Lymphedema symptoms and limb measurement changes in breast cancer survivors treated with neoadjuvant chemotherapy and axillary dissection: results of American College of Surgeons Oncology Group (ACOSOG) Z1071 (Alliance) substudy

Jane M. Armer, Karla V. Ballman, Linda McCall, Nathan C. Armer, Yuanlu Sun, Tipparat Udmuangpia, Kelly K. Hunt, Elizabeth A. Mittendorf, David R. Byrd, Thomas B. Julian, Judy C Boughey

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose: Lymphedema is a potential complication of breast cancer treatment. This longitudinal substudy aimed to prospectively assess arm measurements and symptoms following neoadjuvant chemotherapy and axillary dissection in the ACOSOG/Alliance Z1071 trial to characterize the optimal approach to define lymphedema. Methods: Z1071 enrolled patients with cT0-4, N1-2, M0 disease treated with neoadjuvant chemotherapy. All patients underwent axillary dissection. Bilateral limb volumes, circumferences, and related symptoms were assessed pre-surgery, 1–2 weeks post-surgery, and semiannually for 36 months. Lymphedema definitions included volume increase ≥ 10% or limb circumference increase ≥ 2 cm. Symptoms were assessed by the Lymphedema Breast Cancer Questionnaire. Results: In 488 evaluable patients, lymphedema incidence at 3 years by ≥ 10%-volume-increase was 60.3% (95% CI 55.0–66.2%) and by ≥ 2 cm-circumference increase was 75.4% (95% CI 70.8–80.2%). Symptoms of arm swelling and heaviness decreased from post-surgery for the first 18 months and then were relatively stable. The 3-year cumulative incidence of arm swelling and heaviness was 26.0% (95% CI 21.7–31.1%) and 30.9% (95% CI 26.3–36.3%), respectively. There was limited agreement between the two measurements (kappa 0.27) and between symptoms and measurements (kappa coefficients ranging from 0.05–0.09). Conclusions: Lymphedema incidence by limb volume and circumference gradually increased over 36 months post-surgery, whereas lymphedema symptoms were much lower. These findings underscore the importance of prospective surveillance and evaluation of both limb measurements and symptom assessment. Lymphedema incidence rates varied by definition. We recommend that ≥ 10% volume change criterion be used for lymphedema evaluation for referral for specialist care. Trial registration: NCT00881361

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalSupportive Care in Cancer
DOIs
StateAccepted/In press - Jul 6 2018

Fingerprint

Lymphedema
Survivors
Dissection
Extremities
Breast Neoplasms
Drug Therapy
Arm
Incidence
Symptom Assessment
Referral and Consultation

Keywords

  • Breast cancer survivorship
  • Clinical trials
  • Lymphedema
  • Neoadjuvant chemotherapy
  • Prospective surveillance

ASJC Scopus subject areas

  • Oncology

Cite this

Lymphedema symptoms and limb measurement changes in breast cancer survivors treated with neoadjuvant chemotherapy and axillary dissection : results of American College of Surgeons Oncology Group (ACOSOG) Z1071 (Alliance) substudy. / Armer, Jane M.; Ballman, Karla V.; McCall, Linda; Armer, Nathan C.; Sun, Yuanlu; Udmuangpia, Tipparat; Hunt, Kelly K.; Mittendorf, Elizabeth A.; Byrd, David R.; Julian, Thomas B.; Boughey, Judy C.

In: Supportive Care in Cancer, 06.07.2018, p. 1-9.

Research output: Contribution to journalArticle

Armer, Jane M. ; Ballman, Karla V. ; McCall, Linda ; Armer, Nathan C. ; Sun, Yuanlu ; Udmuangpia, Tipparat ; Hunt, Kelly K. ; Mittendorf, Elizabeth A. ; Byrd, David R. ; Julian, Thomas B. ; Boughey, Judy C. / Lymphedema symptoms and limb measurement changes in breast cancer survivors treated with neoadjuvant chemotherapy and axillary dissection : results of American College of Surgeons Oncology Group (ACOSOG) Z1071 (Alliance) substudy. In: Supportive Care in Cancer. 2018 ; pp. 1-9.
@article{7c74ce6516844bacb950a5d5ad767e86,
title = "Lymphedema symptoms and limb measurement changes in breast cancer survivors treated with neoadjuvant chemotherapy and axillary dissection: results of American College of Surgeons Oncology Group (ACOSOG) Z1071 (Alliance) substudy",
abstract = "Purpose: Lymphedema is a potential complication of breast cancer treatment. This longitudinal substudy aimed to prospectively assess arm measurements and symptoms following neoadjuvant chemotherapy and axillary dissection in the ACOSOG/Alliance Z1071 trial to characterize the optimal approach to define lymphedema. Methods: Z1071 enrolled patients with cT0-4, N1-2, M0 disease treated with neoadjuvant chemotherapy. All patients underwent axillary dissection. Bilateral limb volumes, circumferences, and related symptoms were assessed pre-surgery, 1–2 weeks post-surgery, and semiannually for 36 months. Lymphedema definitions included volume increase ≥ 10{\%} or limb circumference increase ≥ 2 cm. Symptoms were assessed by the Lymphedema Breast Cancer Questionnaire. Results: In 488 evaluable patients, lymphedema incidence at 3 years by ≥ 10{\%}-volume-increase was 60.3{\%} (95{\%} CI 55.0–66.2{\%}) and by ≥ 2 cm-circumference increase was 75.4{\%} (95{\%} CI 70.8–80.2{\%}). Symptoms of arm swelling and heaviness decreased from post-surgery for the first 18 months and then were relatively stable. The 3-year cumulative incidence of arm swelling and heaviness was 26.0{\%} (95{\%} CI 21.7–31.1{\%}) and 30.9{\%} (95{\%} CI 26.3–36.3{\%}), respectively. There was limited agreement between the two measurements (kappa 0.27) and between symptoms and measurements (kappa coefficients ranging from 0.05–0.09). Conclusions: Lymphedema incidence by limb volume and circumference gradually increased over 36 months post-surgery, whereas lymphedema symptoms were much lower. These findings underscore the importance of prospective surveillance and evaluation of both limb measurements and symptom assessment. Lymphedema incidence rates varied by definition. We recommend that ≥ 10{\%} volume change criterion be used for lymphedema evaluation for referral for specialist care. Trial registration: NCT00881361",
keywords = "Breast cancer survivorship, Clinical trials, Lymphedema, Neoadjuvant chemotherapy, Prospective surveillance",
author = "Armer, {Jane M.} and Ballman, {Karla V.} and Linda McCall and Armer, {Nathan C.} and Yuanlu Sun and Tipparat Udmuangpia and Hunt, {Kelly K.} and Mittendorf, {Elizabeth A.} and Byrd, {David R.} and Julian, {Thomas B.} and Boughey, {Judy C}",
year = "2018",
month = "7",
day = "6",
doi = "10.1007/s00520-018-4334-7",
language = "English (US)",
pages = "1--9",
journal = "Supportive Care in Cancer",
issn = "0941-4355",
publisher = "Springer Verlag",

}

TY - JOUR

T1 - Lymphedema symptoms and limb measurement changes in breast cancer survivors treated with neoadjuvant chemotherapy and axillary dissection

T2 - results of American College of Surgeons Oncology Group (ACOSOG) Z1071 (Alliance) substudy

AU - Armer, Jane M.

AU - Ballman, Karla V.

AU - McCall, Linda

AU - Armer, Nathan C.

AU - Sun, Yuanlu

AU - Udmuangpia, Tipparat

AU - Hunt, Kelly K.

AU - Mittendorf, Elizabeth A.

AU - Byrd, David R.

AU - Julian, Thomas B.

AU - Boughey, Judy C

PY - 2018/7/6

Y1 - 2018/7/6

N2 - Purpose: Lymphedema is a potential complication of breast cancer treatment. This longitudinal substudy aimed to prospectively assess arm measurements and symptoms following neoadjuvant chemotherapy and axillary dissection in the ACOSOG/Alliance Z1071 trial to characterize the optimal approach to define lymphedema. Methods: Z1071 enrolled patients with cT0-4, N1-2, M0 disease treated with neoadjuvant chemotherapy. All patients underwent axillary dissection. Bilateral limb volumes, circumferences, and related symptoms were assessed pre-surgery, 1–2 weeks post-surgery, and semiannually for 36 months. Lymphedema definitions included volume increase ≥ 10% or limb circumference increase ≥ 2 cm. Symptoms were assessed by the Lymphedema Breast Cancer Questionnaire. Results: In 488 evaluable patients, lymphedema incidence at 3 years by ≥ 10%-volume-increase was 60.3% (95% CI 55.0–66.2%) and by ≥ 2 cm-circumference increase was 75.4% (95% CI 70.8–80.2%). Symptoms of arm swelling and heaviness decreased from post-surgery for the first 18 months and then were relatively stable. The 3-year cumulative incidence of arm swelling and heaviness was 26.0% (95% CI 21.7–31.1%) and 30.9% (95% CI 26.3–36.3%), respectively. There was limited agreement between the two measurements (kappa 0.27) and between symptoms and measurements (kappa coefficients ranging from 0.05–0.09). Conclusions: Lymphedema incidence by limb volume and circumference gradually increased over 36 months post-surgery, whereas lymphedema symptoms were much lower. These findings underscore the importance of prospective surveillance and evaluation of both limb measurements and symptom assessment. Lymphedema incidence rates varied by definition. We recommend that ≥ 10% volume change criterion be used for lymphedema evaluation for referral for specialist care. Trial registration: NCT00881361

AB - Purpose: Lymphedema is a potential complication of breast cancer treatment. This longitudinal substudy aimed to prospectively assess arm measurements and symptoms following neoadjuvant chemotherapy and axillary dissection in the ACOSOG/Alliance Z1071 trial to characterize the optimal approach to define lymphedema. Methods: Z1071 enrolled patients with cT0-4, N1-2, M0 disease treated with neoadjuvant chemotherapy. All patients underwent axillary dissection. Bilateral limb volumes, circumferences, and related symptoms were assessed pre-surgery, 1–2 weeks post-surgery, and semiannually for 36 months. Lymphedema definitions included volume increase ≥ 10% or limb circumference increase ≥ 2 cm. Symptoms were assessed by the Lymphedema Breast Cancer Questionnaire. Results: In 488 evaluable patients, lymphedema incidence at 3 years by ≥ 10%-volume-increase was 60.3% (95% CI 55.0–66.2%) and by ≥ 2 cm-circumference increase was 75.4% (95% CI 70.8–80.2%). Symptoms of arm swelling and heaviness decreased from post-surgery for the first 18 months and then were relatively stable. The 3-year cumulative incidence of arm swelling and heaviness was 26.0% (95% CI 21.7–31.1%) and 30.9% (95% CI 26.3–36.3%), respectively. There was limited agreement between the two measurements (kappa 0.27) and between symptoms and measurements (kappa coefficients ranging from 0.05–0.09). Conclusions: Lymphedema incidence by limb volume and circumference gradually increased over 36 months post-surgery, whereas lymphedema symptoms were much lower. These findings underscore the importance of prospective surveillance and evaluation of both limb measurements and symptom assessment. Lymphedema incidence rates varied by definition. We recommend that ≥ 10% volume change criterion be used for lymphedema evaluation for referral for specialist care. Trial registration: NCT00881361

KW - Breast cancer survivorship

KW - Clinical trials

KW - Lymphedema

KW - Neoadjuvant chemotherapy

KW - Prospective surveillance

UR - http://www.scopus.com/inward/record.url?scp=85049577961&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85049577961&partnerID=8YFLogxK

U2 - 10.1007/s00520-018-4334-7

DO - 10.1007/s00520-018-4334-7

M3 - Article

C2 - 29980907

AN - SCOPUS:85049577961

SP - 1

EP - 9

JO - Supportive Care in Cancer

JF - Supportive Care in Cancer

SN - 0941-4355

ER -