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      Prospective surveillance model in the home for breast cancer-related lymphoedema: a feasibility study

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          Abstract

          Purpose

          The aim of this study was to assess the feasibility of delivering a prospective surveillance model in the home over 6 months for women at high risk of developing lymphoedema.

          Methods

          A single-group, intervention study recruited 20 women who had surgical and medical treatment for confirmed node-positive invasive breast cancer and therefore at high risk of developing arm lymphoedema. Participants received a package including Bioimpedance Spectroscopy (BIS) monitoring, lymphoedema education and support to promote self-management and physical activity.

          Results

          Participants adhered to BIS monitoring 74% of the time, and felt extremely confident in using the device. By 6 months, mean BIS L-Dex scores had increased from 3.5 (SD 5.6) to 8.4 (SD 11.1); five women (25%) who experienced >  + 6.5 increase in L-Dex score were fitted with a compression garment. Self-reported symptoms and distress decreased by 0.4 out of 10 (95% CI 0.1 to 0.7); number of self-management strategies used increased by 0.6 (95% CI 0.1 to 1.2); and planned exercise increased by 2.8 h/week (95% CI 0.4 to 5.2).

          Conclusions

          These findings indicate a prospective surveillance model of care in the home with BIS is feasible and associated with increased self-management. A Phase II randomised trial is warranted as well as research exploring the costs associated with implementing this model of care for high-risk individuals.

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          Most cited references33

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          Preoperative assessment enables the early diagnosis and successful treatment of lymphedema.

          Peter Soballe, Lucinda A. Pfalzer, Judy B. Springer … (2008)
          The incidence of breast cancer (BC)-related lymphedema (LE) ranges from 7% to 47%. Successful management of LE relies on early diagnosis using sensitive measurement techniques. In the current study, the authors demonstrated the effectiveness of a surveillance program that included preoperative limb volume measurement and interval postoperative follow-up to detect and treat subclinical LE. LE was identified in 43 of 196 women who participated in a prospective BC morbidity trial. Limb volume was measured preoperatively and at 3-month intervals after surgery. If an increase>3% in upper limb (UL) volume developed compared with the preoperative volume, then a diagnosis of LE was made, and a compression garment intervention was prescribed for 4 weeks. Upon reduction of LE, garment wear was continued only during strenuous activity, with symptoms of heaviness, or with visible swelling. Women returned to the 3-month interval surveillance pathway. Statistical analysis was a repeated-measures analysis of variance by time and limb (P
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            A prospective surveillance model for rehabilitation for women with breast cancer.

            Nicole L Stout, Jill M Binkley, Kathryn H Schmitz … (2012)
            The current model of care for individuals with breast cancer focuses on treatment of the disease, followed by ongoing surveillance to detect recurrence. This approach lacks attention to patients' physical and functional well-being. Breast cancer treatment sequelae can lead to physical impairments and functional limitations. Common impairments include pain, fatigue, upper-extremity dysfunction, lymphedema, weakness, joint arthralgia, neuropathy, weight gain, cardiovascular effects, and osteoporosis. Evidence supports prospective surveillance for early identification and treatment as a means to prevent or mitigate many of these concerns. This article proposes a prospective surveillance model for physical rehabilitation and exercise that can be integrated with disease treatment to create a more comprehensive approach to survivorship health care. The goals of the model are to promote surveillance for common physical impairments and functional limitations associated with breast cancer treatment; to provide education to facilitate early identification of impairments; to introduce rehabilitation and exercise intervention when physical impairments are identified; and to promote and support physical activity and exercise behaviors through the trajectory of disease treatment and survivorship.
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              Evaluation of the incidental and planned activity questionnaire (IPEQ) for older people.

              K Delbaere, K Delbaere, K Hauer (2010)
              There is a need for a measure of physical activity that assesses low, basic and high-intensity activities suitable for use in ageing research including falls prevention trials. This study performed a formal validation of the incidental and planned activity questionnaire (IPEQ) by investigating its overall structure and measurement properties. Cross-sectional survey. Community sample. 500 older people (mean age 77.4 years, SD 6.08). The IPEQ was administered as part of a longer assessment in two different postal self-completion formats; one for estimating physical activity during the past week (IPEQ-W) and one for estimating average weekly physical activity over the past 3 months (IPEQ-WA). Test-retest reliability was assessed by the re-administration of the instruments one week later in a subsample of 80 respondents. Both IPEQ versions had good measurement properties, but overall the IPEQ-WA performed better than the IPEQ-W. Rasch analyses indicated the IPEQ-WA had an excellent overall fit. Analysis of the internal structure supported the unidimensionality of the scale with an acceptable internal consistency. The content representation of the items revealed three categories (low, moderate and high levels of physical activity), with a good contribution of items by threshold. The IPEQ-WA had excellent test-retest reliability, intraclass correlation coefficient 0.87) and was able to discriminate differences in physical activity levels between groups differentiated by sex, age and fall risk factors. The IPEQ has excellent psychometric properties and assesses the level of physical activity relating to both basic and more demanding activities. Further research is required to confirm sensitivity to change.
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                Author and article information

                Contributors
                Louise A. Koelmeyer:
                ORCID: http://orcid.org/0000-0002-2736-2330
                Louise.koelmeyer@mq.edu.au
                Journal
                Journal ID (nlm-ta): Breast Cancer Res Treat
                Title: Breast Cancer Research and Treatment
                Publisher: Springer US (New York )
                ISSN (Print): 0167-6806
                ISSN (Electronic): 1573-7217
                Publication date (Electronic): 1 October 2020
                Pages: 1-12
                Affiliations
                [1 ]GRID grid.1004.5, ISNI 0000 0001 2158 5405, Australian Lymphoedema Education, Research and Treatment (ALERT) Program, Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, , Macquarie University, ; Sydney, Australia
                [2 ]Icon Cancer Centre, Sydney, NSW Australia
                [3 ]GRID grid.1004.5, ISNI 0000 0001 2158 5405, Centre for Emotional Health, Department of Psychology, Faculty of Medicine, Health and Human Sciences, , Macquarie University, ; Sydney, Australia
                [4 ]GRID grid.1004.5, ISNI 0000 0001 2158 5405, Department of Health Professions, Faculty of Medicine, Health and Human Sciences, , Macquarie University, ; Sydney, Australia
                Author information
                http://orcid.org/0000-0002-2736-2330
                Article
                Publisher ID: 5953
                DOI: 10.1007/s10549-020-05953-3
                PMC ID: 7529356
                PubMed ID: 33006001
                SO-VID: 66d28f28-7754-4ac8-b687-ed4038b66712
                Copyright © © Springer Science+Business Media, LLC, part of Springer Nature 2020
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date received : 13 August 2020
                Date accepted : 23 September 2020
                Funding
                Funded by: ImpediMed Limited
                Funded by: Sydney Vital
                Categories
                Subject: Clinical Trial

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: breast cancer-related lymphoedema,bioimpedance spectroscopy (bis),home monitoring,prospective surveillance model,phase i trial,feasibility
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: breast cancer-related lymphoedema, bioimpedance spectroscopy (bis), home monitoring, prospective surveillance model, phase i trial, feasibility

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