FLYING AFTER SURGERY

Rianne, here's an analysis of that study:

http://www.stepup-speakout.org/research_updates_and_comments.htm#Compression_garments

Compression Garments on Airplanes

Controversial Study on Wearing Compression Garments While Flying Coming out of SABCS, December, 2008

A controversial study has come out of the San Antonio Breast Cancer Symposium, December, 2008. Air Travel Holds Little Lymphedema Risk for Breast Cancer Survivors.

Note that this study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Also note these prior studies: Lymphedema initiated by aircraft flights. Casley-Smith JR, Casley-Smith JR. Henry Thomas Laboratory, University of Adelaide, S.A., Australia. Precipitating factors in lymphedema : Myths and realities, Author, ROCKSON S. G

Here's the press release:

http://www.medpagetoday.com/MeetingCoverage/SABCS/12142

A study was presented at the 2008 San Antonio Breast Cancer Symposium (SABCS) about the risk of lymphedema when flying. A news release about that study came out in the on-line newsletter, MedPageToday.

According to the news release, the study found that women who've had breast cancer surgery "need not worry" about developing lymphedema when flying.

But, that isn't what the researchers said in their report. The results and conclusions in their SABCS meeting abstract (Abstract #1119) are different from what the news release says. Here's a link to a page with a search engine that can be used to type in the abstract number and access the abstract of the study: http://www.abstracts2view.com/sabcs/sessionindex.php

The study involved 75 women who had recovered from breast cancer surgery and were flying to Queensland, Australia, to participate in a dragon boat regatta. The researchers used "bioimpedance" to measure extracellular fluid in the arms of the women before and after the airplane flights.

One problem with the study is that bioimpedance was the only method the researchers used to see if the women had developed lymphedema. Some lymphedema researchers and clinicians think bioimpedance might not be sensitive enough to detect lymphedema until it reaches a severe form (Stage III). So, swelling that was less severe might not have been detected in this study.

According to the news release in MedPage Today, 5% of the women in the study did develop a "clinically significant" increase in arm fluid, as judged by bioimpedance. Five percent seems like enough of a risk to warrant taking precautions when flying. What is odd is that the researchers reported a different number in their abstract--not 5%--for the prevalence of "clinically significant" arm fluid. They said 15 of the 75 women developed a "clinically significant" increase; and 15 of 75 is 20%, not 5%. Twenty percent is considerable risk. Most women would probably think a risk of 20% was worth "worrying about," and worth taking precautions.

But not all the women in the study were at equal risk of developing lymphedema. Of the 75 women, 12 took fairly short flights to Queensland from other locations in Australia. Only one of those 12 women had a "clinically significant" accumulation of arm fluid. The other 63 women in the study flew all the way to Australia from Canada, which was a much longer flight--a "long haul" flight, according to the researchers. Among the 63 women who took the trans-oceanic flights, 14 had a "clinically significant" increase in arm fluid. So, the women on the longer flights had a 14/63 = 22% chance of developing a "clinically significant" increase in arm fluid. That number would likely attract most women's attention and cause them concern.

According to the researchers, 8 of the 15 women who had a "clinically significant" increase in arm fluid had enough of an increase for it to be diagnostic of lymphedema (i.e., they actually developed lymphedema). All 8 of those women were on the flights from Canada. That means 8/63 = 12.7% of the women who took the trans-oceanic flights developed bona fide lymphedema in association with their flights. The news release said all but 2 of those women had been diagnosed with lymphedema previously. That statement implies that lymphedema triggered by flying is somehow less important if it is a recurrence than if it is a new case. In contrast to that statement in the news release, the number of new cases reported in the abstract was much higher. The researchers said in their abstract that 6 of the 8 women diagnosed with bona fide lymphedema in association with the flight had not had arm swelling prior to the flight--this was a new diagnosis of lymphedema for them.

Finally, the news release failed to emphasize an important point: The women in this study were traveling to Australia to participate in a dragon boat regatta. According to the researchers, 94% of the women in the study had "trained at a moderate to vigorous intensity for the regatta." We can probably assume they were in pretty good shape--their upper-body conditioning was likely much better than that of most women after breast cancer treatment. Several studies have shown that a supervised exercise program involving upper-body strength training can reduce the risk of lymphedema after breast cancer surgery. Wouldn't that mean the women in this study were at lower risk of developing lymphedema in the first place? So, why would the news release mislead their readers by generalizing the findings to all women?

The first sentence in the news release says, "Women who've had breast cancer surgery need not worry that pressure changes in an airplane cabin will bring on lymphedema, researchers found." But that's very different from what the researchers concluded in their abstract. Here's what the abstract said: "For the majority of women who undertake moderate to vigorous upper limb exercise, airplane travel did not have a significant impact on extracellular fluid ratio."
Those two statements mean very different things. The discrepancies in representation of the results of this study are troubling, and should be clarified for the benefit of all women who have been treated for breast cancer and are facing the risk of lymphedema.

I believe this has been published, and actually--bioimpedance is fraught with insensitivity--it requires serial measurements, taken when the patient is laying down, with an empty bladder, no caffeine or alcohol, and is actually possibly best at detecting early increases in extracellular swelling. The manufacturer states that the L-dex is "not intended to diagnose or predict lymphedema." It is manufactured in Australia, hence the reliance on it.

The NLN position paper says to weigh your risk, and get well fitting compression if you decide to wear it.

http://www.lymphnet.org/lymphedemaFAQs/positionPapers.htm

Jane/Onebadboob, is a participant in an NYU research study, where the head researcher does not believe in compression on air flights--with no data to back that up--yet Jane got LE after a plane flight and the graduate student who took her measurements said she was the 180th woman in the study to implicate air flight as a trigger.

It is an area of controversy. Some therapists will recommend a low compression sleeve--15-20 mm, only made by Jobst, with a 20-30 mm gauntlet.

I'd suggest you read the NLN position paper, and hope that helps with your decision.

Kira

Rianne, I bumped a recent thread: this gets discussed again and again on this forum, so you can search for other threads.

The bottom line is that it is a risk, and you have to decide how you chose to approach it.

Kira

I developed lymphedema in my hand and arm on a three-hour flight. I did not have a proper compression sleeve, and it was no fun at all trying to get help in a strange town. In fact, I couldn't get help there and had to fly home again without anything to help contain the swelling. I made a fist of my hand and sat on it all the way home; it was distressing and downright frightening. (And as a strategy for preventing swelling it didn't work!)

Corrie, I'm so happy for you that you've had no problems with LE yet, and I truly hope you'll never join our Sorority of Swell. Once we've been treated for bc we're all at risk for LE for the rest of our lives. It develops when the already-compromised lymph system is overwhelmed, which can happen at any point and is unpredictable.

We all make our own compromises with the risk, and that's as it should be. But we need to understand the risk in order to make informed choices. If I knew when I took that flight what I know now, I would definitely have been prepared and aware. For me that was not a choice, because no one warned me. I hope no bc veteran ever has to face that situation without their knowledge of what it could mean to them.

Has anyone metioned that compression garments need to fit really well or they're a hazard instead of a help? Here's information on fitting of compression garments:
http://www.stepup-speakout.org/proper_fitting_of_lymphedema_garments.htm

Hugs all around, and happy travels!
Binney

I already have LE, so I'm in compression while flying.  But I can tell you that I have learned not to double up on what I know tends to make my LE flare. Flying without compression before my official LE diagnosis caused swelling, and now that I'm wearing compression, I am generally ok even after a full day of flying.  EXCEPT if I get off that final flight and add cardio exercise to my day.  Cardio with lots of arm pumping treats me fine if that's all I'm doing, and I am in a compression shirt for that.  But I simply must not fly and pump arms in cardio exercise --not even speed walking--on that day. That's just my experience, but maybe it's worthwhile thinking about your activity on the day you fly, and being careful about lifting heavy weights or other activities that the LE precautions have us thinking about.  Well, good luck with that if you're hefting a heavy bag!

rianne2580, There have some posts that sisters who have had little or no lymphedema have used Armour Underall compression shirts. I am flying to Europe in a few months and am flying to Florida in about three weeks. I bought two shirts, one short sleeve and one long sleeve that I plan on wearing on the flights and for a couple of hours after. I figure its cheap insurance. I did find that the men's fits better than the ladies sizes. I bough a men's medium after I returned the ladies large. They just seem to be more comfortable and the sleeves fit better. good luck with whatever you decide.