Risk assessment, prevention and early detection of breast cancer related lymphedema: Objective measurements and patient reported outcomes.

Authors

null

Anshumi Desai

University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL

Anshumi Desai , Orli Friedman Eldar , Gili G. Halfteck , Mecker Geraldine Moller , Dido Franceschi , Susan B Kesmodel , Neha Goel , Jessica Crystal , Laura Huang , Diana Molinares , Jennifer J. Hu , Tulay Koru-Sengul , Wei Zhao , Alexis Rafael Narvaez-Rojas , Eli Avisar

Organizations

University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, MD Anderson Cancer Center, Houston, TX, Sylvester Comprehensive Cancer Center, Miami, FL, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL, University of Miami, Miami, FL, University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL, University of miami, Miami, FL, University of Miami, Miller School of Medicine, Division of Surgical Oncology, Miami, FL

Research Funding

Institutional Funding
University Of Miami

Background: Breast cancer-related lymphedema (BCRL) affects the quality of life, but there is no consensus regarding early detection and monitoring. Patient-reported outcomes (PROs) are important in assessing cancer survivor outcomes. LYMPHA (Lymphatic Microsurgical Preventive Healing Approach) and S-LYMPHA (Simplified LYMPHA) have reduced BCRL rates. This study aims to identify the most reliable PRO in a South Florida multi-ethnic population and to study correlations between PROs and objective measurements in the first 6 months after axillary surgery. Methods: Patients aged 18 and above undergoing axillary lymph node dissection (ALND) or axillary radiation were included. L-Dex (Spectroscopy) and three validated questionnaires (LyQLI, Lymphedema Quality of Life Inventory; LyQOL, Lymphedema Quality of Life and FACT-B4+ Functional Assessment of Cancer Therapy-Lymphedema) were recorded at baseline and 6 months post-surgery to assess the association between patient-reported symptoms and BCRL. Lymphedema was defined as L-Dex score outside the normal range, or a 10 unit increase above baseline. Additional variables such as demographics, tumor characteristics, and treatment modalities were considered. Results: Out of 40 recruited patients, 39 were analysed (excluding one deceased patient). One patient was male. Amongst the females,18 were pre-menopausal and 20 were post-menopausal. Hispanic ethnicity was reported by 23 (58.9%) patients compared to 16 (41%) non-Hispanic. White race, African American and other races were reported in 31, 4, and 4 patients respectively. 1, 22, and 16 patients had Cancer stages 1, 2, and 3 respectively. Neo-adjuvant therapy (endocrine or chemotherapy) was administered to 31 patients; 13 and 26 patients had lumpectomy and mastectomy respectively. 18 patients had breast reconstruction. Patients were divided into three groups for analysis: 1) ALND with no axillary radiation (n=33,85%); 2) Sentinel Lymph Node Biopsy (SLNB) with axillary radiation (n=3,8%); 3) ALND with axillary radiation (n=3,8%). In the first group, LYMPHA or S-LYMPHA were associated with lower rates of lymphedema (19% vs, 50%) (p=0.116). No patients in the second or third groups had lymphedema. There were 4 out of 20 (20%) patients with lymphedema with scores above the median for FACT B4+ (p= 0.41) and a lower score (higher quality of life) correlated with lower L-Dex value (p=0.76). The higher score in the physical domain of LyQLI showed higher L-Dex vaue (p=0.826). There was a significant inter-domain correlation in LyQLI and LyQOL (p<0.05 to <0.001). Conclusions: These preliminary results validate the use of PROs alongside objective measurements to assess BCRL. In addition, LYMPHA and S-LYMPHA significantly reduce lymphedema rates. Larger numbers will be necessary to reach statistical significance and to identify the best PRO.

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Abstract Details

Meeting

2023 ASCO Breakthrough

Session Type

Poster Session

Session Title

Poster Session B

Track

Gastrointestinal Cancer,Gynecologic Cancer,Head and Neck Cancer,Quality of Care,Genetics/Genomics/Multiomics,Healthcare Equity and Access to Care,Healthtech Innovations,Models of Care and Care Delivery,Population Health,Viral-Mediated Malignancies

Sub Track

Early Detection and Surveillance

Citation

JCO Global Oncology 9, 2023 (suppl 1; abstr 128)

DOI

10.1200/GO.2023.9.Supplement_1.128

Abstract #

128

Poster Bd #

H4

Abstract Disclosures