Cancer Journal: rehab and LE

kira66715

There appears to be a special issue of the journal "Cancer" addressing morbidity of breast cancer treatment, and rehab.

http://onlinelibrary.wiley.com/doi/10.1002/cncr.v118.8s/issuetoc

They should all be free downloads

One article addressed LE and found:

Median reported incidence in these 11 studies was 20% (range, 0%-94%). It therefore seems plausible to suggest that from 6 months postsurgery, approximately 1 in 5 patients treated for breast cancer will experience sec- ondary lymphedema. The median rate appears to increase with longer follow-up, escalating from 11% up to 12 months to 36% beyond 12 months. Findings also suggest that 45% to 60% of patients with long-term secondary lymphedema present with the condition by 6 months postsurgery,46,59 whereas 70% to 80% present by 12 months postsurgery.59,60 Consequently, it seems clear that despite advances in breast cancer treatment over the past decade, lymphedema continues to be a common con- cern, with new cases presenting well beyond the active treatment period.

Lymphedema is regarded as a persistent or chronic condition. However, results from 2 prospective studies, 1 using an objective measure of lymphedema status and the other a validated self-report measure, suggest this may not be the case for all women. The studies demon- strated that up to 60% of women with evidence of lym- phedema had acute lymphedema (lasting no more than 5 months), dissipating with or without treatment (although commencement of, or adherence to, treatment was not formally assessed). Between 30% and 40% had chronic and/or progressive lymphedema, and between 15% and 22% had fluctuating lymphedema, which may have included intermittent periods without symptoms. There- fore, lymphedema seems transitory for some, with or without treatment, and long-term for others, with or without intermittent periods of relief. This variable nature of lymphedema may further contribute to the wide range of incidence reported throughout the literature. 

Importantly, however, those who present with mild lymphedema are at increased risk (up to 3 increased risk) of developing moderate to severe lymphedema

There is a big push for oncology rehab, and this special edition of the journal addresses it.

It's only two studies, but this is one of the first times I've seen in the literature the description of the variable course of LE.

Kira

olearca

Wow, Kira, thanks for sharing.  I'ts both validating and depressing to read about the variable nature of the LE.  But, at least it addresses  what we all seem to know to be true.

kira66715

Catherine, I totally agree. I found myself wondering why I couldn't be in the transient group....

And we've seen it, we've heard it, and now we're finally seeing it in the literature.

Depressing and validating sums it up so well.

carol57

I'll bet the studies finding genetic tendencies explain at least some of the reason why LE is not transient for everyone.  Thanks for posting this, Kira.

BeckySharp

Very interesting Kira.  Thanks for posting.  Wonder which category I will end up in? Only time will tell.

kira66715

Becky, time and intervention. You've made huge progress with intervention.

In retrospect, I was in super shape prior to the hand fracture, but still needed night time compression. Now, the new normal, is some daytime compression, but always night time compression. My LE therapist thinks I'm back to baseline, but I'd say, not quite as good as I was before the fracture where compression was really only for exercise.

I've read the Cheville study about "mild" LE being a risk for severe LE--they used volume as their determinant of severity.

I know that by treating my LE I've kept my hand/arm from swelling, and hopefully avoided more tissue changes. My LE arm is actually smaller than my "normal" arm, but that does not mean I don't have LE, by any stretch.

As with any chronic disease, memory starts to morph/fade: I remember having more issues early on, and more tolerance of activity at this point.

Hoping you continue to improve.

Kira 

cookiegal

Thanks for posting. There is a new Penn state study about breast cancer rehab in general.

I am glad there is a push for rehab!!