Journal article
Lymphedema symptoms and limb measurement changes in breast cancer survivors treated with neoadjuvant chemotherapy and axillary dissection: results of American College of Surgeons Oncology Group (ACOSOG) Z1071 (Alliance) substudy
Supportive care in cancer, Vol.27(2), pp.495-503
02/01/2019
DOI: 10.1007/s00520-018-4334-7
PMCID: PMC6342501
PMID: 29980907
Abstract
Lymphedema is a potential complication of breast cancer treatment. This longitudinal substudy aimed to prospectively assess arm measurements and symptoms following neoadjuvant chemotherapy and axillary dissection in the ACOSOG/Alliance Z1071 trial to characterize the optimal approach to define lymphedema.
Z1071 enrolled patients with cT0-4, N1-2, M0 disease treated with neoadjuvant chemotherapy. All patients underwent axillary dissection. Bilateral limb volumes, circumferences, and related symptoms were assessed pre-surgery, 1-2 weeks post-surgery, and semiannually for 36 months. Lymphedema definitions included volume increase ≥ 10% or limb circumference increase ≥ 2 cm. Symptoms were assessed by the Lymphedema Breast Cancer Questionnaire.
In 488 evaluable patients, lymphedema incidence at 3 years by ≥ 10%-volume-increase was 60.3% (95% CI 55.0-66.2%) and by ≥ 2 cm-circumference increase was 75.4% (95% CI 70.8-80.2%). Symptoms of arm swelling and heaviness decreased from post-surgery for the first 18 months and then were relatively stable. The 3-year cumulative incidence of arm swelling and heaviness was 26.0% (95% CI 21.7-31.1%) and 30.9% (95% CI 26.3-36.3%), respectively. There was limited agreement between the two measurements (kappa 0.27) and between symptoms and measurements (kappa coefficients ranging from 0.05-0.09).
Lymphedema incidence by limb volume and circumference gradually increased over 36 months post-surgery, whereas lymphedema symptoms were much lower. These findings underscore the importance of prospective surveillance and evaluation of both limb measurements and symptom assessment. Lymphedema incidence rates varied by definition. We recommend that ≥ 10% volume change criterion be used for lymphedema evaluation for referral for specialist care.
NCT00881361.
Details
- Title: Subtitle
- Lymphedema symptoms and limb measurement changes in breast cancer survivors treated with neoadjuvant chemotherapy and axillary dissection: results of American College of Surgeons Oncology Group (ACOSOG) Z1071 (Alliance) substudy
- Creators
- Jane M Armer - University of MissouriKarla V Ballman - Weill Cornell MedicineLinda McCall - Duke UniversityNathan C Armer - University of MissouriYuanlu Sun - University of MissouriTipparat Udmuangpia - University of MissouriKelly K Hunt - The University of Texas MD Anderson Cancer CenterElizabeth A Mittendorf - The University of Texas MD Anderson Cancer CenterDavid R Byrd - University of Washington Medical CenterThomas B Julian - Allegheny Health NetworkJudy C Boughey - Mayo Clinic
- Resource Type
- Journal article
- Publication Details
- Supportive care in cancer, Vol.27(2), pp.495-503
- DOI
- 10.1007/s00520-018-4334-7
- PMID
- 29980907
- PMCID
- PMC6342501
- NLM abbreviation
- Support Care Cancer
- ISSN
- 0941-4355
- eISSN
- 1433-7339
- Grant note
- U10 CA180868 / NCI NIH HHS U10 CA180821 / NCI NIH HHS U10 CA180858 / NCI NIH HHS UG1 CA189823 / NCI NIH HHS U10 CA180790 / NCI NIH HHS U10 CA180882 / NCI NIH HHS UG1CA189823 (Alliance for Clinical Trials in Oncology NCORP Grant), U10CA180821, U10CA180882, U10CA180790, U10CA180858, U10CA180868, and U10CA180888 / National Cancer Institute U10 CA180888 / NCI NIH HHS
- Language
- English
- Date published
- 02/01/2019
- Academic Unit
- Nursing
- Record Identifier
- 9984420939702771
Metrics
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