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Patient-reported outcomes and objective assessments with arm measurement and bioimpedance analysis for lymphedema among breast cancer survivors

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Abstract

Purpose

Lymphedema (LE) decreases the quality of life of breast cancer patients. Objective quantification of PRO may improve the discordance between patient-reported outcomes (PROs) and objective assessments of LE by establishing a standard follow-up for LE. This study determined the prevalence of subjective and objective LE and evaluated the correlation between objective assessment and PRO of LE in primary breast cancer patients undergoing breast and axilla surgery.

Methods

Breast cancer patients who underwent sentinel lymph node biopsy (SN) or axillary lymph node dissection (ALND) more than 1 year after surgery were enrolled. We prospectively evaluated LE using the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) and two objective assessments (arm circumference and bioimpedance) and analyzed their correlations.

Results

Between November 2018 and January 2019, 631 patients (SN; n = 415, ALND; n = 216) were enrolled. The median age, body mass index, and duration from surgery was 56 years, 21.9 kg/m2, and 3.8 years, respectively. The prevalences of subjective and objective LE were 4.1% and 1.4% in the SN group and 51.8% and 24.1% in the ALND group, respectively. The objective assessments were weakly positively correlated with PRO-CTCAE. Arm circumference measurement correlated better than bioimpedance overall and was most strongly correlated with “frequency” (r = 0.485, p < 0.01).

Conclusions

LE occurred in few SN patients. The prevalence of subjective LE was higher than that of objective LE. Arm circumference measurements better reflected PRO than did bioimpedance. These results underscore the limitation of LE detection by subjective or objective methods alone.

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Acknowledgements

We would like to thank all the patients for participating in this study. We are also grateful to Setsuko Nishikawa, Mami Matsuda and other colleagues involved in this study. We would like to thank Editage (www.editage.com) for English language editing.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Breast Oncology, Aichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan

    Mitsuo Terada, Akiyo Yoshimura, Masataka Sawaki, Masaya Hattori, Gondo Naomi, Haruru Kotani, Yayoi Adachi, Madoka Iwase, Ayumi Kataoka, Kayoko Sugino, Makiko Mori, Nanae Horisawa, Yuri Ozaki & Hiroji Iwata

  2. Department of Breast Surgery, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho Mizuho-ku, Nagoya, Aichi, 467-8602, Japan

    Mitsuo Terada

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  1. Mitsuo Terada
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Correspondence to Akiyo Yoshimura.

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Terada, M., Yoshimura, A., Sawaki, M. et al. Patient-reported outcomes and objective assessments with arm measurement and bioimpedance analysis for lymphedema among breast cancer survivors. Breast Cancer Res Treat 179, 91–100 (2020). https://doi.org/10.1007/s10549-019-05443-1

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