Significance of hormone replacement therapy in the experience of Lymphedema in breast cancer survivors

Abstract only availableLittle is known about the relationship between hormone replacement therapy and Lymphedema (LE), the accumulation of lymph in soft tissue with accompanying swelling that affects 20-40% of breast cancer survivors, mainly in the upper extremities. It is known that hormone replacement therapy (HRT), specifically estrogen plus progestin, used to treat menopausal women can contribute to the onset of invasive breast cancer. This study is aimed to examine the possible relationship between HRT with the occurrence and severity of LE in breast cancer patients. A retrospective chart review was conducted on medical records of 97 female participants undergoing breast cancer treatment. Variables identified for investigation included: hormone replacement therapy history, surgical procedure, radiation therapy, anti-estrogen therapy, chemotherapy, occurrence of LE as diagnosed by a medical professional, time till onset of LE from date of surgery, and treatments used to manage the condition. A review was also conducted over patient surveys in order to assess the severity of the illness as reported by the patients. Data showed that 21.6% of the 97 patients included in this review experienced LE diagnosed by a medical professional after treatment for breast cancer. Of those patients with medically diagnosed LE, 43% previously used HRT, while 51.3% of patients without LE had previously used HRT. From these data, several trends were assessed in the relationship between HRT, cancer treatment modalities and medical diagnosis of LE. Data from the surveys suggested that medically diagnosed LE patients with a history of HRT may experience a protective effect because of their collective history of HRT and use of certain cancer treatments. This study suggests that there may be a link between breast cancer patients' experiences following Lymphedema and their historyof hormone replacement therapy and other cancer modalities.Life Sciences Undergraduate Research Opportunity Progra

Prospective nursing study of breast cancer lymphedema: Exploring possible relationships with tamoxifen therapy [abstract]

Abstract only availableFaculty Mentor: Jane Armer, Sinclair School of NursingLymphedema (LE) is a lifetime risk for breast cancer survivors. This predisposes individuals to infection, possibly life-threatening, leads to difficulties in clothing fit and activities of daily living, and also affects self-esteem, self-identity, and quality of life.   Tamoxifen, considered a first-choice adjuvant therapy drug following breast cancer treatment, has been shown to halve the cancer recurrence risk. Tamoxifen is known to influence fluid and electrolyte balance with fluid retention (32%) being one of the most common adverse effects of the drug. Theoretically, it may act at the cellular level by increasing capillary membrane permeability, thus increasing the interstitial fluid movement and workload of a lymphatic system already compromised due to surgery and, often, radiation. Current literature has not reported a definitive association between tamoxifen use and LE occurrence.   The research goal is to explore tamoxifen-related variables in LE occurrence and whether or not LE occurrence is higher in breast cancer survivors who take tamoxifen.   A secondary analysis of data from an established National-Institutes-of-Health-funded parent study will be performed. The NIH study includes more than 200 persons newly-diagnosed with breast cancer who were consented, enrolled, and assessed at pre-op, post-op, and followed for 30 months. In the absence of a “gold standard,” the study defines four measurements of LE in exploring approaches to assessing and diagnosing post-breast cancer LE. In this proposal, data from a self-report of symptoms and tamoxifen use (≥ 6 months) are derived from the nurse interview using a validated measurement tool and medical record review. Data from limb volume estimation are derived from reliable and valid perometry measurement.   Relationship indicators between tamoxifen and LE occurrence would provide an early identifier for at-risk individuals, lay groundwork for targeted interventions, and justify future research examining the underlying physiological cellular mechanism associated with LE emergence in the presence of tamoxifen

Latinas and Breast Cancer in the Midwest: Factors Influencing Survivorship

Latinos are the largest ethnic minority group in the U.S. and the Midwest is experiencing the fastest growth in residents of Hispanic descent. Rural health care delivery systems in these areas must therefore respond to changing demographics and provide culturally appropriate service delivery. The incidence rate of breast cancer among Latinas is lower than that among non-Hispanic women; however an increasing number of Latinas are being diagnosed with breast cancer. Despite higher mortality rates from cancer than non-Hispanic women, more Latinas are being treated for breast cancer and are now facing their own unique survivorship experiences This paper addresses factors that may influence Latinas\u27 breast cancer survivorship in the Midwest (e.g., risk factors such as biology, lifestyle, culturally mediated health beliefs; access to necessary cancer care in rural areas) and survey research on survivorship experiences in cultural contexts. Essential areas for future research are identified

The psychosocial response to lymphedema

Abstract only availableLymphedema, a life-altering disease, affects many breast cancer survivors throughout the world. Manifested as either an acute or chronic illness, lymphedema can occur at any time during and following post-breast cancer treatment as the result of damaged lymph vessels. Resulting in the accumulation of protein-rich fluid in the affected limb, lymphedema inhibits the mobility of the limb and is both disabling and disfiguring. These factors ultimately result in a variety of psychosocial responses from both the patient and the family, including lowered self-esteem and depression in the patient and role modification of the family. Cultural and age factors also affect the patient's perception and understanding of the disease, further necessitating new approaches to health care practice. A preliminary content analysis of qualitative responses on impact of lymphedema following breast cancer treatment described by study participants will also be provided. [Funded by NIH R01 NR05432-03 to J. Armer.]NIH Grant to J. Arme

Self-reported symptoms and managment by midwestern breast cancer survivors

Lymphedema (LE) is a life-long potential consequence of breast cancer treatment that may affect quality of life of breast cancer survivors in long-term survivorship. Previous studies reported that about 2 million women living with breast cancer are at a lifetime risk for LE development. Information from self-reported lymphedema symptoms and its management will provide potential early detection and intervention to manage LE. The purposes of this study were: To report the frequency of occurrence of commonly self- reported LE symptoms following breast cancer diagnosis and treatment. To find the most commonly reported self-management actions taken for the five LE symptoms.Research supported by NIH/NINR NR05342/NR010293, University of Missouri PRIME funds, and Ellis Fischel Cancer Center research funds

Breast cancer-related lymphedema: A literature review for clinical practice

AbstractLymphedema is the swelling of soft tissues as a result of the accumulation of protein-rich fluid in extracellular spaces. Secondary lymphedema is precipitated by an event causing blockage or interruption of the lymphatic vessels. Secondary lymphedema is a potential complication that may affect the quality of life of patients treated for breast cancer. Life-long risk factors of post-breast cancer lymphedema are related to the extent of axillary node involvement, type of breast surgery, and radiation therapy. These factors decrease lymphatic drainage and increase stasis of fluids in the areas of skin and subcutaneous tissues that drain to regional lymph nodes. Breast cancer-related lymphedema can involve the arm and hand, as well as the breast and trunk on the operative side. Clinical symptom assessment and circumferential measures are widely used to evaluate lymphedema. Treatment of lymphedema associated with breast cancer can include combined modality approaches, compression therapy, therapeutic exercises, and pharmacotherapy

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment

Effects of weight-lifting or resistance exercise on breast cancer-related lymphedema: A systematic review

The purpose of this systematic review was to identify the effects of weight-lifting or resistance exercise on breast cancer-related lymphedema. Published articles written in English were retrieved from electronic databases, including ScienceDirect, PubMed, Scopus, and CINAHL databases. Hand-searches for unpublished papers were also completed. Content analysis was used to examine articles that met the inclusion criteria. Among 525 searched papers, 15 papers met the inclusion criteria: 13 trials evaluated weight-lifting or resistance exercise alone and two trials evaluated weight-lifting or resistance exercise plus aerobic exercise. The results of the review showed that no arm volume change was observed for either exercise modality. In addition, six included studies showed that weight-lifting or resistance exercise did not cause lymphedema or adverse events in patients at risk of breast cancer-related lymphedema. For patients with breast cancer-related lymphedema, six studies reported that change of swelling outcome measures were not significantly different between the weight-lifting or resistance exercise group and the control group. However, three included studies reported that volume of arm was significantly more reduced in the weight-lifting or resistance exercise group than those in the control group. The findings suggest that supervised resistance exercise may be safe, feasible, and beneficial in patients with breast cancer-related lymphedema or at risk for breast cancer-related lymphedema. However, the limitation of small sample size implies that further research is needed to confirm these findings. Keywords: Breast neoplasms, Lymphedema, Resistance training, Weight liftin

Complexities of Adherence and Post-Cancer Lymphedema Management

Breast cancer survivors are at increased risk for breast cancer-related lymphedema (BCRL), a chronic, debilitating, condition that is progressive and requires lifelong self-management. Up to 40% of 3 million breast cancer survivors in the US will develop BCRL, which has no cure, is irreversible, and requires self-management with regimens that may include multiple components. The complexities of treatment can negatively affect adherence to BCRL self-management which is critical to preventing progressive swelling and infection. The aim of this review of contemporary literature published from 2005–2015 is to examine the complexities of BCRL self-management, to identify adherence-focused studies relevant to BCRL, and to summarize barriers to self-management of BCRL. Six electronic indices were searched from which 120 articles were retrieved; 17 were BCRL-focused; and eight met inclusion criteria. Seventeen of 120 articles identified barriers to self-management of BCRL such as complexities of treatment regimens, symptom burden, balance of time for treatment and life demands, and lack of education and support; however, only eight studies included outcome measures of adherence to BCRL treatment regimens with a subsequent improvement in reduced limb volumes and/or perceptions of self-efficacy and self-regulation. A major limitation is the few number of rigorously developed outcome measures of BCRL adherence. In addition, randomized studies are needed with larger sample sizes to establish adequate levels of evidence for establishing best practice standards for improving adherence to BCRL self-management treatment regimens