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Long-Term Burden of Breast Cancer-Related Lymphedema

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  • Published:
Current Breast Cancer Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Breast cancer-related lymphedema (BCRL) remains a significant burden for breast cancer survivors. With improved survival, recognition of the long-term burden of BCRL on patients is increasingly important.

Recent Findings

Surveillance for BCRL is recommended by expert consensus guidelines, with detection of early BCRL associated with lower rates of persistent disease; however, currently, there are no recommendations regarding frequency nor duration. Formal guidelines may reduce the long-term burden of worry for patients. Once BCRL develops, patients experience the life-long burden of managing a chronic disease, including remaining compliant with complex therapy and negative effects on quality of life. With long-term treatment also comes significant financial toxicity through direct cost of treatment and indirect costs, including loss of productivity and income.

Summary

The long-term burdens of BCRL exist in all who need surveillance and in those with BCRL as chronic disease management, worse quality of life, and financial toxicity.

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Data Availability

No datasets were generated or analysed during the current study.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. American Cancer Society. Cancer Facts & Figures 2022. Atlanta: American Cancer Society; 2022.

    Google Scholar 

  2. DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol. 2013;14(6):500–15.

    Article  PubMed  Google Scholar 

  3. Boughey JC, Suman VJ, Mittendorf EA, Ahrendt GM, Wilke LG, Taback B, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310(14):1455–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Giuliano AE, Ballman KV, McCall L, Beitsch PD, Brennan MB, Kelemen PR, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) randomized clinical trial. JAMA. 2017;318(10):918–26.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Donker M, van Tienhoven G, Straver ME, Meijnen P, van de Velde CJ, Mansel RE, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981–22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014;15(12):1303–10.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Society of Surgical Oncology. Choosing wisely. 2016. Available at: https://www.surgonc.org/wp-content/uploads/2020/11/SSO-5things-List_2020-Updates-11-2020.pdf. Accessed 10 Nov 2023

  7. The American Society of Breast Surgeons. Consensus guideline on axillary management for patients with in-situ and invasive breast cancer: a concise overview. 2022. Available at: https://www.breastsurgeons.org/resources/statements. Accessed 10 Nov 2023

  8. Rafn BS, Christensen J, Larsen A, Bloomquist K. Prospective surveillance for breast cancer-related arm lymphedema: a systematic review and meta-analysis. J Clin Oncol. 2022;40(9):1009–26.

    Article  PubMed  Google Scholar 

  9. Kilgore LJ, Korentager SS, Hangge AN, Amin AL, Balanoff CR, Larson KE, et al. Reducing breast cancer-related lymphedema (BCRL) through prospective surveillance monitoring using bioimpedance spectroscopy (BIS) and patient directed self-interventions. Ann Surg Oncol. 2018;25(10):2948–52.

    Article  PubMed  Google Scholar 

  10. Ridner SH, Dietrich MS, Cowher MS, Taback B, McLaughlin S, Ajkay N, et al. A randomized trial evaluating bioimpedance spectroscopy versus tape measurement for the prevention of lymphedema following treatment for breast cancer: interim analysis. Ann Surg Oncol. 2019;26(10):3250–9.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ridner SH, Dietrich MS, Boyages J, Koelmeyer L, Elder E, Hughes TM, et al. A comparison of bioimpedance spectroscopy or tape measure triggered compression intervention in chronic breast cancer lymphedema prevention. Lymphat Res Biol. 2022;20(6):618–28. This randomized control trial examines lymphedema surveillance with either tape measure vs bioimpedance, with initiation of compression therapy if threshold is met. The authors found that in both arms a small portion of patients progressed to require complex decongestive therapy, supporting improved outcomes with surveillance.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Donahue PMC, MacKenzie A, Filipovic A, Koelmeyer L. Advances in the prevention and treatment of breast cancer-related lymphedema. Breast Cancer Res Treat. 2023;200(1):1–14.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Paramanandam VS, Dylke E, Clark GM, Daptardar AA, Kulkarni AM, Nair NS, et al. 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. J Clin Oncol. 2022;40(18):2004–12. This randomized control trial compares prophylactic post-operative compression sleeves vs standard of care until 3 months after completion of adjuvant therapy. They found decreased arm swelling by bioimpedence with prophylactic compression.

    Article  CAS  PubMed  Google Scholar 

  14. Thompson M, Korourian S, Henry-Tillman R, Adkins L, Mumford S, Westbrook KC, et al. Axillary reverse mapping (ARM): a new concept to identify and enhance lymphatic preservation. Ann Surg Oncol. 2007;14(6):1890–5.

    Article  PubMed  Google Scholar 

  15. Tummel E, Ochoa D, Korourian S, Betzold R, Adkins L, McCarthy M, et al. Does axillary reverse mapping prevent lymphedema after lymphadenectomy? Ann Surg. 2017;265(5):987–92.

    Article  PubMed  Google Scholar 

  16. Coriddi M, Dayan J, Bloomfield E, McGrath L, Diwan R, Monge J, et al. Efficacy of immediate lymphatic reconstruction to decrease incidence of breast cancer-related lymphedema: preliminary results of randomized controlled trial. Ann Surg. 2023. This study is a preliminary analysis of a randomized control trial comparing immediate lymphatic reconstruction vs control after ALND. Final analysis with longer-term follow up is planned to be published in the future.

  17. Le NK, Liu L, Jesus Cruz R, Parikh J, Rotatori RM, Wainwright DJ, et al. Efficacy of immediate lymphatic reconstruction in prevention of breast cancer-related lymphedema. Ann Plast Surg. 2023;90(6S Suppl 4):S363–5.

    Article  CAS  PubMed  Google Scholar 

  18. Hill WKF, Deban M, Platt A, Rojas-Garcia P, Jost E, Temple-Oberle C. Immediate lymphatic reconstruction during axillary node dissection for breast cancer: a systematic review and meta-analysis. Plast Reconstr Surg Glob Open. 2022;10(5):e4291.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lin Q, Yang T, Yongmei J, et al. Prediction models for breast cancer-related lymphedema: a systematic review and critical appraisal. Syst Rev. 2022;11:217.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Rochlin DH, Barrio AV, McLaughlin S, Van Zee KJ, Woods JF, Dayan JH, et al. Feasibility and clinical utility of prediction models for breast cancer-related lymphedema incorporating racial differences in disease incidence. JAMA Surg. 2023;158(9):954–64.

    Article  PubMed  Google Scholar 

  21. Position Statement of the National Lymphedema Network. Screening and early detection of breast cancer related lymphedema: the imperative. 2011. Available at https://lymphnet.org/position-papers. Accessed 10 Nov 2023

  22. McLaughlin SA, DeSnyder SM, Klimberg S, Alatriste M, Boccardo F, Smith ML, et al. Considerations for clinicians in the diagnosis, prevention, and treatment of breast cancer-related lymphedema, recommendations from an expert panel: part 2: preventive and therapeutic options. Ann Surg Oncol. 2017;24(10):2827–35.

    Article  PubMed  Google Scholar 

  23. NCCN Clinical Practice Guidelines in Oncology. Survivorship.Version 1.2023. 2023. Available at https://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf. Accessed 10 Nov 2023

  24. Executive Committee of the International Society of L. The diagnosis and treatment of peripheral lymphedema: 2020 Consensus Document of the International Society of Lymphology. Lymphology. 2020;53(1):3–19.

    Google Scholar 

  25. Ostby PL, Armer JM, Dale PS, Van Loo MJ, Wilbanks CL, Stewart BR. Surveillance recommendations in reducing risk of and optimally managing breast cancer-related lymphedema. J Pers Med. 2014;4(3):424–47.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Paskett ED, Le-Rademacher J, Oliveri JM, Liu H, Seisler DK, Sloan JA, et al. A randomized study to prevent lymphedema in women treated for breast cancer: CALGB 70305 (Alliance). Cancer. 2021;127(2):291–9. This multi-centered, randomized control trial compared prophylactic compression plus education to education only after breast cancer surgery. They found no difference in rates of lymphedema at 18 months, but had low rate of compliance.

    Article  PubMed  Google Scholar 

  27. Rupp J, Hadamitzky C, Henkenberens C, Christiansen H, Steinmann D, Bruns F. Frequency and risk factors for arm lymphedema after multimodal breast-conserving treatment of nodal positive breast cancer - a long-term observation. Radiat Oncol. 2019;14(1):39.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Brunelle C, Skolny M, Ferguson C, Swaroop M, O’Toole J, Taghian AG. Establishing and sustaining a prospective screening program for breast cancer-related lymphedema at the massachusetts general hospital: lessons learned. J Pers Med. 2015;5(2):153–64.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Norman SA, Localio AR, Potashnik SL, SimoesTorpey HA, Kallan MJ, Weber AL, et al. Lymphedema in breast cancer survivors: incidence, degree, time course, treatment, and symptoms. J Clin Oncol. 2009;27(3):390–7.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Petrek JA, Senie RT, Peters M, Rosen PP. Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis. Cancer. 2001;92(6):1368–77.

    Article  CAS  PubMed  Google Scholar 

  31. Armer JM, Stewart BR. Post-breast cancer lymphedema: incidence increases from 12 to 30 to 60 months. Lymphology. 2010;43(3):118–27.

    CAS  PubMed  PubMed Central  Google Scholar 

  32. McDuff SGR, Mina AI, Brunelle CL, Salama L, Warren LEG, Abouegylah M, et al. Timing of lymphedema after treatment for breast cancer: when are patients most at risk? Int J Radiat Oncol Biol Phys. 2019;103(1):62–70. This large, retrospective review examines risk factors for development of breast cancer related lymphedema with long term follow up and examines risk factors for timing of lymphedema onset.

    Article  PubMed  Google Scholar 

  33. McLaughlin SA, Bagaria S, Gibson T, Arnold M, Diehl N, Crook J, et al. Trends in risk reduction practices for the prevention of lymphedema in the first 12 months after breast cancer surgery. J Am Coll Surg. 2013;216(3):380–9 (quiz 511-3).

    Article  PubMed  Google Scholar 

  34. Gandhi A, Xu T, DeSnyder SM, Smith GL, Lin R, Barcenas CH, et al. Prospective, early longitudinal assessment of lymphedema-related quality of life among patients with locally advanced breast cancer: the foundation for building a patient-centered screening program. Breast. 2023;68:205–15.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Ferguson CM, Swaroop MN, Horick N, Skolny MN, Miller CL, Jammallo LS, et al. Impact of ipsilateral blood draws, injections, blood pressure measurements, and air travel on the risk of lymphedema for patients treated for breast cancer. J Clin Oncol. 2016;34(7):691–8.

    Article  PubMed  Google Scholar 

  36. Cemal Y, Pusic A, Mehrara BJ. Preventative measures for lymphedema: separating fact from fiction. J Am Coll Surg. 2011;213(4):543–51.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Jammallo LS, Miller CL, Horick NK, Skolny MN, O’Toole J, Specht MC, et al. Factors associated with fear of lymphedema after treatment for breast cancer. Oncol Nurs Forum. 2014;41(5):473–83.

    Article  PubMed  Google Scholar 

  38. Uhlmann RA, Mott SL, Curry M, Phadke S, Sugg SL, Erdahl LM, et al. Analysis of the understanding and worry about lymphedema of patients with breast cancer. Ann Surg Oncol. 2022;29(10):6428–37.

    Article  PubMed  Google Scholar 

  39. Yates HSK. At what point can I lift things? Women’s satisfaction with lymphoedema prevention information after breast cancer surgery. Collegian. 2019;26(3):335–40.

    Article  Google Scholar 

  40. Perdomo M, Davies C, Levenhagen K, Ryans K, Gilchrist L. Patient education for breast cancer-related lymphedema: a systematic review. J Cancer Surviv. 2023;17(2):384–98.

    Article  PubMed  Google Scholar 

  41. Vignes S, Porcher R, Arrault M, Dupuy A. Long-term management of breast cancer-related lymphedema after intensive decongestive physiotherapy. Breast Cancer Res Treat. 2007;101(3):285–90.

    Article  PubMed  Google Scholar 

  42. Winters H, Tielemans HJP, Paulus V, Hummelink S, Slater NJ, Ulrich DJO. A systematic review and meta-analysis of vascularized lymph node transfer for breast cancer-related lymphedema. J Vasc Surg Venous Lymphat Disord. 2022;10(3):786-95 e1.

    Article  PubMed  Google Scholar 

  43. Jung  C, Kim J, Seo YJ, Song KJ, Gelvosa MN, Kwon JG et al. Who will continuously depend on compression to control persistent or progressive breast cancer-related Lymphedema sespite 2 Years of conservative care? J Clin Med. 2020;9(11):3640.

  44. Boris M, Weindorf S, Lasinkski S. Persistence of lymphedema reduction after noninvasive complex lymphedema therapy. Oncology (Williston Park). 1997;11(1):99–109 (discussion 10, 13-4).

    CAS  PubMed  Google Scholar 

  45. Cal A, Bahar Z. Women’s barriers to prevention of lymphedema after breast surgery and home care needs: a qualitative study. Cancer Nurs. 2016;39(6):E17–25.

    Article  PubMed  Google Scholar 

  46. Brown JC, Kumar A, Cheville AL, Tchou JC, Troxel AB, Harris SR, et al. Association between lymphedema self-care adherence and lymphedema outcomes among women with breast cancer-related lymphedema. Am J Phys Med Rehabil. 2015;94(4):288–96.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Jeffs E, Ream E, Shewbridge A, Cowan-Dickie S, Crawshaw D, Huit M, et al. Exploring patient perception of success and benefit in self-management of breast cancer-related arm lymphoedema. Eur J Oncol Nurs. 2016;20:173–83.

    Article  PubMed  Google Scholar 

  48. Ridner SH, Dietrich MS, Kidd N. Breast cancer treatment-related lymphedema self-care: education, practices, symptoms, and quality of life. Support Care Cancer. 2011;19(5):631–7.

    Article  PubMed  Google Scholar 

  49. Ostby PL, Armer JM, Smith K, Stewart BR. Patient perceptions of barriers to self-management of breast cancer-related lymphedema. West J Nurs Res. 2018;40(12):1800–17.

    Article  PubMed  Google Scholar 

  50. Eaton LH, Narkthong N, Hulett JM. Psychosocial issues associated with breast cancer-related lymphedema: a literature review. Curr Breast Cancer Rep. 2020;12(4):216–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Jorgensen MG, Toyserkani NM, Hansen FG, Bygum A, Sorensen JA. The impact of lymphedema on health-related quality of life up to 10 years after breast cancer treatment. NPJ Breast Cancer. 2021;7(1):70. This large retrospective study examines quality of life, both physical and psychosocial, with long term follow up. The authors compare impact of physical attributes of lymphedema as well as duration of follow up and their impact on specific quality of life outcomes.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Taghian NR, Miller CL, Jammallo LS, O’Toole J, Skolny MN. Lymphedema following breast cancer treatment and impact on quality of life: a review. Crit Rev Oncol Hematol. 2014;92(3):227–34.

    Article  PubMed  Google Scholar 

  53. Togawa K, Ma H, Smith AW, Neuhouser ML, George SM, Baumgartner KB, et al. Self-reported symptoms of arm lymphedema and health-related quality of life among female breast cancer survivors. Sci Rep. 2021;11(1):10701.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Clough-Gorr KM, Ganz PA, Silliman RA. Older breast cancer survivors: factors associated with self-reported symptoms of persistent lymphedema over 7 years of follow-up. Breast J. 2010;16(2):147–55.

    Article  PubMed  Google Scholar 

  55. Cheng MH, Ho OA, Tsai TJ, Lin YL, Kuo CF. Breast cancer-related lymphedema correlated with incidence of cellulitis and mortality. J Surg Oncol. 2022;126(7):1162–8.

    Article  CAS  PubMed  Google Scholar 

  56. Park SI, Yang EJ, Kim DK, Jeong HJ, Kim GC, Sim YJ. Prevalence and epidemiological factors involved in cellulitis in Korean patients with lymphedema. Ann Rehabil Med. 2016;40(2):326–33.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Dean LT, Moss SL, Ransome Y, Frasso-Jaramillo L, Zhang Y, Visvanathan K, et al. “It still affects our economic situation”: long-term economic burden of breast cancer and lymphedema. Support Care Cancer. 2019;27(5):1697–708.

    Article  PubMed  Google Scholar 

  58. Dean LT, Ransome Y, Frasso-Jaramillo L, Moss SL, Zhang Y, Ashing K, et al. Drivers of cost differences between US breast cancer survivors with or without lymphedema. J Cancer Surviv. 2019;13(5):804–14.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Basta MN, Fox JP, Kanchwala SK, Wu LC, Serletti JM, Kovach SJ, et al. Complicated breast cancer-related lymphedema: evaluating health care resource utilization and associated costs of management. Am J Surg. 2016;211(1):133–41.

    Article  PubMed  Google Scholar 

  60. Bian J, Shen A, Yang W, Zhang L, Qiang W. Financial toxicity experienced by patients with breast cancer-related lymphedema: a systematic review. Support Care Cancer. 2023;31(6):354. This systematic review describes the financial burden that lymphedema treatment has upon patients including cost of outpatient visits, supplies and hospital admissions.

    Article  PubMed  Google Scholar 

  61. 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(12):2007–14.

    Article  PubMed  Google Scholar 

  62. De Vrieze T, Nevelsteen I, Thomis S, De Groef A, Tjalma WAA, Gebruers N, et al. What are the economic burden and costs associated with the treatment of breast cancer-related lymphoedema? A systematic review. Support Care Cancer. 2020;28(2):439–49.

    Article  PubMed  Google Scholar 

  63. Weiss R. Cost of a lymphedema treatment mandate - 16 years of experience in the Commonwealth of Virginia. Health Econ Rev. 2022;12(1):40. This study describes the impact of cost of lymphedema treatment after introduction of a lymphedema treatment mandate, requiring insurance coverage of lymphedema treatment by the Commonwealth of Virginia.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Stout NL, Pfalzer LA, Springer B, Levy E, McGarvey CL, Danoff JV, et al. Breast cancer-related lymphedema: comparing direct costs of a prospective surveillance model and a traditional model of care. Phys Ther. 2012;92(1):152–63.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA

    Anna C. Beck

  2. Department of Surgery, Division of Surgical Oncology, University of Iowa Hospitals and Clinics, Rm 4636 JCP, 200 Hawkins Drive, Iowa City, IA, 52242, USA

    Ingrid M. Lizarraga

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  1. Anna C. Beck
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A.B. and I.L. wrote the main manuscript text and A.B. prepared the figure.

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Correspondence to Ingrid M. Lizarraga.

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Beck, A.C., Lizarraga, I.M. Long-Term Burden of Breast Cancer-Related Lymphedema. Curr Breast Cancer Rep (2024). https://doi.org/10.1007/s12609-024-00539-0

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