Use of a prospective surveillance model to prevent breast cancer treatment-related lymphedema: a single-center experience
Identifieur interne : 000948 ( Main/Exploration ); précédent : 000947; suivant : 000949Use of a prospective surveillance model to prevent breast cancer treatment-related lymphedema: a single-center experience
Auteurs : Eun Joo Yang ; Soyeon Ahn [Corée du Sud] ; Eun-Kyu Kim [Corée du Sud] ; Eunyoung Kang [Corée du Sud] ; Youngmi Park [Corée du Sud] ; Jae-Young Lim ; Sung-Won Kim [Corée du Sud]Source :
- Breast Cancer Research and Treatment [ 0167-6806 ] ; 2016.
Abstract
Breast cancer patients undergoing axillary lymph node dissection (ALND) are at risk of lymphedema (LE). Successful management of LE relies on early diagnosis using sensitive modalities. In the current study, we explored the effectiveness of a surveillance program for lymphedema management (SLYM) compared to standard care.
Breast cancer patients who underwent ALND in Seoul National University Bundang Hospital from January 2008 to December 2015 were included in this prospective study. The SLYM commenced in May 2011. The LE outcomes of patients treated prior to initiation of the SLYM were compared with those of patients after SLYM implementation.
A total of 707 patients were included, 390 in the SLYM group and 317 in the historical control (HC) group. A total of 203 patients (28.7 %) had episodes of all-stage LE during follow-up. Of these, 126 (19.7 %) were in the surveillance group and 77 (24.3 %) in the HC group. The overall 5-year cumulative incidence of LE (greater than stage 3) was 25 (95 % CI 15.4–34.6) (6.4 %) in the SLYM group and 48 (95 % CI, 15.4–34.6) (15.1 %) in the HC group. In the SLYM group, poor compliance had a significant impact on LE incidence (
Surveillance improves LE prevention compared to clinical evaluation. The first visit to the LE clinic should be made within 1 month after surgery. In the first year, visits should be made at intervals of less than 3 months.
The online version of this article (doi:10.1007/s10549-016-3993-7) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1007/s10549-016-3993-7
PubMed: 27665585
PubMed Central: 5065580
Affiliations:
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Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam-si</wicri:regionArea><wicri:noRegion>Seongnam-si</wicri:noRegion></affiliation></author><author><name sortKey="Kim, Eun Kyu" sort="Kim, Eun Kyu" uniqKey="Kim E" first="Eun-Kyu" last="Kim">Eun-Kyu Kim</name><affiliation wicri:level="1"><nlm:aff id="Aff3">Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Korea</nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea>Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si</wicri:regionArea><wicri:noRegion>Seongnam-si</wicri:noRegion></affiliation></author><author><name sortKey="Kang, Eunyoung" sort="Kang, Eunyoung" uniqKey="Kang E" first="Eunyoung" last="Kang">Eunyoung Kang</name><affiliation wicri:level="1"><nlm:aff id="Aff3">Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Korea</nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea>Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si</wicri:regionArea><wicri:noRegion>Seongnam-si</wicri:noRegion></affiliation></author><author><name sortKey="Park, Youngmi" sort="Park, Youngmi" uniqKey="Park Y" first="Youngmi" last="Park">Youngmi Park</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam-si, Korea</nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea>Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam-si</wicri:regionArea><wicri:noRegion>Seongnam-si</wicri:noRegion></affiliation></author><author><name sortKey="Lim, Jae Young" sort="Lim, Jae Young" uniqKey="Lim J" first="Jae-Young" last="Lim">Jae-Young 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Gyeonggi-do 463-707 Korea</nlm:aff><wicri:noCountry code="subfield">Gyeonggi-do 463-707 Korea</wicri:noCountry></affiliation></author><author><name sortKey="Ahn, Soyeon" sort="Ahn, Soyeon" uniqKey="Ahn S" first="Soyeon" last="Ahn">Soyeon Ahn</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam-si, Korea</nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea>Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam-si</wicri:regionArea><wicri:noRegion>Seongnam-si</wicri:noRegion></affiliation></author><author><name sortKey="Kim, Eun Kyu" sort="Kim, Eun Kyu" uniqKey="Kim E" first="Eun-Kyu" last="Kim">Eun-Kyu Kim</name><affiliation wicri:level="1"><nlm:aff id="Aff3">Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Korea</nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea>Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si</wicri:regionArea><wicri:noRegion>Seongnam-si</wicri:noRegion></affiliation></author><author><name sortKey="Kang, Eunyoung" sort="Kang, Eunyoung" uniqKey="Kang E" first="Eunyoung" last="Kang">Eunyoung Kang</name><affiliation wicri:level="1"><nlm:aff id="Aff3">Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Korea</nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea>Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si</wicri:regionArea><wicri:noRegion>Seongnam-si</wicri:noRegion></affiliation></author><author><name sortKey="Park, Youngmi" sort="Park, Youngmi" uniqKey="Park Y" first="Youngmi" last="Park">Youngmi Park</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam-si, Korea</nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea>Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam-si</wicri:regionArea><wicri:noRegion>Seongnam-si</wicri:noRegion></affiliation></author><author><name sortKey="Lim, Jae Young" sort="Lim, Jae Young" uniqKey="Lim J" first="Jae-Young" last="Lim">Jae-Young Lim</name><affiliation><nlm:aff id="Aff1">Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do 463-707 Korea</nlm:aff><wicri:noCountry code="subfield">Gyeonggi-do 463-707 Korea</wicri:noCountry></affiliation></author><author><name sortKey="Kim, Sung Won" sort="Kim, Sung Won" uniqKey="Kim S" first="Sung-Won" last="Kim">Sung-Won Kim</name><affiliation wicri:level="3"><nlm:aff id="Aff4">Daerim St. Mary’s Hospital, Seoul, Korea</nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea>Daerim St. Mary’s Hospital, Seoul</wicri:regionArea><placeName><settlement type="city">Séoul</settlement><region type="capital">Région capitale de Séoul</region></placeName></affiliation></author></analytic><series><title level="j">Breast Cancer Research and Treatment</title><idno type="ISSN">0167-6806</idno><idno type="eISSN">1573-7217</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Purpose</title><p>Breast cancer patients undergoing axillary lymph node dissection (ALND) are at risk of lymphedema (LE). Successful management of LE relies on early diagnosis using sensitive modalities. In the current study, we explored the effectiveness of a surveillance program for lymphedema management (SLYM) compared to standard care.</p></sec><sec><title>Methods</title><p>Breast cancer patients who underwent ALND in Seoul National University Bundang Hospital from January 2008 to December 2015 were included in this prospective study. The SLYM commenced in May 2011. The LE outcomes of patients treated prior to initiation of the SLYM were compared with those of patients after SLYM implementation.</p></sec><sec><title>Results</title><p>A total of 707 patients were included, 390 in the SLYM group and 317 in the historical control (HC) group. A total of 203 patients (28.7 %) had episodes of all-stage LE during follow-up. Of these, 126 (19.7 %) were in the surveillance group and 77 (24.3 %) in the HC group. The overall 5-year cumulative incidence of LE (greater than stage 3) was 25 (95 % CI 15.4–34.6) (6.4 %) in the SLYM group and 48 (95 % CI, 15.4–34.6) (15.1 %) in the HC group. In the SLYM group, poor compliance had a significant impact on LE incidence (<italic>OR</italic> = 2.98, <italic>P</italic> = 0.002). Low level of self-monitoring and insight scores were significantly related to LE incidence (<italic>OR</italic> = 1.31, <italic>P</italic> = 0.025) after adjusting for age, body mass index, the type of surgery chosen, radiation therapy, and chemotherapy. With a cut-off of 29.5 days from operation to the first visit to the LE clinic, the sensitivity was 60 % and the specificity 61 % in terms of predicting a LE event.</p></sec><sec><title>Conclusions</title><p>Surveillance improves LE prevention compared to clinical evaluation. The first visit to the LE clinic should be made within 1 month after surgery. In the first year, visits should be made at intervals of less than 3 months.</p></sec><sec><title>Electronic supplementary material</title><p>The online version of this article (doi:10.1007/s10549-016-3993-7) contains supplementary material, which is available to authorized users.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Cheville, Al" uniqKey="Cheville A">AL Cheville</name></author><author><name sortKey="Mcgarvey, Cl" uniqKey="Mcgarvey C">CL McGarvey</name></author><author><name sortKey="Petrek, Ja" uniqKey="Petrek J">JA Petrek</name></author><author><name sortKey="Russo, Sa" uniqKey="Russo S">SA Russo</name></author><author><name sortKey="Thiadens, Sr" uniqKey="Thiadens S">SR Thiadens</name></author><author><name sortKey="Taylor, Me" uniqKey="Taylor M">ME Taylor</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hayes, Sc" uniqKey="Hayes S">SC Hayes</name></author><author><name 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uniqKey="Schulman Green D">D Schulman-Green</name></author><author><name sortKey="Schilling, Ls" uniqKey="Schilling L">LS Schilling</name></author><author><name sortKey="Lorig, K" uniqKey="Lorig K">K Lorig</name></author><author><name sortKey="Wagner, Eh" uniqKey="Wagner E">EH Wagner</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Aujoulat, I" uniqKey="Aujoulat I">I Aujoulat</name></author><author><name sortKey="Marcolongo, R" uniqKey="Marcolongo R">R Marcolongo</name></author><author><name sortKey="Bonadiman, L" uniqKey="Bonadiman L">L Bonadiman</name></author><author><name sortKey="Deccache, A" uniqKey="Deccache A">A Deccache</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Maunsell, E" uniqKey="Maunsell E">E Maunsell</name></author><author><name sortKey="Lauzier, S" uniqKey="Lauzier S">S Lauzier</name></author><author><name sortKey="Brunet, J" uniqKey="Brunet J">J Brunet</name></author><author><name sortKey="Pelletier, S" uniqKey="Pelletier S">S Pelletier</name></author><author><name sortKey="Osborne, Rh" uniqKey="Osborne R">RH Osborne</name></author><author><name sortKey="Campbell, Hs" uniqKey="Campbell H">HS Campbell</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Corée du Sud</li></country><region><li>Région capitale de Séoul</li></region><settlement><li>Séoul</li></settlement></list><tree><noCountry><name sortKey="Lim, Jae Young" sort="Lim, Jae Young" uniqKey="Lim J" first="Jae-Young" last="Lim">Jae-Young Lim</name><name sortKey="Yang, Eun Joo" sort="Yang, Eun Joo" uniqKey="Yang E" first="Eun Joo" last="Yang">Eun Joo Yang</name></noCountry><country name="Corée du Sud"><noRegion><name sortKey="Ahn, Soyeon" sort="Ahn, Soyeon" uniqKey="Ahn S" first="Soyeon" last="Ahn">Soyeon Ahn</name></noRegion><name sortKey="Kang, Eunyoung" sort="Kang, Eunyoung" uniqKey="Kang E" first="Eunyoung" last="Kang">Eunyoung Kang</name><name sortKey="Kim, Eun Kyu" sort="Kim, Eun Kyu" uniqKey="Kim E" first="Eun-Kyu" last="Kim">Eun-Kyu Kim</name><name sortKey="Kim, Sung Won" sort="Kim, Sung Won" uniqKey="Kim S" first="Sung-Won" last="Kim">Sung-Won Kim</name><name sortKey="Park, Youngmi" sort="Park, Youngmi" uniqKey="Park Y" first="Youngmi" last="Park">Youngmi Park</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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