Main Session
Sep
28
PQA 02 - Lung Cancer/Thoracic Malignancies, Patient Reported Outcomes/QoL/Survivorship, Pediatric Cancer
2528 - A Temporal Perspective: Charting and Predicting Treatment Response in Breast Cancer-Related Lymphedema
Presenter(s)
Enoch Yu, BS - Queen's University, Kingston, ON
E. Yu1, A. Liu2,3, P. Wong1,4, and J. Y. Y. Kwan1,4; 1Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada, 2Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada, 3Department of Biostatistics, University of Toronto, Toronto, ON, Canada, 4Department of Radiation Oncology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
Purpose/Objective(s):
Breast cancer-related lymphedema (BCRL) is a debilitating side effect of breast cancer treatment. The main treatment for lymphedema is multimodal complete decongestive therapy (CDT), encompassing skin care, exercise, manual lymphatic drainage and compression therapy. Prior studies have assessed for factors predicting CDT efficacy, but most have limited follow-up. Analysis of the extended BCRL disease trajectory as well as long-term compliance, response to and side effects of CDT remain underexplored.Materials/Methods:
We conducted a retrospective chart review of patients with BCRL diagnosis receiving CDT and seen at a quaternary survivorship clinic from 2000 to 2021. Patients with primary/bilateral lymphedema, CDT contraindications or missing volume data were excluded. Arm volume, CDT compliance (scored on a scale between 0%=zero compliance and 100%=full compliance) and CDT-related side effects were retrieved at each visit. Lymphedema volumetric response trajectories were classified as increased or stable/decreased based on the long-term CDT outcomes. Descriptive statistics and univariable logistic regression were performed.Results:
Out of the 120 BCRL patients seen, 72 patients met inclusion criteria. Median age was 53.5 (Q1-Q3 48.3-61.6), BMI 30.2 (27.0-34.4) and 72% were married. All breast cancer stages were included, 20.8% treated with mastectomy and 66.7% with axillary lymph node dissection. A median of 12.5 lymph nodes (LNs) were removed (5-19). Most had adjuvant radiotherapy (99%) and hormone therapy (72%); 64% received chemotherapy. At the clinic, patients presented with a median of 6.7% (1.6-15.4%) increased arm volume compared to the unaffected arm, with 69% having heaviness symptoms. Overall, 70.8% of patients responded with stable or decreased arm volumes from CDT. Median follow-up was 1178 days (354-2339) and overall CDT compliance was 56.2% (42.8-70%). Of note, arm volumetric responses were dynamic during CDT with an initial rise in volume seen in 65.2% of patients, at a median of 187 days (91-611). Maximum reduction in volume for all patients occurred at a median of 518 days (293-1427). Notably, 34.8% of patients had side effects from CDT such as discomfort (20.8%), functional impairment (5.6%), sensation of heat (5.6%) and pruritus (2.8%). Median time to side effect presentation was 525 days (144-1260). Logistic regression revealed that stable/decreased arm volume responses to CDT were associated with lower BMI (OR 0.87, p=0.018). No significant associations were found with age, marital status, estrogen receptor status, number of LNs removed, presence of heaviness symptoms, initial volumetric severity or CDT compliance.Conclusion:
Response to CDT in BCRL is variable and may be associated with patient factors such as BMI. Future validation of results in larger cohorts of patients is required to confirm predictive factors for CDT response.