Impact of Body Mass Index and Weight Fluctuation on Lymphedema Risk in Patients Treated for Breast Cancer
Identifieur interne : 003756 ( Pmc/Corpus ); précédent : 003755; suivant : 003757Impact of Body Mass Index and Weight Fluctuation on Lymphedema Risk in Patients Treated for Breast Cancer
Auteurs : Lauren S. Jammallo ; Cynthia L. Miller ; Marybeth Singer ; Nora K. Horick ; Melissa N. Skolny ; Michelle C. Specht ; Jean O'Toole ; Alphonse G. TaghianSource :
- Breast cancer research and treatment [ 0167-6806 ] ; 2013.
Abstract
Identifying risk factors for lymphedema in patients treated for breast cancer has become increasingly important given the current lack of standardization surrounding diagnosis and treatment. Reports on the association of body mass index (BMI) and weight change with lymphedema risk are conflicting. We sought to examine the impact of pre-operative BMI and post-treatment weight change on the incidence of lymphedema.
From 2005-2011, 787 newly-diagnosed breast cancer patients underwent prospective arm volume measurements with a Perometer pre- and post-operatively. BMI was calculated from same-day weight and height measurements. Lymphedema was defined as a relative volume change (RVC) of ≥10%. Univariate and multivariate Cox proportional hazards models were used to evaluate the association between lymphedema risk and pre-operative BMI, weight change, and other demographic and treatment factors.
By multivariate analysis, a pre-operative BMI ≥30 was significantly associated with an increased risk of lymphedema compared to a pre-operative BMI <25 and 25-<30 (p = 0.001 and p = 0.012, respectively). Patients with a pre-operative BMI 25-<30 were not at an increased risk of lymphedema compared to patients with a pre-operative BMI<25 (p= 0.409). Furthermore, large post-operative fluctuations in weight, regardless of whether they reflected weight gain or loss (i.e. 10 pounds gained/lost per month), resulted in a significantly increased risk of lymphedema (HR: 1.97, p = <0.0001).
Pre-operative BMI of ≥30 is an independent risk factor for lymphedema, whereas a BMI of 25-<30 is not. Large post-operative weight fluctuations also increase risk of lymphedema. Patients with a pre-operative BMI≥30 and those who experience large weight fluctuations during and after treatment for breast cancer should be considered at higher-risk for lymphedema. Close monitoring or early intervention to ensure optimal treatment of the condition may be appropriate for these patients.
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DOI: 10.1007/s10549-013-2715-7
PubMed: 24122390
PubMed Central: 3873728
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Impact of Body Mass Index and Weight Fluctuation on Lymphedema Risk in Patients Treated for Breast Cancer</title><author><name sortKey="Jammallo, Lauren S" sort="Jammallo, Lauren S" uniqKey="Jammallo L" first="Lauren S." last="Jammallo">Lauren S. Jammallo</name><affiliation><nlm:aff id="A1">Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA</nlm:aff></affiliation></author><author><name sortKey="Miller, Cynthia L" sort="Miller, Cynthia L" uniqKey="Miller C" first="Cynthia L." last="Miller">Cynthia L. Miller</name><affiliation><nlm:aff id="A1">Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA</nlm:aff></affiliation></author><author><name sortKey="Singer, Marybeth" sort="Singer, Marybeth" uniqKey="Singer M" first="Marybeth" last="Singer">Marybeth Singer</name><affiliation><nlm:aff id="A2">Cancer Center, Tufts Medical Center, Boston, MA</nlm:aff></affiliation></author><author><name sortKey="Horick, Nora K" sort="Horick, Nora K" uniqKey="Horick N" first="Nora K." last="Horick">Nora K. Horick</name><affiliation><nlm:aff id="A3">Biostatistics Center, Massachusetts General Hospital, Boston, MA</nlm:aff></affiliation></author><author><name sortKey="Skolny, Melissa N" sort="Skolny, Melissa N" uniqKey="Skolny M" first="Melissa N." last="Skolny">Melissa N. Skolny</name><affiliation><nlm:aff id="A1">Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA</nlm:aff></affiliation></author><author><name sortKey="Specht, Michelle C" sort="Specht, Michelle C" uniqKey="Specht M" first="Michelle C." last="Specht">Michelle C. Specht</name><affiliation><nlm:aff id="A4">Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA</nlm:aff></affiliation></author><author><name sortKey="O Toole, Jean" sort="O Toole, Jean" uniqKey="O Toole J" first="Jean" last="O'Toole">Jean O'Toole</name><affiliation><nlm:aff id="A5">Department of Physical and Occupational Therapy, Massachusetts General Hospital, Boston, MA</nlm:aff></affiliation></author><author><name sortKey="Taghian, Alphonse G" sort="Taghian, Alphonse G" uniqKey="Taghian A" first="Alphonse G." last="Taghian">Alphonse G. Taghian</name><affiliation><nlm:aff id="A1">Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24122390</idno><idno type="pmc">3873728</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3873728</idno><idno type="RBID">PMC:3873728</idno><idno type="doi">10.1007/s10549-013-2715-7</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">003756</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">003756</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Impact of Body Mass Index and Weight Fluctuation on Lymphedema Risk in Patients Treated for Breast Cancer</title><author><name sortKey="Jammallo, Lauren S" sort="Jammallo, Lauren S" uniqKey="Jammallo L" first="Lauren S." last="Jammallo">Lauren S. Jammallo</name><affiliation><nlm:aff id="A1">Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA</nlm:aff></affiliation></author><author><name sortKey="Miller, Cynthia L" sort="Miller, Cynthia L" uniqKey="Miller C" first="Cynthia L." last="Miller">Cynthia L. Miller</name><affiliation><nlm:aff id="A1">Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA</nlm:aff></affiliation></author><author><name sortKey="Singer, Marybeth" sort="Singer, Marybeth" uniqKey="Singer M" first="Marybeth" last="Singer">Marybeth Singer</name><affiliation><nlm:aff id="A2">Cancer Center, Tufts Medical Center, Boston, MA</nlm:aff></affiliation></author><author><name sortKey="Horick, Nora K" sort="Horick, Nora K" uniqKey="Horick N" first="Nora K." last="Horick">Nora K. Horick</name><affiliation><nlm:aff id="A3">Biostatistics Center, Massachusetts General Hospital, Boston, MA</nlm:aff></affiliation></author><author><name sortKey="Skolny, Melissa N" sort="Skolny, Melissa N" uniqKey="Skolny M" first="Melissa N." last="Skolny">Melissa N. Skolny</name><affiliation><nlm:aff id="A1">Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA</nlm:aff></affiliation></author><author><name sortKey="Specht, Michelle C" sort="Specht, Michelle C" uniqKey="Specht M" first="Michelle C." last="Specht">Michelle C. Specht</name><affiliation><nlm:aff id="A4">Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA</nlm:aff></affiliation></author><author><name sortKey="O Toole, Jean" sort="O Toole, Jean" uniqKey="O Toole J" first="Jean" last="O'Toole">Jean O'Toole</name><affiliation><nlm:aff id="A5">Department of Physical and Occupational Therapy, Massachusetts General Hospital, Boston, MA</nlm:aff></affiliation></author><author><name sortKey="Taghian, Alphonse G" sort="Taghian, Alphonse G" uniqKey="Taghian A" first="Alphonse G." last="Taghian">Alphonse G. Taghian</name><affiliation><nlm:aff id="A1">Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA</nlm:aff></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="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title><p id="P1">Identifying risk factors for lymphedema in patients treated for breast cancer has become increasingly important given the current lack of standardization surrounding diagnosis and treatment. Reports on the association of body mass index (BMI) and weight change with lymphedema risk are conflicting. We sought to examine the impact of pre-operative BMI and post-treatment weight change on the incidence of lymphedema.</p></sec><sec id="S2"><title>Methods</title><p id="P2">From 2005-2011, 787 newly-diagnosed breast cancer patients underwent prospective arm volume measurements with a Perometer pre- and post-operatively. BMI was calculated from same-day weight and height measurements. Lymphedema was defined as a relative volume change (RVC) of ≥10%. Univariate and multivariate Cox proportional hazards models were used to evaluate the association between lymphedema risk and pre-operative BMI, weight change, and other demographic and treatment factors.</p></sec><sec id="S3"><title>Results</title><p id="P3">By multivariate analysis, a pre-operative BMI ≥30 was significantly associated with an increased risk of lymphedema compared to a pre-operative BMI <25 and 25-<30 (p = 0.001 and p = 0.012, respectively). Patients with a pre-operative BMI 25-<30 were not at an increased risk of lymphedema compared to patients with a pre-operative BMI<25 (p= 0.409). Furthermore, large post-operative fluctuations in weight, regardless of whether they reflected weight gain or loss (i.e. 10 pounds gained/lost per month), resulted in a significantly increased risk of lymphedema (HR: 1.97, p = <0.0001).</p></sec><sec id="S4"><title>Conclusions</title><p id="P4">Pre-operative BMI of ≥30 is an independent risk factor for lymphedema, whereas a BMI of 25-<30 is not. Large post-operative weight fluctuations also increase risk of lymphedema. Patients with a pre-operative BMI≥30 and those who experience large weight fluctuations during and after treatment for breast cancer should be considered at higher-risk for lymphedema. Close monitoring or early intervention to ensure optimal treatment of the condition may be appropriate for these patients.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">8111104</journal-id><journal-id journal-id-type="pubmed-jr-id">1254</journal-id><journal-id journal-id-type="nlm-ta">Breast Cancer Res Treat</journal-id><journal-id journal-id-type="iso-abbrev">Breast Cancer Res. Treat.</journal-id><journal-title-group><journal-title>Breast cancer research and treatment</journal-title></journal-title-group><issn pub-type="ppub">0167-6806</issn><issn pub-type="epub">1573-7217</issn></journal-meta><article-meta><article-id pub-id-type="pmid">24122390</article-id><article-id pub-id-type="pmc">3873728</article-id><article-id pub-id-type="doi">10.1007/s10549-013-2715-7</article-id><article-id pub-id-type="manuscript">NIHMS531443</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Impact of Body Mass Index and Weight Fluctuation on Lymphedema Risk in Patients Treated for Breast Cancer</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Jammallo</surname><given-names>Lauren S.</given-names></name><degrees>B.S.</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Miller</surname><given-names>Cynthia L.</given-names></name><degrees>B.S.</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Singer</surname><given-names>Marybeth</given-names></name><degrees>M.S., A.N.P.-B.C., A.O.C.N., A.C.H.P.N.</degrees><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Horick</surname><given-names>Nora K.</given-names></name><degrees>M.S.</degrees><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Skolny</surname><given-names>Melissa N.</given-names></name><degrees>M.S.H.A.</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Specht</surname><given-names>Michelle C.</given-names></name><degrees>M.D.</degrees><xref ref-type="aff" rid="A4">4</xref></contrib><contrib contrib-type="author"><name><surname>O'Toole</surname><given-names>Jean</given-names></name><degrees>P.T., M.P.H., C.L.T.-L.A.N.A.</degrees><xref ref-type="aff" rid="A5">5</xref></contrib><contrib contrib-type="author"><name><surname>Taghian</surname><given-names>Alphonse G.</given-names></name><degrees>M.D., Ph.D.</degrees><xref ref-type="aff" rid="A1">1</xref></contrib></contrib-group><aff id="A1"><label>1</label>Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA</aff><aff id="A2"><label>2</label>Cancer Center, Tufts Medical Center, Boston, MA</aff><aff id="A3"><label>3</label>Biostatistics Center, Massachusetts General Hospital, Boston, MA</aff><aff id="A4"><label>4</label>Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA</aff><aff id="A5"><label>5</label>Department of Physical and Occupational Therapy, Massachusetts General Hospital, Boston, MA</aff><author-notes><corresp id="CR1"><bold>Corresponding Author Contact Information:</bold> Alphonse G. Taghian, M.D., Ph.D. 100 Blossom Street, Boston, MA02114, Tel: 617-726-6050, Fax: 617-726-3603 <email>ataghian@partners.org</email></corresp></author-notes><pub-date pub-type="nihms-submitted"><day>12</day><month>12</month><year>2013</year></pub-date><pub-date pub-type="ppub"><month>11</month><year>2013</year></pub-date><pub-date pub-type="pmc-release"><day>01</day><month>11</month><year>2014</year></pub-date><volume>142</volume><issue>1</issue><elocation-id>10.1007/s10549-013-2715-7</elocation-id><abstract><sec id="S1"><title>Background</title><p id="P1">Identifying risk factors for lymphedema in patients treated for breast cancer has become increasingly important given the current lack of standardization surrounding diagnosis and treatment. Reports on the association of body mass index (BMI) and weight change with lymphedema risk are conflicting. We sought to examine the impact of pre-operative BMI and post-treatment weight change on the incidence of lymphedema.</p></sec><sec id="S2"><title>Methods</title><p id="P2">From 2005-2011, 787 newly-diagnosed breast cancer patients underwent prospective arm volume measurements with a Perometer pre- and post-operatively. BMI was calculated from same-day weight and height measurements. Lymphedema was defined as a relative volume change (RVC) of ≥10%. Univariate and multivariate Cox proportional hazards models were used to evaluate the association between lymphedema risk and pre-operative BMI, weight change, and other demographic and treatment factors.</p></sec><sec id="S3"><title>Results</title><p id="P3">By multivariate analysis, a pre-operative BMI ≥30 was significantly associated with an increased risk of lymphedema compared to a pre-operative BMI <25 and 25-<30 (p = 0.001 and p = 0.012, respectively). Patients with a pre-operative BMI 25-<30 were not at an increased risk of lymphedema compared to patients with a pre-operative BMI<25 (p= 0.409). Furthermore, large post-operative fluctuations in weight, regardless of whether they reflected weight gain or loss (i.e. 10 pounds gained/lost per month), resulted in a significantly increased risk of lymphedema (HR: 1.97, p = <0.0001).</p></sec><sec id="S4"><title>Conclusions</title><p id="P4">Pre-operative BMI of ≥30 is an independent risk factor for lymphedema, whereas a BMI of 25-<30 is not. Large post-operative weight fluctuations also increase risk of lymphedema. Patients with a pre-operative BMI≥30 and those who experience large weight fluctuations during and after treatment for breast cancer should be considered at higher-risk for lymphedema. Close monitoring or early intervention to ensure optimal treatment of the condition may be appropriate for these patients.</p></sec></abstract><kwd-group><kwd>Lymphedema</kwd><kwd>Body Mass Index</kwd><kwd>Weight Fluctuation</kwd><kwd>Breast Cancer</kwd></kwd-group><funding-group><award-group><funding-source country="United States">National Cancer Institute : NCI</funding-source><award-id>R01 CA139118 || CA</award-id></award-group></funding-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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