Leg Lymphedema - 2006 Abstracts

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Leg Lymphedema - 2006 Abstracts

Postby patoco » Fri Jun 09, 2006 9:30 pm

Leg Lymphedema - 2006 Abstracts

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The incidence of symptomatic lower-extremity lymphedema following
treatment of uterine corpus malignancies: A 12-year experience at
Memorial Sloan-Kettering Cancer Center.

2006 May 30

Abu-Rustum NR, Alektiar K, Iasonos A, Lev G, Sonoda Y, Aghajanian C,
Chi DS, Barakat RR.

Gynecology Service, Department of Surgery, Memorial Sloan-Kettering
Cancer Center, 1275 York Avenue, New York, NY 10021, USA.

OBJECTIVES: To describe the incidence of symptomatic postoperative lower-extremity lymphedema in women treated for uterine corpus cancer, and to evaluate its relationship to regional lymph node removal and postoperative therapy.

METHODS: A retrospective chart review of all patients with uterine
corpus cancer managed over a 12-year period (1/93-12/04). All patients
had a hysterectomy as part of their therapy. We identified patients
with leg lymphedema - as described by the physician or reported by the
patient - through medical records. We excluded cases of leg edema that
developed secondary to medical conditions such as cardiovascular and
renal disease, venous thrombosis, and end-stage recurrent malignancy.
Lymphedema dermal changes and related fibrosis were graded using the
common terminology criteria for adverse events.

RESULTS: In all, 1289 patients with uterine corpus malignancy were evaluated. We excluded other chronic lower-extremity edema that was related to a variety of medical conditions in 74 patients (5.7%). With
a median follow-up of 3 years (interquartile range, 1.1-5.4 years), new
symptomatic post-treatment lower-extremity lymphedema was noted in 16 patients. Patients who had lymph nodes removed at initial surgery had a higher rate of developing lymphedema (16/670, 2.4%) than those who did not (0/619, 0%) (P = 0.0001). Furthermore, symptomatic lymphedema was limited to patients who had 10 or more regional lymph nodes removed 16/469 (3.4%). Lymphedema was noted at a median of 5.3 months after surgery (range, 1-32 months). Lymphedema was unilateral in 11 patients (69%) and bilateral in 5 (31%); moreover, it was considered grade 1 in 12 patients (75%) and grade 2 in 4 (25%). Age, weight, stage, type of hysterectomy, and type of postoperative adjuvant therapy were not associated with lymphedema.

CONCLUSIONS:To date, this is the largest series evaluating
symptomatic lower-extremity lymphedema in women with uterine corpus
cancer. Patients who had 10 or more regional lymph nodes removed at
initial surgery appeared to be at higher risk for developing new
symptomatic leg lymphedema. Patients undergoing surgery with
lymphadenectomy for uterine corpus malignancy should be informed about the possibility of postoperative new symptomatic leg lymphedema.

A prospective evaluation of leg lymphedema is needed to accurately
determine the incidence, severity, and risk factors of this

PMID: 16740298 [PubMed - as supplied by publisher]

* * * *

Lower limb lymphedema: experiences and perceptions of cancer patients in the late palliative stage.

2006 Spring

Frid M, Strang P, Friedrichsen MJ, Johansson K.

Physiotherapy Unit, Karolinska University Hospital, Stockholm, Sweden.

Lower limb lymphedema (LLL) is a common but neglected problem in
palliative cancer patients. No studies have focused on these patients'
experiences of lymphedema. The aims of this study were to explore
patients' experiences regarding LLL and how they manage to deal with
this in the late palliative stage.

METHODS: Thirteen patients with cancer-related LLL were included to
satisfy a maximum variation sampling strategy. Interviews were analyzed
using a qualitative phenomenographic method.

RESULTS: LLL influenced the patients' thoughts about the future. Body
image was often strongly influenced. Interactions with other persons
were perceived as both positive and negative, and a range of coping
strategies were expressed.

CONCLUSION: LLL can exert a considerable influence on the physical
experiences and the psychosocial situation of cancer patients in
palliative care. Areas in need of increased education, attention, and
further research are highlighted.

PMID: 16689409 [PubMed - in process]

* * * *

Assessment of health-related quality of life in patients with
lymphedema of the lower limb

2006 Mar-Apr;14

Franks PJ, Moffatt CJ, Doherty DC, Williams AF, Jeffs E, Mortimer PS.

Centre for Research & Implementation of Clinical Practice, Faculty of
Health & Human Sciences, Thames Valley University, London, United
Kingdom. peter.fra...@tvu.ac.uk

The purpose of this study was to examine the use of a number of tools
in the evaluation of health-related quality of life in patients with
lower limb lymphedema, and to determine the consequences of cancer
history and concurrent leg ulceration. Patients in one health trust
having lower limb lymphedema were identified and interviewed at entry
and after 24 weeks. The short form-36 (SF-36), modified Barthel scale,
McGill short form pain questionnaire, and Euroqol were administered at
both time points. Of the 164 (median age=76.9 years, 70.7% women)
patients who comprised the study population, 15.2% had a history of
cancer and 30.4% had coexisting current leg ulceration. Internal
consistencies were high for all scales (Cronbach's alpha >0.80). There
were high ceiling effects for a number of SF-36 scores, and high floor
effects in these and the McGill short form pain questionnaire, scales.
Despite these limitations, there was strong evidence that treatment led
to significant improvements in six of eight scores of the SF-36, three
of three scores of the McGill short form pain questionnaire and the
modified Barthel scale (all p<0.05). The improvement in physical
functioning was significantly greater for patients who entered the
study with a leg ulcer (mean different=9.1, 95% confidence interval
2.1-16.1, p=0.011). Patients treated with compression bandaging had
significantly greater improvements for physical functioning (10.2) than
those treated with compression hosiery (-1.5) or no treatment (-2.0),
p=0.001. Of the tools assessed, the SF-36, appears to be the most
appropriate for use in this patient group.

PMID: 16630098 [PubMed - in process]

See Also:

Management of lower limb lymphoedema in the United Kingdom. (Mar 2006)
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