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Impact of severe obesity

With obesity rates increasing worldwide we compared lymphedema (LE) patients with and without concomitant diagnosis of severe obesity (SO), in regard to their baseline demographics, health-related characteristics, treatment plans and patient outcomes. Design: Retrospective observational cohort. Methods: The IBM MarketScan Database was examined (2013–2019) for patients with a new diagnosis of LE. Of 60,284 LE patients identified 6,588 had severe obesity defined by a BMI> 40 kg/m2. The demographics and other characteristics of SO were compared to patients with LE without SO. Results: SO and LE diagnosis increased two-fold from 2013-2019. LE SO+ patients were younger (57.8 vs 60.8 years, having more men (37.7% vs. 24.9%, than the LE SO- patients. More comorbidities were observed in LE SO+ compared to LE SO-, (diabetes 46.0% vs. 24.9 %, heart failure 18.3% vs. 7.4%, hypertension 75.0% vs. 47.6%, renal disease 24.8% vs. 11.9%. Use of diuretics in the LE SO+ group was greater 57.6% vs. 38.0%. LE SO+ patients had higher risk of cellulitis 34.5% vs. 13.5%. Specific LE treatment was given more often to LED SO- 66.3% vs. 64.3%. This was significant for manual lymphatic drainage 46.6% vs. 40.0% and physical therapy 55.4% vs. 51.6%, but not for compression garments 18.2% vs. 17.7%. However, more LE SO+ patients received pneumatic compression device treatment 20.9% vs. 13.7%. Conclusion: There was an increase in SO associated LE. LE SO+ patients have over a two and half-fold increase in cellulitis incidence, with significant increase in medical resource utilization and cost. Despite this, LE SO patients receive less specific therapy such as compression, which has proven to reduce cellulitis incidence.

Source: Clinical impact of severe obesity in lymphedema. Eur J Vas Endovasc Surg. 2022 Nov 17: S1078-5884(22)00759-6. Doi: 10.1016

Telehealth for education and monitoring

Purpose: The primary aim of this study was to compare the attendance rates at a group lymphedema education and same-day individual surveillance appointment between telehealth (TH) and in-person (IP) care for participants following breast cancer (BC) surgery. Secondary aims included evaluating participant satisfaction and costs between the two service models. Methods: Participants following axillary lymph node dissection surgery attended a group lymphedema education and same-day 1:1 monitoring session via their preferred mode (TH or IP). Attendance rates, satisfaction and costs were recorded for both cohorts, and technical disruption and clinician satisfaction for the TH cohort.

Results: Fifty-five individuals participated; all 28 participants who nominated the IP intervention attended, while 22/27 who nominated the TH intervention attended an appointment. Overall reported participant experience was positive with no significant differences between cohorts. Clinicians reported high satisfaction for delivery of education (median = 4[IQR 4-5]) and individual assessment (median = 4[IQR 3-4]) via TH. Median attendance costs per participant were Australian $39.68 (Q1-Q3 $28.52$68.64) for TH and Australian $154.26 (Q1-Q3 $81.89-$251.48) for the IP cohort. Conclusion: Telehealth-delivered lymphedema education and assessment for individuals following BC surgery was associated with favourable satisfaction, cost savings and minimal technical issues despite lower attendance than IP care. This study contributes to the growing evidence for TH and its potential applicability to other populations where risk for cancer-related lymphedema exists.

Source: Evaluating telehealth for the education and monitoring of lymphoedema and shoulder dysfunction after breast cancer surgery. Support Care Cancer. 2023 Mar 28;31(4):239. doi: 10.1007/s00520-023-07693-8.

Seasonal variations

Breast cancer-related lymphedema (BCRL) is a common complication of breast cancer treatment. Anecdotal and qualitative research suggests that heat and hot weather cause an exacerbation of BCRL; however, there is little quantitative evidence to support this. This article investigated the relationship between seasonal climate variation and limb size, volume, fluid distribution, and diagnosis in women following BC treatment.

Methods/Results: 25 women aged between 38-82 years were recruited. Participants completed anthropometric, circumferential, and bioimpedance measures and a survey on three occasions: November (spring), February (summer), and June (winter). Diagnostic criteria of >2 cm and >200 mL difference between the affected and unaffected arm, and a positive bioimpedance ratio of >1.139 for a dominant arm and >1.066 for nondominant arm was applied across the three measurement occasions found. Conclusion: There was no statistically significant variation in limb size, volume, or fluid distribution in this population across spring, summer, and winter, although there were linked trends in these values. The diagnosis of lymphedema, however, varied between individual participants throughout the year. This has important implications for the implementation/commencement of treatment and management. Further research with a larger population in different climates is required to explore the status of women with respect to BCRL. The use of common clinical diagnostic criteria did not result in consistent diagnostic classification of BCRL for the women involved in this study.

Source: Seasonal variations in upper limb size, volume, fluid distribution, and lymphedema diagnosis, following breast cancer treatment PMID:36812466 | DOI:10.1089/lrb.2022.0017 Lymphat Res Biol. 2023 Feb 22.