New Study Shows LE more common than thought

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kira66715
kira66715 Member Posts: 4,681
edited June 2014 in Lymphedema

Since LE has no single definition, studies will vary, but this study "feels" more correct, and since the crew at Mass General put out a study last year saying the risk of LE was so low after SNB, that surgeons shouldn't factor in LE in their decisions, this would argue they should.

This is a nice, big study. It's just an abstract, so we don't have all the details.

http://www.firstwordpharma.com/node/1196009#axzz2wdiMTsPJ

Lymph-Oedema More Common Than Realised After Sentinel Lymph-Node Dissection: Presented at SSO




March 17th, 2014

By Nancy A. Melville
    PHOENIX, Arizona -- March 17, 2014 -- Lymph-oedema after sentinel
    lymph-node dissection occurs more commonly than previously expected, and
    increases with time among women treated for early-stage breast cancer,
    according to researchers at the 67th Annual Cancer Symposium of the
    Society of Surgical Oncology (SSO).A previous prospective, multicentre study from the American Society
    of Surgeons Oncology Group (ACOSOG) demonstrated an incidence of
    lymph-oedema of 7% at 6 months after sentinel lymph-node dissection in
    women with early-stage breast cancer. The study was undertaken to
    evaluate the prognostic significance of micrometastasis. Eligible
    patients included women with clinical T1-2 N0 M0 breast cancer.Following up on the longer-term incidence of lymph-oedema in the same
    cohort, researchers compared 5,210 women who underwent sentinel-node
    dissection with 885 who had complete axillary lymph-node dissection.The cumulative incidence of lymph-oedema after sentinel lymph-node
    dissection was 3.7% at 1 year, 8.9% at 3 years, and 11.9% at 5 years by
    subjective assessment (n = 3,993), stated lead author Mediget Teshome,
    MD, University of Texas M.D. Anderson Cancer Center, Houston, Texas,
    speaking here on March 14. The incidence by objective arm measurements
    (n = 3,918) was 10.5% at 1 year, 17.4% at 3 years, and 24.1% at 5 years.Following axillary lymph-node dissection, the incidence of
    lymph-oedema was 14.0% at 1 year, 32.9% at 3 years, and 41.0% at 5 years
    by subjective assessment (n = 865), and was 17.0% at 1 year, 30.6% at 3
    years, and 40.3% at 5 years by objective arm measurement (n = 853).The strongest predictors of objective lymph-oedema, according to
    multivariate analysis, were increasing age (odds ratio [OR] = 1.01, 95%
    confidence interval [CI]: 1.01 to 1.02, P< .0001); body mass index ≥ 30 (OR = 1.81, CI: 1.59 to 2.06, P< .0001); and axillary lymph-node dissection (OR = 1.74, CI: 1.50 to 2.02, P< .0001).Reports of decreased range of motion and paraesthesias were more common than lymph-oedema after axillary surgery.“We found a 24.1% cumulative incidence of lymph-oedema at 5 years
    after sentinel lymph-node dissection, with increases in lymph-oedema at
    each assessment varying from 6.5% to 9.2%,” said Dr. Teshome.“This occurrence is more frequent than clinically suspected,” Dr.
    Teshome added. “Populations at risk include patients who are older,
    obese, and require completion axillary lymph-node dissection.”Dr. Teshome speculated that the higher incidence may be explained by
    improvement in symptoms over time, secondary to interventions. “Further
    directions include assessment of the severity of lymph-oedema after
    sentinel lymph-node dissection and evaluation of patient education,
    prevention efforts, and treatment strategies for lymph-oedema,” she
    concluded.[Presentation title: Long-Term Incidence of Lymphedema After Sentinel Lymph NodeDissection for Early Stage Breast Cancer: ACOSOG Z0010(Alliance). Abstract #3]

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Comments

  • Lia13
    Lia13 Member Posts: 52
    edited March 2014

    Thanks for this Kira :-)

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited March 2014
    This is an interesting study Kira. Thanks for posting. It doesn't surprise me that these figures are higher than first thought.
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  • NatsFan
    NatsFan Member Posts: 3,745
    edited March 2014

    My first reaction to this was:  "No sh*t, Sherlock!"  It's what we in the LE community have been trying to tell our surgeons and others in the medical community for years.  LE is not rare; SNB is not LE risk-free; LE can be triggered 2-3+ years later; it's not all in our heads, etc., etc., etc.

    Nice to have yet another study we can print out to show to any skeptics on our medical team we run into.  Sad that we still have so many surgeons in denial about LE.  You know the ones: "None of my patients ever gets LE."  Devil

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  • MsPharoah
    MsPharoah Member Posts: 1,034
    edited March 2014

    My BS always sends his patients for an LE assessment and to be fitted for garments, regardless if they have 1 or all nodes removed.  While I appreciated that, when I told him how fearful I was to have LE, he poo poo'd me by saying...."so, breast cancer isn't scary?"  While I understand that node dissection is standard of care, it would be nice if doctors acknowledged that LE impacts QOL, is something to be prevented and is certainly scary.  I responded by saying.  "Everything is scary now, doctor!" 

    MsP

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  • kira66715
    kira66715 Member Posts: 4,681
    edited March 2014

    MsP--everything is scary. Your bs is the rarity, unfortunately.

    In the last year we've seen Sarah McLaughlin publish a study of her own patients, who had a low incidence of LE and conclude that all women with breast cancer were worrying about LE for no reason. She has actually been very responsive to feedback. Clearly she's a good surgeon, but a single surgeon study can't be extrapolated to all women.

    When I worked for the rad onc's I saw that some surgeon's patients had a lot of LE (my surgeon, the queen of oncoplastic surgery was a prime offender) and other surgeons' patients seemed to rarely get it. As I heard in a lecture at the NLN: "treat the tissues gently"

    And the MGH crew, who I now find troubling--I used to think they were so cutting edge with their perometer but they've chosen to use it not for good (IMO) but to deny LE; published that the incidence of LE was so low after SNB (yet their study showed it was relatively high and got higher with time--they didn't read what they wrote?), that surgeons should feel free to do SNB's during a prophy mx without factoring in the risk of LE. (As Binney wrote recently: you can't cure stupid.) 

    Mary--I completely agree with everything you wrote! I know I feel like "Captain Obvious" but the oncology community is so immersed in their denial that we just have to keep stating the facts.

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  • juneping
    juneping Member Posts: 1,594
    edited March 2014

    kira - i thought i read it somewhere that the skill of the surgeon also matters...that seems to match your observations...

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  • kira66715
    kira66715 Member Posts: 4,681
    edited March 2014

    juneping, I heard a lecture at the NLN by a surgeon who strongly argued that surgeons need to treat the tissues gently, and that was my observation. The rates of LE that I saw while working in rad onc varied greatly between surgeons.

    One surgeon had the lowest rates, and others, unfortunately mine included, had very high rates. My surgeon was all about "cosmesis" how pretty it looked and she literally tore the tissue. I read an article on oncoplastic breast surgery and the trauma that the surgeon creates is kind of horrendous.

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