clin Oncol. 2002;20:4242–8. CrossRef
- McWayne J, Heiney SP. Psychologic and social sequelae of secondary lymphedema: a review. Cancer. 2005;104:457–66. CrossRef
- Pain SJ, Vowler SL, Purushotham AD. Is physical function a more appropriate measure than volume excess in the assessment of breast cancer-related lymphoedema (BCRL)? Eur J Cancer. 2003;39:2168–72. CrossRef
- Paskett ED. Breast cancer-related lymphedema: attention to a significant problem resulting from cancer diagnosis. J Clin Oncol. 2008;26:5666–7. CrossRef
- International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema. 2009 Consensus document of the International Society of Lymphology. Lymphology. 2009;42:51–60.
- Badger C, Preston N, Seers K, Mortimer P. Physical therapies for reducing and controlling lymphoedema of the limbs. Cochrane Database Syst Rev. 2004;Oct 18;:CD003141.
- Lawenda BD, Mondry TE, Johnstone PA. Lymphedema: a primer on the identification and management of a chronic condition in oncologic treatment. CA Cancer J Clin. 2009;59:8–24. CrossRef
- Erickson VS, Pearson ML, Ganz PA, Adams J, Kahn KL. Arm edema in breast cancer patients. J Natl Cancer Inst. 2001;93:96–111. CrossRef
- Ko DS, Lerner R, Klose G, Cosimi AB. Effective treatment of lymphedema of the extremities. Arch Surg. 1998;133:452–8. CrossRef
- Yamamoto R, Yamamoto T. Effectiveness of the treatment-phase of two-phase complex decongestive physiotherapy for the treatment of extremity lymphedema. Int J Clin Oncol. 2007;12:463–8. CrossRef
- Bertelli G, Venturini M, Forno G, Macchiavello F, Dini D. An analysis of prognostic factors in response to conservative treatment of postmastectomy lymphedema. Surg Gynecol Obstet. 1992;175:455–60.
- Forner-Cordero I, Muñoz-Langa J, DeMiguel-Jimeno JM, Rel-Monzo P. Physical therapies in the treatment of lymphedema: preliminary results of a phase III, multicenter, randomized, double-blind, controlled study. Abstracts of the XXXIV ESL congress, June 25–27, Naples, Italy. Eur J Lymphol Relat Probl. 2008;19:6.
- Ramos SM, O’Donnell LS, Knight G. Edema volume, not timing, is the key to success in lymphedema treatment. Am J Surg. 1999;178:311–5. CrossRef
- Vignes S, Porcher R, Champagne A, Dupuy A. Predictive factors of response to intensive decongestive physiotherapy in upper limb lymphedema after breast cancer treatment: a cohort study. Breast Cancer Res Treat. 2006;98:1–6. CrossRef
- Kurz I. Textbook of Dr. Vodder’s manual lymph drainage. In: Harris RS, eds. Therapy. 2nd ed. Heidelberg (Germany): Karl S. Haug Publishers; 1989.
- Chen YW, Tsai HJ, Hung HC, Tsauo JY. Reliability study of measurements for lymphedema in breast cancer patients. Am J Phys Med Rehabil. 2008;87:33–8. CrossRef
- Deltombe T, Jamart J, Recloux S, Legrand C, Vandenbroeck N, Theys S, et al. Reliability and limits of agreement of circumferential, water displacement, and optoelectronic volumetry in the measurement of upper limb lymphedema. Lymphology. 2007;40:26–34.
- George SL. Identification and assessment of prognostic factors. Semin Oncol. 1988;15:462–71.
- Lyman GH. Risk assessment in oncology clinical practice. From risk factors to risk models. Oncology. 2003;17:8–13.
- Kleinbaum DG. Logistic regression. A self-Learning text. New York: Springer-Verlag; 1994.
- Badger CM, Peacock JL, Mortimer PS. A randomized, controlled, parallel-group clinical trial comparing multilayer bandaging followed by hosiery versus hosiery alone in the treatment of patients with lymphedema of the limb. Cancer. 2000;88:2832–37. CrossRef
- Johansson K, Albertsson M, Ingvar C, Ekdahl C. Effects of compression bandaging with or without manual lymph drainage treatment in patients with postoperative arm lymphedema. Lymphology. 1999;32:103–10.
- McNeely ML, Magee DJ, Lees AW, Bagnall KM, Haykowsky M, Hanson J. The addition of manual lymph drainage to compression therapy for breast cancer related lymphedema: a randomized controlled trial. Breast Cancer Res Treat. 2004;86:95–106. CrossRef
- Clark M. Compression bandages: principles and definitions. In: European wound management association. Understanding compression therapy. London: Medical Education Partnership Ltd, 2003; 5–7.
- Partsch H. Understanding the pathophysiological effects of compression. In: European wound management association. Understanding compression therapy. London: Medical Education Partnership Ltd; 2003. p. 2–4.
- Kligman L, Wong RK, Johnston M, Laetsch NS. The treatment of lymphedema related to breast cancer: a systematic review and evidence summary. Support Care Cancer. 2004;12:421–31. CrossRef
- Lymphoedema Framework. Best practice for the management of lymphoedema. International Consensus. London: MEP Ltd; 2006.
- Moseley AL, Carati CJ, Piller NB. A systematic review of common conservative therapies for arm lymphoedema secondary to breast cancer treatment. Ann Oncol. 2007;18:639–46. CrossRef
- Forner-Cordero I, Muñoz-Langa J, Albiach-Gascó L, Maldonado-Garrido D. Efficacy of garments in the long-term management of post-mastectomy lymphedema: preliminary results from prospective cohort study. Eur J Lymphol Relat Probl. 2007;17:7–11.
- Shaw C, Mortimer P, Judd PA. Randomized controlled trial comparing a low-fat diet with a weight-reduction diet in breast cancer-related lymphedema. Cancer. 2007;109:1949–56. CrossRef
- Bergan JJ, Sparks S, Angle N. A comparison of compression pumps in the treatment of lymphedema. Vasc Endovascular Surg. 1998;32:455–62. CrossRef
- Forner-Cordero I, Navarro-Monsoliu R, Muñoz-Langa J, Rel-Monzó P. Early or late diagnosis of lymphedema in our Lymphedema Unit. Eur J Lymphol Relat Probl. 2006;16:19–23.
- Bar Ad V, Cheville A, Solin LJ, Dutta P, Both S, Harris EER. Time course of mild arm lymphedema after breast conservation treatment for early-stage breast cancer. Int J Radiation Oncology Biol Phys. doi:10.1016/j.ijrobp.2009.01.024, 2009; Aug 1 [Epub ahead of print].
- Szuba A, Rockson SG. Lymphedema: anatomy, physiology and pathogenesis. Vasc Med. 1997;2:321–6.
- Brorson H, Ohlin K, Olsson G, Nilsson M. Adipose tissue dominates chronic arm lymphedema following breast cancer: an analysis using volume rendered CT images. Lymphat Res Biol. 2006;4:199–210. CrossRef
- Predictive Factors of Response to Decongestive Therapy in Patients with Breast-Cancer-Related Lymphedema
Annals of Surgical Oncology
Volume 17, Issue 3 , pp 744-751
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Physical Medicine and Rehabilitation Specialist, Hospital La Fe, Valencia, Spain
- 2. Medical Oncology, University Hospital Dr Peset, Valencia, Spain
- 3. Bioengineering Group, Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
- 4. Rehabilitation Unit, Hospital San Pedro, Logroño, Spain