Upper-Limb Disability and the Severity of Lymphedema Reduce the Quality of Life of Patients with Breast Cancer-Related Lymphedema.

Breast cancer-related lymphedema (BCRL) is characterized by arm swelling, pain, and discomfort, reducing the quality of life (QoL) of affected individuals. BRCL is caused via the blockage or disruption of the lymphatic vessels following cancer treatments, leading to an accumulation of fluid in the affected arm. While current BCRL rehabilitation treatments seek to reduce arm swelling, our study aimed to examine the impact of both the magnitude of lymphedema (ΔVolume) and arm disability on three dimensions of QoL: social, physical, and psychological. Using the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) and the Upper Limb Lymphedema 27 questionnaire (ULL) in a group of 30 patients, we found that the magnitude of lymphedema (ΔVolume) was associated with the social dimension of QoL (r = 0.37, p = 0.041), but not with other dimensions. On the other hand, arm disability was associated with all evaluated dimensions of QoL (social, physical, and psychological: p < 0.001, p = 0.019, and p = 0.050 (borderline), respectively). These findings suggest that BCRL rehabilitation strategies should not only aim to reduce the magnitude of lymphedema but should also seek to improve or preserve arm functionality to enhance the QoL of BCRL patients.

Terapia descongestiva como complemento a la cirugía de anastomosis linfáticovenosas y transferencia de linfonodos vascularizados: Una revisión de la literatura / Decongestive therapy as an adjunct to lymphatic-venous anastomosis surgery and vascularized lymph node transfer: A review of the literature

Resumen Introducción: El linfedema es una enfermedad inflamatoria crónica que afecta cerca de 250 millones de personas en el mundo. El tratamiento tradicional es la terapia descongestiva. Últimamente, existe la opción de complementar el tratamiento tradicional con procedimientos quirúrgicos fisiológicos como anastomosis linfáticovenosas y transferencia de linfonodos vascularizados. Sin embargo, la evidencia del uso de la terapia descongestiva en los cuidados pre y posoperatorios en estas cirugías es limitada. Objetivo: Evaluar el uso de terapia descongestiva como complemento a la cirugía de linfedema mediante anastomosis linfáticovenosas y transferencia de linfonodos vascularizados. Materiales y Método: Se realizó una revisión de la literatura en las siguientes bases de datos: Cochrane, Pubmed y Google académico, utilizando los siguientes términos mesh: "anastomosis, surgical", "lymphedema", "perioperative care", "microsurgery", "rehabilitation", "therapy", "lymph nodes", "bypass", "lymphedema and microsurgery". Se incluyó aquellos artículos que describían el uso de la terapia descongestiva en los cuidados pre- y posoperatorios. Resultados: Se identificó un total de 201 artículos y 12 fueron incluidos en el análisis. La evidencia reporta que las terapias más usadas en el cuidado pre- y posoperatorio son compresión, drenaje linfático manual y tratamientos personalizados. Sin embargo, la mayoría de los autores hace una descripción vaga de las terapias mencionadas. Discusión y Conclusión: La evidencia respecto al uso de terapia descongestiva como tratamiento complementario es débil. Los expertos recomiendan su uso, sin embargo, se necesitan futuras investigaciones que describan el uso de cada uno de sus componentes como complemento de procedimientos quirúrgicos fisiológicos para el manejo del linfedema.

Background: Lymphedema is a disease that affects about 250 million people around the world. The traditional treatment is decongestive therapy. In the past years, there is the option to complementing the traditional treatment with physiological surgical procedures such as lymphatic-venous anastomosis (LVA) and vascularized lymph node transfer (VLNT). However, the evidence for the use of decongestive therapy in pre- and post-operative care in these surgeries is limited. Aim: To evaluate the use of decongestive therapy as a complement to lymphedema surgery such a lymphatic-venous anastomosis and transfer of vascularized lymph nodes. Materials and Method: A literature review was carried out in the following databases: Cochrane, Pubmed and Academic Google, using the following mesh terms: "anastomosis, surgical", "lymphedema", "perioperative care", "microsurgery", "rehabilitation", "therapy", "lymph nodes","bypass", "lymphedema and microsurgery". "Those articles that described the use of decongestive therapy in pre- and post-operative care were included. Results: 201 articles were identified and 12 were included in the analysis. The evidence reports that the most used therapies in pre- and post-operative care are compression, manual lymphatic drainage and personalized treatments. However, most of the authors give a vague description of the mentioned therapies. Discussion and Conclusion: The evidence regarding the use of decongestive therapy as a complementary treatment is weak. Experts recommend its use; however, future research is needed to describe the use of each of its components as a complement to physiological surgical procedures for the management of lymphedema.

Effect of Supervised Resistance Training on Arm Volume, Quality of Life and Physical Perfomance Among Women at High Risk for Breast Cancer-Related Lymphedema: A Study Protocol for a Randomized Controlled Trial (STRONG-B).

Objectives: To determine the preventive effects of supervised resistance training on arms volume, quality of life, physical performance, and handgrip strength in Chilean women at high risk for breast cancer-related lymphedema (BCRL) undergoing chemotherapy. Design: Randomized control trial. Participants: One hundred and six women at high risk for breast cancer-related lymphedema aged 18 to 70 years. Interventions: Participants will be randomized into two groups: [a] intervention, who will receive 12 weeks of supervised resistance training (STRONG-B) during adjuvant chemotherapy; and [b] control, who will receive education to promote lymphatic and venous return, maintain range of motion, and promote physical activity. Main Outcome Measures: The primary outcome will be arms volume measured with an optoelectric device (perometer NT1000). Secondary outcomes will be quality of life, handgrip strength, and physical performance. Primary and secondary outcomes will be measured at baseline, just after the intervention, and 3 and 6 months after. Statistical analysis will be performed following intention-to-treat and per-protocol approaches. The treatment effect will be calculated using linear mixed models. Discussion: The STRONG-B will be a tailored supervised resistance training that attempts to prevent or mitigate BCRL in a population that, due to both intrinsic and extrinsic factors, will commonly suffer from BCRL. Clinical Trial Registration: [https://clinicaltrials.gov/ct2/show/NCT04821609], identifier NCT04821609.

Concordancia entre el Perómetro y la Medición de Perímetros en la Estimación del Volumen del Miembro Superior / Concordance between perometer and perimeter measurement for estimate upper limb volume

Introducción: El linfedema es una alteración del sistema linfático cuyo tratamiento convencional es la terapia descongestiva. Para evaluar la respuesta al tratamiento, es necesario medir el volumen el miembro superior. Objetivo: Determinar el nivel de concordancia entre el perómetro y las mediciones perimetrales en la estimación de volumen del miembro superior. Métodos: Estudio transversal. El volumen de ambos miembros superiores se estimó con tres métodos: [a] perómetro, [b] perímetro cada 4cm (método 4cm), y [c] con puntos anatómicos (método 5cm). Resultados: En comparación al perómetro, el método 4cm subestimó, en promedio, 315 mL (límites de concordancia: - 875 mL a 243 mL). El método 5cm subestimó, en promedio, 394 mL (límites de concordancia: - 975 mL a 186 mL), y la subestimación aumentó a medida que aumentaba el volumen del miembro superior. Conclusiones: El perómetro y las mediciones perimetrales tienen un bajo nivel de concordancia en la estimación del volumen del miembro superior.

Introduction: Lymphedema is an alteration of the lymphatic system and the conventional treatment is decongestive therapy. The upper limb measurement is needed to evaluate the treatment results. Objective: To determine the concordance between perometer and perimeter measurements in the upper limb volume. Methods: Cross-sectional study. The volume of both upper limbs was estimated with three methods: [a] perometer, [b] perimeter every 4cm (4cm method), and [c] with anatomical points (method 5cm). Results: Compared to the perometer, the 4cm method underestimated, on average, 315 mL (concordance limits ± 875 mL to 243 mL). The 5cm method underestimated, on average, 394 mL (concordance limits: ± 975 mL to 186 mL), and underestimation increased as the upper limb volume increased. Conclusions: The perometer and perimeter measurements have a low level of concordance in the estimation of upper limb volume.

Sistema de selección de sistemas elastocompresivos en personas con cáncer de mama de un hospital con recursos limitados / Selection system for elastocompressive systems in people with breast cancer from a hospital with limited resources

El cáncer de mama es un problema de salud pública en Chile. El linfedema es un trastorno linfovascular secundario a la extirpación de los ganglios linfáticos por cirugía en el cáncer de mama, que produce un aumento del volumen y la fibrosis en el miembro superior. Diferentes prendas de compresión son usadas para la prevención y el tratamiento del linfedema. Por eso, el programa de Garantías Ex-plícitas en Salud garantiza la entrega de sistemas elastocompresivos a las personas con diagnóstico de cáncer de mama para prevenir y tratar el linfedema. Sin embargo, en hospitales públicos los sistemas elastocompresivos pueden ser recursos limitados, por eso, muchas veces se deben priorizar. Este artículo tiene por objetivo describir un sistema de selección de sistemas elastocompresivos en personas con diagnóstico de cáncer de mama en el modelo de atención kinesiológico temprano y prospectivo.

Breast cancer is a public health problem in Chile. Lymphedema is a lymphovascular disorder secondary to the removal of lymph nodes by surgery in breast cancer, resulting in increased volume and fibrosis in the upper limb. Different compression garments are used for the prevention and treatment of lymphedema. Therefore, the "Garantías Explícitas en Salud" program guarantees the delivery of compression garments to people diagnosed with breast cancer to prevent and treat lymphedema. However, in public hospitals, the compression garments can be limited resources, so they often need to be prioritized. This article aims to describe the selection system for compression garments in people diagnosed with breast cancer in the early and prospective physical therapy care model.

Telerehabilitation for people with breast cancer through the COVID-19 pandemic in Chile.

Adapting face-to-face physical therapy consultations in cancer care to a model of telerehabilitation has been necessary, given the imminent spread of the COVID-19 pandemic. In this respect, the current model of telerehabilitation for people with breast cancer can be described as a method of continuing physical therapy treatment, in a public hospital with limited resources.

Axillary web syndrome among Chilean women with breast cancer: incidence and possible predisposing factors.

PURPOSE: Breast cancer (BC) is the most common cancer in women worldwide. The main treatment for BC is surgery, which involves an axillary procedure that associates with the development of axillary web syndrome (AWS). The incidence of AWS among Chilean women with BC and its possible predisposing factors are currently unknown. Thus, we aimed to (1) determine the incidence of AWS among Chilean women with BC after surgery and (2) identify possible predisposing factors. METHODS: Within 90 days post-surgery, patients were assessed for AWS, i.e., palpable or visible axillary cords in the axillary region extending down from the mid-axilla to the ipsilateral arm. We then computed the odds ratio with 95% confidence interval (OR [95% CI]) for having AWS considering the following predisposing factors: age, body mass index (BMI), number of lymph nodes removed, axillary procedure, days from surgery to the physical therapy assessment, hospital for the surgery, type of breast surgery, and neoadyuvant chemotherapy. RESULTS: AWS was present in 49 out of 107 patients (45.8%). Younger age and lower BMI appeared as the sole predisposing factors for AWS (age, 0.95 [0.91-0.99]; BMI, normal weight 1.00, overweight 0.35 [0.11-1.12], obesity 0.28 [0.08-0.97]). CONCLUSION: The incidence of AWS among Chilean women with BC was 45.8%. Our study also confirms data from previous reports showing that younger age and low BMI are associated with the development of AWS.

Implementación de un modelo de atención kinesiológico, temprano y prospectivo, en personas con cáncer de mama / Implementation of an early and prospective physical therapy model care in people with breast cancer

Resumen El cáncer de mama es un problema de salud pública en Chile y el mundo por su alta incidencia. La cirugía es un pilar fundamental en el tratamiento del cáncer de mama. Hasta un 60% de las personas tratadas por cáncer de mama presentan alteraciones funcionales en el miembro superior. Existen modelos sanitarios para la rehabilitación de las alteraciones funcionales, sin embargo, en Chile no es un estándar en la atención de salud. Este artículo describe: 1) las alteraciones del miembro superior secundarias a la cirugía por cáncer de mama y 2) un modelo de atención kinesiológico, temprano y prospectivo, para personas tratadas por cáncer de mama.

Breast cancer is a public health problem in Chile and the world due to high incidence. Surgery is the mainstay in the breast cancer treatment. Up to 60% of people receiving this management have functional morbidity in the upper limb. There are rehabilitation health models care for the functional morbidity, however, in Chile is not a standard in the health care. This article describes: 1) upper limb morbidity secondary to breast cancer surgery, and 2) early and prospective physical Therapy model care for people with breast cancer.

Physical activity levels and preferences of patients with breast cancer receiving chemotherapy in Chile.

PURPOSE: In Chilean patients with breast cancer (BC) receiving chemotherapy we aimed to (a) report the levels of physical activity (PA), (b) compare clinical/socio-demographic parameters among patients with different levels of PA, and (c) explore exercise preferences. METHODS: Patients (n = 112) completed a questionnaire regarding their PA habits, and another questionnaire regarding their preferences for an exercise program. Patients were then divided into three groups based on the exercise guidelines for patients with BC (150 min/week of moderate exercise, or 75 min/week of vigorous exercise). The groups were (i) not engaging in any moderate-to-vigorous PA (MVPA), (ii) engaging in some MVPA, but not meeting the guidelines, and (iii) meeting the guidelines. Clinical/socio-demographic parameters and preferences for exercise were compared between groups. RESULTS: Only 13% of patients with BC met the exercise guidelines. These patients were younger, had been diagnosed more recently, and had fewer children than patients not engaging in MVPA. There were no differences in the preferences for exercise between groups. Overall, patients preferred to exercise with other patients (76%), at moderate intensity (67%), performing different activities (94%), supervised (94%), with a fixed schedule (69%), and to do group activities (90%). CONCLUSION: Most patients with BC receiving chemotherapy did not meet the exercise guidelines. Patients > 50 years old and with > 2 children were the most inactive. Efforts to increase PA levels should focus especially on these patients. The preferences for exercise reported here will help to increase adherence to exercise programs and improve outcomes for these patients in Chile.

Efectos del ejercicio físico en pacientes oncológicos sometidos a transplante de precursores hematopoyéticos / Effects of the physical exercise in oncologic patients submitted to hematopoietic precursors transplant

En Chile, el cáncer constituye la segunda causa de muerte para la población pediátrica y adulta. La tasa de sobrevida a 5 años alcanza un 60 por ciento y 75 por ciento par adultos y niños, respectivamente. La terapia antineoplásica conlleva una serie de efectos secundarios que van a alterar el desarrollo normal del paciente. Específicamente, el Trasplante de Presursores Hematopoyéticos (TPH), caracterizado por su agresividad, va a producir un notable deterioro tanto de la condición física como psicológica del paciente. Hoy en día, la actividad física ha sido propuesta como una intervención terapéutica en pacientes con cáncer afectados por la alteraciones secundarias a los tratamientos antineoplásicos. Se ha demostrado que un entrenamiento aeróbico de moderada intensidad provoca resultados fisiológicos positivos en pacientes oncológicos generales. Esta revisión de la literatura se basa en los efectos del entrenamiento aeróbico en pacientes con cáncer sometidos a TPH.

In Chile. Cancers is the second cause leading to death in pediatric and adult population. The 5 year-survival rate reaches 60 percent and 75 percent for adults and children, respectively. The current cancer treatments are not exempt of side effects that after the normal development in the patient. Specifically, Stem Cell Transplantation (SCT), characterized by its aggressiveness will produce a notable deterioration in the physical and psychological patient's condition. Today, the physical activity has been considered a therapeutic intervention in cancer patients affected by side effects of the oncology treatments. It has been demonstrated that an aerobic training of moderate intensity causes positive physiologic results in general cancer patients. This literature review is based on the aerobic training effects in cancer patients submitted to SCT.