Preventing breast-cancer related lymphedema after treatment

Conventional guidance on ipsilateral blood draws, injections, wearing of compression sleeve not beneficial;Increased arm volume associated with BMI =25 and prior axillary lymph node dissection, history of regional lymph node radiation and cellulitis

AFTER BREAST cancer surgery, women are generally advised by their physicians to avoid ipsilateral blood draws, injections, and having their blood pressure checked on the ipsilateral arm, especially after breast cancer treatment like radiotherapy.

However, based on data recently published by Ferguson CM et al. (J Clin Oncol 2016 March 1), this conventional guidance to prevent breast-cancer related lymphedema (BCRL) and possibly cellulitis in the ipsilateral arm does not seem to be beneficial to the patient, and may even be a source of anxiety and stress. This includes the wearing of compression arm sleeves during air travel. Air travel is known to trigger or aggravate lympedema in the ipsilateral arm of some breast cancer patients after surgery and treatment.

In the study, after doing a multivariate analysis, the researchers found that significant increases in arm volume were associated with BMI =25 and prior axillary lymph node dissection, regional lymph node radiation, and a history of cellulitis.

The investigators serially assessed bilateral arm volume in women with newly diagnosed breast cancer, during each visit. They were also requested to fill up surveys about whether they had engaged in nonprecautionary behaviors. It is to be noted that the patients were not routinely advised on the conventional guidance for lympedema prevention.

The median follow-up was 24 months in the 632 women involved in the study (median age at diagnosis, 52; median body-mass index [BMI], 26 kg/m2). Around seven out of 10 participants underwent sentinel node biopsy and 74 percent had two to six measurements. A total of 2900 survey responses were obtained, and the rates of nonprecautionary events were: two percent (injections), eight percent (blood draws), 16 percent (BP measurements), and 30 percent (air travel).

An aggregate of 3041 measurements was completed, and there was no significant association between increased arm volume and occurrence of blood draws, injections, and number or duration of flights.

Commenting on the study in the New England Journal of Medicine Journal Watch, Laila Samiian, MD and Andrew M. Kaunitz, MD said that though there are well-established risk factors for BCRL, this important study “debunks conventional guidance that blood draws, injections, BP assessment, and air travel raise risk for lymphedema in a low-risk population (e.g., most underwent sentinel node biopsy and had lower prevalence of obesity than that seen nationally).” They clarified though that data is still lacking if these activities raise risk for cellulitis in women who already have lymphedema.

Vital Signs Issue 85 Vol. 4, March 1-31 2016