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

Katarina Blom

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

Bidragets översatta titel : Tidig diagnos, behandling and Hälso-Relaterad Livskvalitet hos kvinnor med mindre bröstcancer-relaterade lymfödem.

Katarina Blom

Rehabilitering och hållbar hälsa

Forskningsoutput: Avhandling › Doktorsavhandling (sammanläggning)

218 Nedladdningar (Pure)

Sammanfattning

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.

Bidragets översatta titel	Tidig diagnos, behandling and Hälso-Relaterad Livskvalitet hos kvinnor med mindre bröstcancer-relaterade lymfödem.
Originalspråk	engelska
Kvalifikation	Doktor
Tilldelande institution	Institutionen för hälsovetenskaper
Handledare	Brogårdh, Christina, handledare Johansson, Karin, Biträdande handledare Nilsson-Wikmar, Lena, Biträdande handledare, Extern person
Tilldelningsdatum	2022 dec. 5
Utgivningsort	Lund
Förlag	Lund University, Faculty of Medicine
ISBN (tryckt)	978-91-8021-320-2
Status	Published - 2022

Bibliografisk information

Defence details
Date: 2022-12-05
Time: 13:00
Place: Hörsal 01, Health Sciences Centre, Baravägen 3 i Lund. Join by Zoom: https://lu-se.zoom.us/j/66708402673
External reviewer(s)
Name: Ahlberg, Karin
Title: Professor
Affiliation: Sahlgrenska Akadmin, Göteborgs universitet

Ämnesklassifikation (UKÄ)

Sjukgymnastik

FN:s Globala mål

Denna forskningsoutput relaterar till följande Globala mål

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Avhandling Katarina Blom Slutversion utan bilagor (e-spik)Publicerad version, 4,39 MB

3 Artikel i vetenskaplig tidskrift

Tissue Dielectric Constant and Water Displacement Method can detect changes of mild Breast cancer-related arm lymphedema.
Karlsson, K., Johansson, K., Nilsson-Wikmar, L. B. & Brogårdh, C., 2022 juni, I: Lymphatic Research and Biology. 20, 3, s. 325-334
Forskningsoutput: Tidskriftsbidrag › Artikel i vetenskaplig tidskrift › Peer review
Early intervention with compression garments prevents progression in mild breast cancer-related arm lymphedema: a randomized controlled trial
Blom, K. Y., Johansson, K. I., Nilsson-Wikmar, L. B. & Brogårdh, C. B., 2022, I: Acta Oncologica. 61, 7, s. 897-905 9 s.
Forskningsoutput: Tidskriftsbidrag › Artikel i vetenskaplig tidskrift › Peer review

Öppen tillgång
Palpation of Increased Skin and Subcutaneous Thickness, Tissue Dielectric Constant, and Water Displacement Method for Diagnosis of Early Mild Arm Lymphedema
Karlsson, K., Nilsson-Wikmar, L., Brogårdh, C. & Johansson, K., 2020, I: Lymphatic Research and Biology. 18, 3, s. 219-225 7 s.
Forskningsoutput: Tidskriftsbidrag › Artikel i vetenskaplig tidskrift › Peer review

Citera det här

@phdthesis{5d33dc7610e541c9a814807c62a823d8,

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

abstract = "Background: Early diagnosis and treatment of Breast Cancer-RelatedLymphedema (BCRL) are important to prevent lymphedema progress and impacton Health-Related Quality of Life (HRQOL). The treatment includes self-care andtreatment 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 mildBCRL were included. In paper I (n=72), the proportion of mild BCRL detected withTDC and/or Water Displacement Method (WDM) in combination with skinpalpation at diagnosis were evaluated. Also, association between TDC and WDMmeasurements 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 aftersurgery and at a lower LRV compared to the WDM method, but both methodstogether 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 showprogression and could manage without compression. Adherence to self-care wascomparable 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 earlydiagnosis. 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 compressiongarment has a minor negative impact on HRQOL and needs to be considered inrelation to the preventive effect. The results have important clinical implications for diagnosing, treatment, clinical decision making and patient education in women with mild BCRL. ",

keywords = "lymphedema, breast cancer, compression garment, Diagnosis, treatment, health-related quality of life",

author = "Katarina Blom",

note = "Defence details Date: 2022-12-05 Time: 13:00 Place: H{\"o}rsal 01, Health Sciences Centre, Barav{\"a}gen 3 i Lund. Join by Zoom: https://lu-se.zoom.us/j/66708402673 External reviewer(s) Name: Ahlberg, Karin Title: Professor Affiliation: Sahlgrenska Akadmin, G{\"o}teborgs universitet",

year = "2022",

language = "English",

isbn = "978-91-8021-320-2",

series = "Lund University, Faculty of Medicine Doctoral Dissertation Series",

publisher = "Lund University, Faculty of Medicine",

number = "2022:158",

type = "Doctoral Thesis (compilation)",

school = "Department of Health Sciences",

}

TY - THES

T1 - Early diagnosis, treatment, and Health-Related Quality of Life in women with mild Breast Cancer-Related Lymphedema.

AU - Blom, Katarina

N1 - Defence details Date: 2022-12-05 Time: 13:00 Place: Hörsal 01, Health Sciences Centre, Baravägen 3 i Lund. Join by Zoom: https://lu-se.zoom.us/j/66708402673 External reviewer(s) Name: Ahlberg, Karin Title: Professor Affiliation: Sahlgrenska Akadmin, Göteborgs universitet

PY - 2022

Y1 - 2022

N2 - Background: Early diagnosis and treatment of Breast Cancer-RelatedLymphedema (BCRL) are important to prevent lymphedema progress and impacton Health-Related Quality of Life (HRQOL). The treatment includes self-care andtreatment 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 mildBCRL were included. In paper I (n=72), the proportion of mild BCRL detected withTDC and/or Water Displacement Method (WDM) in combination with skinpalpation at diagnosis were evaluated. Also, association between TDC and WDMmeasurements 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 aftersurgery and at a lower LRV compared to the WDM method, but both methodstogether 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 showprogression and could manage without compression. Adherence to self-care wascomparable 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 earlydiagnosis. 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 compressiongarment has a minor negative impact on HRQOL and needs to be considered inrelation to the preventive effect. The results have important clinical implications for diagnosing, treatment, clinical decision making and patient education in women with mild BCRL.

AB - Background: Early diagnosis and treatment of Breast Cancer-RelatedLymphedema (BCRL) are important to prevent lymphedema progress and impacton Health-Related Quality of Life (HRQOL). The treatment includes self-care andtreatment 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 mildBCRL were included. In paper I (n=72), the proportion of mild BCRL detected withTDC and/or Water Displacement Method (WDM) in combination with skinpalpation at diagnosis were evaluated. Also, association between TDC and WDMmeasurements 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 aftersurgery and at a lower LRV compared to the WDM method, but both methodstogether 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 showprogression and could manage without compression. Adherence to self-care wascomparable 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 earlydiagnosis. 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 compressiongarment has a minor negative impact on HRQOL and needs to be considered inrelation to the preventive effect. The results have important clinical implications for diagnosing, treatment, clinical decision making and patient education in women with mild BCRL.

KW - lymphedema

KW - breast cancer

KW - compression garment

KW - Diagnosis

KW - treatment

KW - health-related quality of life

M3 - Doctoral Thesis (compilation)

SN - 978-91-8021-320-2

T3 - Lund University, Faculty of Medicine Doctoral Dissertation Series

PB - Lund University, Faculty of Medicine

CY - Lund

ER -

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

Sammanfattning

Bibliografisk information

Ämnesklassifikation (UKÄ)

FN:s Globala mål

Tillgång till dokument

Fingeravtryck

Forskningsoutput

Tissue Dielectric Constant and Water Displacement Method can detect changes of mild Breast cancer-related arm lymphedema.

Early intervention with compression garments prevents progression in mild breast cancer-related arm lymphedema: a randomized controlled trial

Palpation of Increased Skin and Subcutaneous Thickness, Tissue Dielectric Constant, and Water Displacement Method for Diagnosis of Early Mild Arm Lymphedema

Citera det här