Risk factors for breast cancer–related lymphedema in patients undergoing 3 years of prospective surveillance with intervention

Louise A. Koelmeyer; Katrina Gaitatzis; Mary S. Dietrich; Chirag S. Shah; John Boyages; Sarah A. McLaughlin; Bret Taback; Deonni P. Stolldorf; Elisabeth Elder; T. Michael Hughes; James R. French; Nicholas Ngui; Jeremy M. Hsu; Andrew Moore; Sheila H. Ridner

doi:10.1002/cncr.34377

Risk factors for breast cancer–related lymphedema in patients undergoing 3 years of prospective surveillance with intervention

Louise A. Koelmeyer, Katrina Gaitatzis, Mary S. Dietrich, Chirag S. Shah, John Boyages, Sarah A. McLaughlin, Bret Taback, Deonni P. Stolldorf, Elisabeth Elder, T. Michael Hughes, James R. French, Nicholas Ngui, Jeremy M. Hsu, Andrew Moore, Sheila H. Ridner

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Abstract

Background: To evaluate risk factors (treatment-related, comorbidities, and lifestyle) for breast cancer-related lymphedema (BCRL) within the context of a Prospective Surveillance and Early Intervention (PSEI) model of care for subclinical BCRL. Methods: The parent randomized clinical trial assigned patients newly diagnosed with breast cancer to PSEI with either bioimpedance spectroscopy (BIS) or tape measurement (TM). Surgical, systemic and radiation treatments, comorbidities, and lifestyle factors were recorded. Detection of subclinical BCRL (change from baseline of either BIS L-Dex ≥6.5 or tape volume ≥ 5% and < 10%) triggered an intervention with compression therapy. Volume change from baseline ≥10% indicated progression to chronic lymphedema and need for complex decongestive physiotherapy. In this secondary analysis, multinomial logistic regressions including main and interaction effects of the study group and risk factors were used to test for factor associations with outcomes (no lymphedema, subclinical lymphedema, progression to chronic lymphedema after intervention, progression to chronic lymphedema without intervention). Post hoc tests of significant interaction effects were conducted using Bonferroni-corrected alphas of.008; otherwise, an alpha of.05 was used for statistical significance. Results: The sample (n = 918; TM = 457; BIS = 461) was female with a median age of 58.4 years. Factors associated with BCRL risk included axillary lymph node dissection (ALND) (p <.001), taxane-based chemotherapy (p <.001), regional nodal irradiation (RNI) (p ≤.001), body mass index >30 (p =.002), and rurality (p =.037). Mastectomy, age, hypertension, diabetes, seroma, smoking, and air travel were not associated with BCRL risk. Conclusions: Within the context of 3 years of PSEI for subclinical lymphedema, variables of ALND, taxane-based chemotherapy, RNI, body mass index >30, and rurality increased risk.

Original language	English
Pages (from-to)	3408-3415
Number of pages	8
Journal	Cancer
Volume	128
Issue number	18
Early online date	7 Jul 2022
DOIs	https://doi.org/10.1002/cncr.34377
Publication status	Published - 15 Sept 2022

Bibliographical note

Copyright the Author(s) 2022. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

bioimpedance spectroscopy
breast cancer
intervention
lymphedema
prospective surveillance

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10.1002/cncr.34377Licence: CC BY-NC

Publisher version (open access)Final published version, 214 KBLicence: CC BY-NC

Cite this

Koelmeyer, L. A., Gaitatzis, K., Dietrich, M. S., Shah, C. S., Boyages, J., McLaughlin, S. A., Taback, B., Stolldorf, D. P., Elder, E., Hughes, T. M., French, J. R., Ngui, N., Hsu, J. M., Moore, A., & Ridner, S. H. (2022). Risk factors for breast cancer–related lymphedema in patients undergoing 3 years of prospective surveillance with intervention. Cancer, 128(18), 3408-3415. https://doi.org/10.1002/cncr.34377

@article{798d926ecca64e69b64a66d8b1752d05,

title = "Risk factors for breast cancer–related lymphedema in patients undergoing 3 years of prospective surveillance with intervention",

abstract = "Background: To evaluate risk factors (treatment-related, comorbidities, and lifestyle) for breast cancer-related lymphedema (BCRL) within the context of a Prospective Surveillance and Early Intervention (PSEI) model of care for subclinical BCRL. Methods: The parent randomized clinical trial assigned patients newly diagnosed with breast cancer to PSEI with either bioimpedance spectroscopy (BIS) or tape measurement (TM). Surgical, systemic and radiation treatments, comorbidities, and lifestyle factors were recorded. Detection of subclinical BCRL (change from baseline of either BIS L-Dex ≥6.5 or tape volume ≥ 5% and < 10%) triggered an intervention with compression therapy. Volume change from baseline ≥10% indicated progression to chronic lymphedema and need for complex decongestive physiotherapy. In this secondary analysis, multinomial logistic regressions including main and interaction effects of the study group and risk factors were used to test for factor associations with outcomes (no lymphedema, subclinical lymphedema, progression to chronic lymphedema after intervention, progression to chronic lymphedema without intervention). Post hoc tests of significant interaction effects were conducted using Bonferroni-corrected alphas of.008; otherwise, an alpha of.05 was used for statistical significance. Results: The sample (n = 918; TM = 457; BIS = 461) was female with a median age of 58.4 years. Factors associated with BCRL risk included axillary lymph node dissection (ALND) (p <.001), taxane-based chemotherapy (p <.001), regional nodal irradiation (RNI) (p ≤.001), body mass index >30 (p =.002), and rurality (p =.037). Mastectomy, age, hypertension, diabetes, seroma, smoking, and air travel were not associated with BCRL risk. Conclusions: Within the context of 3 years of PSEI for subclinical lymphedema, variables of ALND, taxane-based chemotherapy, RNI, body mass index >30, and rurality increased risk.",

keywords = "bioimpedance spectroscopy, breast cancer, intervention, lymphedema, prospective surveillance",

author = "Koelmeyer, {Louise A.} and Katrina Gaitatzis and Dietrich, {Mary S.} and Shah, {Chirag S.} and John Boyages and McLaughlin, {Sarah A.} and Bret Taback and Stolldorf, {Deonni P.} and Elisabeth Elder and Hughes, {T. Michael} and French, {James R.} and Nicholas Ngui and Hsu, {Jeremy M.} and Andrew Moore and Ridner, {Sheila H.}",

note = "Copyright the Author(s) 2022. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",

year = "2022",

month = sep,

day = "15",

doi = "10.1002/cncr.34377",

language = "English",

volume = "128",

pages = "3408--3415",

journal = "Cancer",

issn = "0008-543X",

publisher = "John Wiley & Sons",

number = "18",

}

Koelmeyer, LA , Gaitatzis, K, Dietrich, MS, Shah, CS, Boyages, J, McLaughlin, SA, Taback, B, Stolldorf, DP, Elder, E, Hughes, TM, French, JR, Ngui, N, Hsu, JM, Moore, A & Ridner, SH 2022, 'Risk factors for breast cancer–related lymphedema in patients undergoing 3 years of prospective surveillance with intervention', Cancer, vol. 128, no. 18, pp. 3408-3415. https://doi.org/10.1002/cncr.34377

TY - JOUR

T1 - Risk factors for breast cancer–related lymphedema in patients undergoing 3 years of prospective surveillance with intervention

AU - Koelmeyer, Louise A.

AU - Gaitatzis, Katrina

AU - Dietrich, Mary S.

AU - Shah, Chirag S.

AU - Boyages, John

AU - McLaughlin, Sarah A.

AU - Taback, Bret

AU - Stolldorf, Deonni P.

AU - Elder, Elisabeth

AU - Hughes, T. Michael

AU - French, James R.

AU - Ngui, Nicholas

AU - Hsu, Jeremy M.

AU - Moore, Andrew

AU - Ridner, Sheila H.

N1 - Copyright the Author(s) 2022. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2022/9/15

Y1 - 2022/9/15

N2 - Background: To evaluate risk factors (treatment-related, comorbidities, and lifestyle) for breast cancer-related lymphedema (BCRL) within the context of a Prospective Surveillance and Early Intervention (PSEI) model of care for subclinical BCRL. Methods: The parent randomized clinical trial assigned patients newly diagnosed with breast cancer to PSEI with either bioimpedance spectroscopy (BIS) or tape measurement (TM). Surgical, systemic and radiation treatments, comorbidities, and lifestyle factors were recorded. Detection of subclinical BCRL (change from baseline of either BIS L-Dex ≥6.5 or tape volume ≥ 5% and < 10%) triggered an intervention with compression therapy. Volume change from baseline ≥10% indicated progression to chronic lymphedema and need for complex decongestive physiotherapy. In this secondary analysis, multinomial logistic regressions including main and interaction effects of the study group and risk factors were used to test for factor associations with outcomes (no lymphedema, subclinical lymphedema, progression to chronic lymphedema after intervention, progression to chronic lymphedema without intervention). Post hoc tests of significant interaction effects were conducted using Bonferroni-corrected alphas of.008; otherwise, an alpha of.05 was used for statistical significance. Results: The sample (n = 918; TM = 457; BIS = 461) was female with a median age of 58.4 years. Factors associated with BCRL risk included axillary lymph node dissection (ALND) (p <.001), taxane-based chemotherapy (p <.001), regional nodal irradiation (RNI) (p ≤.001), body mass index >30 (p =.002), and rurality (p =.037). Mastectomy, age, hypertension, diabetes, seroma, smoking, and air travel were not associated with BCRL risk. Conclusions: Within the context of 3 years of PSEI for subclinical lymphedema, variables of ALND, taxane-based chemotherapy, RNI, body mass index >30, and rurality increased risk.

AB - Background: To evaluate risk factors (treatment-related, comorbidities, and lifestyle) for breast cancer-related lymphedema (BCRL) within the context of a Prospective Surveillance and Early Intervention (PSEI) model of care for subclinical BCRL. Methods: The parent randomized clinical trial assigned patients newly diagnosed with breast cancer to PSEI with either bioimpedance spectroscopy (BIS) or tape measurement (TM). Surgical, systemic and radiation treatments, comorbidities, and lifestyle factors were recorded. Detection of subclinical BCRL (change from baseline of either BIS L-Dex ≥6.5 or tape volume ≥ 5% and < 10%) triggered an intervention with compression therapy. Volume change from baseline ≥10% indicated progression to chronic lymphedema and need for complex decongestive physiotherapy. In this secondary analysis, multinomial logistic regressions including main and interaction effects of the study group and risk factors were used to test for factor associations with outcomes (no lymphedema, subclinical lymphedema, progression to chronic lymphedema after intervention, progression to chronic lymphedema without intervention). Post hoc tests of significant interaction effects were conducted using Bonferroni-corrected alphas of.008; otherwise, an alpha of.05 was used for statistical significance. Results: The sample (n = 918; TM = 457; BIS = 461) was female with a median age of 58.4 years. Factors associated with BCRL risk included axillary lymph node dissection (ALND) (p <.001), taxane-based chemotherapy (p <.001), regional nodal irradiation (RNI) (p ≤.001), body mass index >30 (p =.002), and rurality (p =.037). Mastectomy, age, hypertension, diabetes, seroma, smoking, and air travel were not associated with BCRL risk. Conclusions: Within the context of 3 years of PSEI for subclinical lymphedema, variables of ALND, taxane-based chemotherapy, RNI, body mass index >30, and rurality increased risk.

KW - bioimpedance spectroscopy

KW - breast cancer

KW - intervention

KW - lymphedema

KW - prospective surveillance

UR - http://www.scopus.com/inward/record.url?scp=85133531960&partnerID=8YFLogxK

U2 - 10.1002/cncr.34377

DO - 10.1002/cncr.34377

M3 - Article

C2 - 35797441

SN - 0008-543X

VL - 128

SP - 3408

EP - 3415

JO - Cancer

JF - Cancer

IS - 18

ER -