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24 July 2008
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Lymphedema prevalent in breast cancer patients and related to activity
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MedWire News: One-third of all breast cancer patients develop lymphedema in the 18 months following surgery, say Australian researchers who found that around 40% of these women suffer the condition for more than 3 months.
Older age at treatment, more extensive surgery and greater number of dissected axillary nodes increased the likelihood of developing lymphedema, whereas having a partner, being treated on the dominant side, and participation in regular activity decreased the odds.
Sandra Hayes (Queensland University of Technology, Brisbane) and co-workers comment: "Secondary lymphedema is arguably the most problematic and dreaded complication of breast cancer treatment.
"More systematic surveillance for earlier detection and the potential benefits of physical activity to prevent lymphedema and mitigate symptoms warrant further clinical integration and research."
Reported rates of lymphedema vary widely in the literature and little is known about prevention and associated risk factors, leading it to be regarded as an "incurable, progressive, disfiguring, and disabling disorder that is difficult to treat," says the team
Hayes and colleagues set out to better characterize lymphedema in a sample of 287 breast cancer patients participating in a wider investigation - The Pulling Through Study - designed to track and assess the physical and psychosocial recovery of women after breast cancer treatment.
Lymphedema status was assessed using bioimpedance spectroscopy every 3 months between 6 and 18 months after surgery.
Factors that increased the risk for lymphedema included older age at treatment (≥50 years vs <50 years, odds ratio[OR]=3.1), more extensive surgery (mastectomy vs local excision, OR=1.5), having a sedentary as opposed to sufficiently active lifestyle (OR=1.9), and having more lymph node excised (≥20 vs 0, OR=3.5).
Meanwhile, factors that appeared to protect against lymphedema were having a lower than national average yearly income (OR=0.5), being treated on the dominant side (OR=0.6), having greater childcare responsibilities (child ≤14 years vs no children, OR=0.2), and having better than average upper-body function (OR=0.6)
The researchers speculate that women with lower incomes tend to have manual occupations and therefore a more active lifestyle than women with higher incomes, while the same principle may apply to women with children to care for.
The authors emphasize that physical activity is "amenable to interventions and should be investigated for... preventive and therapeutic effects among women after treatment for breast cancer."
The research is published in the Journal of Clinical Oncology.
J Clin Oncol 2008; 26: 3536-3542
http://jco.ascopubs.org/cgi/content/abstract/26/21/3536
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