Breast cancer-related arm lymphedema: fluctuation over six months and the effect of the weather

Background: An understanding of normal fluctuation of lymphedema over time is important to identify real change, whether it is from response to treatment or worsening of the condition. The weather is another factor that possibly influences lymphedema but has had minimal investigation to date. The purpose of this study was to determine the extent to which breast cancer-related lymphedema (BCRL) fluctuated over a 6-month period and the influence of temperature, humidity, and barometric pressure. Method and Results: Women with unilateral BCRL (n = 26) and without BCRL (n = 17) were measured on nine occasions over 6 months using a standardized protocol. Measures included self-reported arm swelling, arm volume, and extracellular fluid with bioimpedance. Daily weather data were obtained for analysis of effects on lymphedema. Neither arm volume nor extracellular fluid varied significantly for women with lymphedema; coefficients of variation were 2.3% and 3.7%, respectively. Women without lymphedema had even less fluctuation, with coefficient of variation of 1.9% for arm volume and 2.9% for ECF. Correlation of weather and lymphedema data showed that temperature was the only aspect of the weather to have any effect on BCRL, with the maximum temperature on the day before measurement slightly affecting ECF (r = 0.27, p < 0.001), arm volume (r = 0.23, p < 0.001), and self-reported swelling (r = 0.26, p < 0.001). For women without lymphedema, the weather did not affect any measure. Conclusions: Established BCRL is relatively stable over a 6-month period. Temperature was the only aspect of the weather found to impact lymphedema

A patient-based self-examination survey for staging the severity of lymphoedema

Background: A lymphoedema self-assessment tool can help therapists deliver appropriate advice, and prioritise patients who are on waiting lists or who cannot access a lymphoedema clinic. Aims: This pilot study aims to assess the validity and reliability of the Lymphoedema Self-Examination Survey (LYSES) and the relationship between outcomes obtained through LYSES and healthcare professionals' lymphoedema assessment. Methods: Participants with lymphoedema (n=54) completed the LYSES, with the same survey repeated 1 week later. Bioimpedance measurement and International Society of Lymphology (ISL) staging were conducted by lymphoedema healthcare professionals, blinded to each other. Results: There was little agreement between self-reports of elevation being helpful and ISL staging of ≤I (k= -0.154), substantial agreement between self-reports of indentation and ISL staging of II (k=0.631), and poor agreement between self-reports and healthcare professionals' reports of skin firmness and skin changes (>ISL stage IIb) (k=0.089 and k=0.466, respectively). Lymphoedema severity based on ISL staging was able to account for 31% of the variability in L-Dex rank scores (p=0.005). Conclusion: LYSES cannot be used as an accurate self-report surve

A Profile of physiotherapy clinical education

The purpose of the study was to examine clinical education placement data to generate a profile of providers and examine the students? exposure to health care and educational factors during clinical education. A retrospective audit of clinical placement rosters was undertaken for 3 calendar years (2001?2003). Data were analysed overall and by clinical school for sites and placements, public or private sector and type of placement. Over the 3- year period, 209 sites provided 3475 clinical placements, with the number of placements increasing from 1066 placements in 2001 to 1133 in 2002 and to 1276 in 2003. Overall, 72.2% of placements were located in metropolitan Sydney. The proportion from regional providers increased over the 3 years from 11.8% to 15.1%. Overall 85.8% of placements were delivered by public providers. The profile indicated that a considerable number of clinical sites were utilised with an emphasis on large public hospitals. The challenge for curriculum development is to reduce the clinical education demands on current providers while ensuring graduates meet entry-level standards of physiotherapy.9 page(s

Segmental measurement of breast cancer-related arm lymphoedema using perometry and bioimpedance spectroscopy

Detection of lymphedema, particularly its mild stage, is clinically challenging. The aim of this study was to determine whether segmental bioimpedance spectroscopy (BIS) provided additional information to whole arm BIS in assessing women with or at risk of lymphedema following breast cancer

Transient swelling versus lymphoedema in the first year following surgery for breast cancer

The aim was to better understand the incidence, time course and risk factors for swelling in the arm on the side of surgery over the first year following surgery for breast cancer