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Early diagnosis, treatment, and Health-Related Quality of Life in women with mild Breast Cancer-Related Lymphedema.

Blom, Katarina LU (2022) In Lund University, Faculty of Medicine Doctoral Dissertation Series
Abstract
Background: Early diagnosis and treatment of Breast Cancer-Related
Lymphedema (BCRL) are important to prevent lymphedema progress and impact
on Health-Related Quality of Life (HRQOL). The treatment includes self-care and
treatment with compression garment. In mild BCRL, the lymphedema can be local, without an increase in arm volume. Tissue Dielectric Constant (TDC), measuring local tissue water in skin and subcutis, had not been used for diagnosis and to evaluate treatment in mild BCRL before. Also, knowledge about the effect of wearing a compression garment and its impact on HRQOL was unknown. The overall aim of this thesis was to evaluate diagnostic methods, treatment, and HRQOL in women with mild BCRL.
Methods: Women... (More)
Background: Early diagnosis and treatment of Breast Cancer-Related
Lymphedema (BCRL) are important to prevent lymphedema progress and impact
on Health-Related Quality of Life (HRQOL). The treatment includes self-care and
treatment with compression garment. In mild BCRL, the lymphedema can be local, without an increase in arm volume. Tissue Dielectric Constant (TDC), measuring local tissue water in skin and subcutis, had not been used for diagnosis and to evaluate treatment in mild BCRL before. Also, knowledge about the effect of wearing a compression garment and its impact on HRQOL was unknown. The overall aim of this thesis was to evaluate diagnostic methods, treatment, and HRQOL in women with mild BCRL.
Methods: Women treated with axillary node dissection and diagnosed with mild
BCRL were included. In paper I (n=72), the proportion of mild BCRL detected with
TDC and/or Water Displacement Method (WDM) in combination with skin
palpation at diagnosis were evaluated. Also, association between TDC and WDM
measurements and lymphedema related factors were examined. In paper II,
(n= 46),changes in local tissue water (TDC) and Lymphedema Relative Volume (LRV) measured with WDM after 1,2,3 and 6 months standard treatment were examined. In paper III, (n=70), differences between compression group (CG) and non compression group (NCG) in changes of local tissue water (TDC), LRV (WDM), and subjective symptoms after 1,2,3 and 6 months were investigated. Also, adherence to self-care at 6 months was examined. In paper IV, (n=51), difference between CG and NCG in disease specific HRQOL was investigated with the Lymphedema Quality of Life Inventory (LyQLI) at 6 months.
Results: The TDC method detected more patients with mild BCRL, earlier after
surgery and at a lower LRV compared to the WDM method, but both methods
together with skin palpation for diagnosis were needed. Also, there was a negative association between local tissue water and LRV (paper I). Both TDC and WDM could detect a significant reduction in BCRL over a 6 months period of standard treatment. The participants with BCRL, detected with TDC, decreased in local tissue water, but all participants had a similar decrease in LRV. Also, in a majority of participants, the site with the highest TDC ratio changed to another site (paper II). Early treatment with a compression garment for 6 months could prevent progression in mild BCRL, showing smaller proportion of progression in LRV, larger reduction in LRV and local tissue water, and early reduced experience of tension, compared to NCG. However, 43% in the NCG group did not show
progression and could manage without compression. Adherence to self-care was
comparable in both groups (paper III). The participants in both CG and NCG rated a high HRQOL, but the CG experienced a higher negative impact on HRQOL in the practical domain and in some of the items in the psychosocial domain compared to the NCG (paper IV).
Conclusions: TDC and WDM can be used together with skin palpation for early
diagnosis. Both methods could detect changes in mild BCRL during treatment and can be used to evaluate treatment. Early treatment with compression garment for 6 months could prevent progression of mild BCRL, but almost half of the participants in the NCG did not show progression. Wearing a compression
garment has a minor negative impact on HRQOL and needs to be considered in
relation to the preventive effect. The results have important clinical implications for diagnosing, treatment, clinical decision making and patient education in women with mild BCRL. (Less)
Abstract (Swedish)
Bakgrund: Tidig diagnos och behandling av bröstcancer-relaterade lymfödem
(BCRL) är viktigt för att förhindra försämring och påverkan på livskvalitet. Vid
mindre BCRL i arm, kan det ansamlas lymfvätska lokalt i den ytliga vävnaden, utan en volymökning. Tissue Dielectric Constant (TDC), är en metod som mäter lokal vävnadsvätska i hud och subkutan vävnad och hade inte använts tidigare för att diagnostisera och utvärdera behandling av mindre armlymfödem.
I behandlingen ingår bland annat användning av en kompressionsärm, men kunskapen om effekten och påverkan på livskvalitet saknades. Det övergripande syftet med avhandlingen var att utvärdera diagnostiska metoder, behandling och hälsorelaterad livskvalitet hos kvinnor med mindre... (More)
Bakgrund: Tidig diagnos och behandling av bröstcancer-relaterade lymfödem
(BCRL) är viktigt för att förhindra försämring och påverkan på livskvalitet. Vid
mindre BCRL i arm, kan det ansamlas lymfvätska lokalt i den ytliga vävnaden, utan en volymökning. Tissue Dielectric Constant (TDC), är en metod som mäter lokal vävnadsvätska i hud och subkutan vävnad och hade inte använts tidigare för att diagnostisera och utvärdera behandling av mindre armlymfödem.
I behandlingen ingår bland annat användning av en kompressionsärm, men kunskapen om effekten och påverkan på livskvalitet saknades. Det övergripande syftet med avhandlingen var att utvärdera diagnostiska metoder, behandling och hälsorelaterad livskvalitet hos kvinnor med mindre BCRL.
Metod: Kvinnor som opererats med axillutrymning och diagnostiserats med mindre BCRL i arm inkluderades. I artikel I (72 deltagare), undersöktes andelen med mindre BCRL som upptäckts med TDC och/eller Pletysmografi/Water
Displacement Method (WDM) i kombination med palpation av huden vid diagnos.
Även faktorer relaterade till lymfödem och sambandet mellan lokal vävnadsvätska och relativ lymfödemvolym undersöktes. I artikel II (46 deltagare), undersöktes förändringar i lokal vävnadsvätska (TDC) och relativ lymfödemvolym (WDM) efter 1,2,3 och 6 månaders användning av en kompressionsärm. I artikel III (70 deltagare) jämfördes skillnader i förändring av lokal vävnadsvätska (TDC), relativ lymfödemvolym (WDM), och subjektiva symtom efter 1,2,3 och 6 månader, mellan de som använt och inte använt kompressionsärm. Även frekvens av egenvård vid 6 mån undersöktes. I artikel IV (51 deltagare), undersöktes skillnader i upplevd hälsorelaterad livskvalitet mellan de som använt och inte använt kompressionsärm under 6 månader.
Resultat: TDC-metoden kunde upptäcka fler patienter med mindre BCRL, tidigare
efter operationen och vid en lägre lymfödemvolym jämfört med WDM, men båda
metoderna tillsammans med palpation av huden behöver användas vid
diagnostisering. Det fanns ett samband mellan ansamling av lokal vävnadsvätska
(TDC) och relativ lymfödemvolym (WDM) (artikel I). Både TDC och WDM kan
mäta förändringar av BCRL under behandling och kan användas vid utvärdering av behandling. De deltagare med BCRL som upptäckts med TDC metoden minskade i lokal vävnadsvätska, men alla deltagare minskade i relativ lymfödemvolym. Det högsta TDC värdet förflyttades i en majoritet av fallen till en annan mätpunkt under interventionen (artikel II). Tidig behandling med kompressionsärm under 6 månader kunde förhindra försämring av mindre armlymfödem, då den minskade relativ lymfödemvolym, lokal vävnadsvätska och minskade upplevelsen av spänning i armen, jämfört med deltagare som inte använt kompressionsärm. Emellertid, så var det 43% av de som inte använde kompressionsärm som inte försämrades i relativ lymfödemvolym och kunde klara sig utan behandling med kompressionsärm. Det var ingen skillnad i frekvens av egenvård mellan grupperna (artikel III). Deltagarna med mindre BCRL i båda grupperna skattade en hög hälsorelaterad livskvalitet, men de som använde kompressionsärm upplevde mer negativ påverkan på hälsorelaterad livskvalitet i den praktiska domänen och i några psykosociala aspekter jämfört med de som inte använt kompressionsärm (artikel IV).
Slutsatser: TDC och WDM kan användas tillsammans med palpation av huden för
att diagnostisera tidiga mindre BCRL. Båda metoderna kan mäta förändring under behandling och kan användas vid utvärdering av behandling. Tidig behandling med kompressionsärm under 6 månader förhindrar försämring av mindre BCRL, men nästan hälften av de deltagare som inte använt kompressionsärm försämrades inte. Att använda kompressionsärm har en mindre negativ påverkan på upplevd hälsorelaterad livskvalitet och behöver beaktas i relation till den preventiva effekten av att använda kompressionsärm. Resultaten i avhandlingen har viktiga kliniska implikationer för diagnostik, behandling och patientutbildning hos kvinnor med mindre BCRL. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Professor Ahlberg, Karin, Sahlgrenska Akadmin, Göteborgs universitet
organization
alternative title
Tidig diagnos, behandling and Hälso-Relaterad Livskvalitet hos kvinnor med mindre bröstcancer-relaterade lymfödem.
publishing date
type
Thesis
publication status
published
subject
keywords
lymphedema, breast cancer, compression garment, Diagnosis, treatment, health-related quality of life
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
issue
2022:158
pages
80 pages
publisher
Lund University, Faculty of Medicine
defense location
Hörsal 01, Health Sciences Centre, Baravägen 3 i Lund. Join by Zoom: https://lu-se.zoom.us/j/66708402673
defense date
2022-12-05 13:00:00
ISSN
1652-8220
ISBN
978-91-8021-320-2
language
English
LU publication?
yes
id
5d33dc76-10e5-41c9-a814-807c62a823d8
date added to LUP
2022-11-09 16:26:00
date last changed
2022-11-17 11:26:39
@phdthesis{5d33dc76-10e5-41c9-a814-807c62a823d8,
  abstract     = {{Background: Early diagnosis and treatment of Breast Cancer-Related<br/>Lymphedema (BCRL) are important to prevent lymphedema progress and impact<br/>on Health-Related Quality of Life (HRQOL). The treatment includes self-care and<br/>treatment with compression garment. In mild BCRL, the lymphedema can be local, without an increase in arm volume. Tissue Dielectric Constant (TDC), measuring local tissue water in skin and subcutis, had not been used for diagnosis and to evaluate treatment in mild BCRL before. Also, knowledge about the effect of wearing a compression garment and its impact on HRQOL was unknown. The overall aim of this thesis was to evaluate diagnostic methods, treatment, and HRQOL in women with mild BCRL.<br/>Methods: Women treated with axillary node dissection and diagnosed with mild<br/>BCRL were included. In paper I (n=72), the proportion of mild BCRL detected with<br/>TDC and/or Water Displacement Method (WDM) in combination with skin<br/>palpation at diagnosis were evaluated. Also, association between TDC and WDM<br/>measurements and lymphedema related factors were examined. In paper II,<br/>(n= 46),changes in local tissue water (TDC) and Lymphedema Relative Volume (LRV) measured with WDM after 1,2,3 and 6 months standard treatment were examined. In paper III, (n=70), differences between compression group (CG) and non compression group (NCG) in changes of local tissue water (TDC), LRV (WDM), and subjective symptoms after 1,2,3 and 6 months were investigated. Also, adherence to self-care at 6 months was examined. In paper IV, (n=51), difference between CG and NCG in disease specific HRQOL was investigated with the Lymphedema Quality of Life Inventory (LyQLI) at 6 months.<br/>Results: The TDC method detected more patients with mild BCRL, earlier after<br/>surgery and at a lower LRV compared to the WDM method, but both methods<br/>together with skin palpation for diagnosis were needed. Also, there was a negative association between local tissue water and LRV (paper I). Both TDC and WDM could detect a significant reduction in BCRL over a 6 months period of standard treatment. The participants with BCRL, detected with TDC, decreased in local tissue water, but all participants had a similar decrease in LRV. Also, in a majority of participants, the site with the highest TDC ratio changed to another site (paper II). Early treatment with a compression garment for 6 months could prevent progression in mild BCRL, showing smaller proportion of progression in LRV, larger reduction in LRV and local tissue water, and early reduced experience of tension, compared to NCG. However, 43% in the NCG group did not show<br/>progression and could manage without compression. Adherence to self-care was<br/>comparable in both groups (paper III). The participants in both CG and NCG rated a high HRQOL, but the CG experienced a higher negative impact on HRQOL in the practical domain and in some of the items in the psychosocial domain compared to the NCG (paper IV).<br/>Conclusions: TDC and WDM can be used together with skin palpation for early<br/>diagnosis. Both methods could detect changes in mild BCRL during treatment and can be used to evaluate treatment. Early treatment with compression garment for 6 months could prevent progression of mild BCRL, but almost half of the participants in the NCG did not show progression. Wearing a compression<br/>garment has a minor negative impact on HRQOL and needs to be considered in<br/>relation to the preventive effect. The results have important clinical implications for diagnosing, treatment, clinical decision making and patient education in women with mild BCRL.}},
  author       = {{Blom, Katarina}},
  isbn         = {{978-91-8021-320-2}},
  issn         = {{1652-8220}},
  keywords     = {{lymphedema; breast cancer; compression garment; Diagnosis; treatment; health-related quality of life}},
  language     = {{eng}},
  number       = {{2022:158}},
  publisher    = {{Lund University, Faculty of Medicine}},
  school       = {{Lund University}},
  series       = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
  title        = {{Early diagnosis, treatment, and Health-Related Quality of Life in women with mild Breast Cancer-Related Lymphedema.}},
  url          = {{https://lup.lub.lu.se/search/files/128082829/Avhandling_Katarina_Blom_Slutversion_utan_bilagor_e_spik_.pdf}},
  year         = {{2022}},
}