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

• Published in: Cancer Vol. 128; no. 18; pp. 3408 - 3415
• Main Authors: Koelmeyer, Louise A, Gaitatzis, Katrina, Dietrich, Mary S, Shah, Chirag S, Boyages, John, McLaughlin, Sarah A, Taback, Bret, Stolldorf, Deonni P, Elder, Elisabeth, Hughes, T Michael, French, James R, Ngui, Nicholas, Hsu, Jeremy M, Moore, Andrew, Ridner, Sheila H
• Format: Journal Article
• Language: English
• Published: Atlanta Wiley Subscription Services, Inc 01-09-2022
• Subjects: Air transportation; Aircraft; Body mass; Body mass index; Body size; Breast cancer; Cancer therapies; Chemotherapy; Comorbidity; Compression; Context; Diabetes mellitus; Hypertension; Intervention; Irradiation; Lymph nodes; Lymphedema; Oncology; Patients; Radiation; Risk analysis; Risk factors; Secondary analysis; Spectroscopy; Surveillance; Taxanes
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.34377

BackgroundTo 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.MethodsThe 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.ResultsThe 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.ConclusionsWithin 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.