Spring Pathways 2025 (Volume 14, Issue 2) REFERENCES

Pathways Spring 2025 Volume 14 Issue 2 REFERENCES A full set of references can be found at: https://www.canadalymph.ca/pathways-references/

New best practice recommendations For the prevention and management of wounds related to lower limb lymphedema

By David Keast and Janet Kuhnke 1.​ Kuhnke JL, Burrows C, Evans R, Botros M, Hoover J, Corks I. Best Practice Recommendation Updates 2024: Methodology for developing foundations of best practice for skin and wound management 2023;21(2): 62-65. DOI: 10.56885/BEGL1924 2.​ Keast DH, Burian EA, Moffatt CJ, Nørregaard S, Karlsmark T. The dilemma of wounds in chronic oedema/lymphoedema. J Wound Care. 2021 Dec 1;30(Sup12b):7-17. DOI: 10.12968/jowc.2021.30.Sup12b.7 3.​ Carroll BJ, Singhal D. Advances in lymphedema: an under-recognized disease with a hopeful future for patients. Vasc Med. 2024 Feb;29(1):70-84. DOI: 10.1177/1358863X231215329 4.​ Torgbenu E, Luckett T, Buhagiar M, Phillips JL. Practice points for lymphoedema care in low- and middle- income countries developed by nominal group technique. BMC Health Serv Res. 2023 Jul 8;23(1):740. DOI: 10.1186/s12913-023-09786-w 5.​ Borman P. Lymphedema diagnosis, treatment, and follow-up from the view point of physical medicine and rehabilitation specialists. Turk J Phys Med Rehabil. 2018 Sep 3;64(3):179-197. DOI: 10.5606/tftrd.2018.3539 6.​ O'Donnell TF Jr, Allison GM, Iafrati MD. A systematic review of guidelines for lymphedema and the need for contemporary intersocietal guidelines for the management of lymphedema. J Vasc Surg Venous Lymphat Disord. 2020 Jul;8(4):676-684. DOI: 10.1016/j.jvsv.2020.03.006 7.​ Letellier M, Keast DH, Towers A, Damji A. The prevalence of lymphedema in Canada: an update. 2024 winter. Available from : https://issuu.com/canadianlymphedemaframework/docs/winter_pathways_2024-25_volu me_14_issue_1_refer 8.​ Keast DH. Obesity: The Canadian perspective. Lymphedema Pathways. 2020 Summer:14-15. Available from: https://issuu.com/canadianlymphedemaframework/docs/obesity._canadian_per-spective _lymphedema_related 9.​ Statistics Canada. An overview of weight and height measurements on World Obesity Day. 2024 Mar 24. Available from:

https://www.statcan.gc.ca/o1/en/plus/5742-overview-weight-and-height-measurements-w orld-obesity-day 10.​Keast D, Towers A. The rising prevalence of lymphedema in Canada: a continuing dialogue. Canadian Lymphedema Magazine. 2017(Spring):5-8. Available from: https://canadalymph.ca/wp-content/uploads/2015/04/PATHWAYS-Spring-2017-The-risin g-prevalence-of-lymphedema-in-Canada.pdf 11.​Keast DH, Kuhnke JL, Hettrick H. Lymphedema: issues and interventions. Wound Care Canada. 2019;17(2):10-22. Available from: https://www.woundscanada.ca/docman/public/wound-care-canada-magazine/2019-vol-1 7-no-2/1474-lymphedema/file

Advocating for lymphedema: Awareness, Access, and Action

By Anne-Marie Joncas BOX 1 National foundations to approach ●​ Health Canada​ Potential alignment: Funding and support for initiatives that improve healthcare delivery for chronic conditions like lymphedema. ●​ Canadian Cancer Society Potential alignment: Lymphedema related to cancer treatments, such as breast cancer surgery. ●​ Heart & Stroke Foundation Potential alignment: Shared concerns around circulatory health and swelling. ●​ The Kidney Foundation of Canada Potential alignment: Potential overlaps in chronic illness management and patient education. ●​ Canadian Diabetes Association (Diabetes Canada) + provincial divisions Potential alignment: Collaboration on wounds, swelling and circulation issues common in diabetes patients. ●​ Canadian Institute of Health Research (CIHR) Focus: Health research funding across various fields, including chronic disease and community care. ●​ Mental health foundation of Canada Potential alignment: Addressing the psychological impact of living with a chronic condition like lymphedema. ●​ Lymphatic Education & Research Network (LE&RN) - Canada Chapter Direct alignment: Advocacy, awareness, and funding for lymphedema-specific initiatives. ●​ Canadian Society for Vascular Surgery (CSVS) Alignment: Advocates multidisciplinary management of chronic vascular conditions.

●​ Fondation de l'Institut de Cardiologie de Montréal Alignment: Although focused on the heart, it also funds projects related to vascular health, including venous insufficiency. ●​ Obesity Canada Potential alignment: Lymphedema often intersects with obesity issues. ●​ Wounds Canada Potential alignment: Overlaps in treatment of chronic wounds and swelling ●​ Public Health Agency of Canada (PHAC) While not a foundation, PHAC funds public health initiatives and could support lymphedema advocacy campaigns. ●​ Canadian Foundation for Healthcare Improvement (CFHI) Potential alignment: Structuring care pathways for lymphedema patients ●​ Patients for Patient Safety Canada (PPSC) Potential alignment: Reducing risks associated with untreated lymphedema

In the trenches A provincial Advocacy Story

By Christine Chandler The British Columbia Lymphedema Association (BCLA) developed a patient survey to engage the province-wide community. We had a 30% response rate to the 600 surveys distributed through BCLA members, contacts, patients of lymphedema therapists and doctors. With the help of two pre-med student volunteers, data was condensed into a series of Infographics depicting: demographics, health region, length of time before diagnosis, costs involved and effect on quality of life.

INFOGRAPHICS - not included in the article.

See Infographics on the following pages.

Evidence based risk reduction recommendations for people at risk or with breast cancer related lymphedema The Pathways Editorial Board is pleased to promote recently published research from the LANA Summit along various themes. This is the first of a series of interviews with some of the authors who were involved, discussing the process, but more importantly, soliciting their ideas of how to translate this new knowledge into clinical practice.

RESEARCH PAPER: Current Evidence on Patient Precautions for Reducing Breast Cancer-Related Lymphedema Manifestation and Progression Risks: https://pubmed.ncbi.nlm.nih.gov/39417905/ Julie Hunley, David Doubblestein, Elizabeth Campione CONSENSUS STATEMENT: Evidence-based recommendations regarding risk reduction practices for people at risk of or with breast cancer-related lymphedema: consensus from an expert panel: https://pubmed.ncbi.nlm.nih.gov/39438352/ Cheryl L. Brunelle, Katherine Jackson, Shirin M. Shallwani, Julie H. Hunley, Anna Kennedy, Sarah French, Alexandra Hill, Electra D. Paskett, Katrina Rush, Saskia R.J. Thiadens, Joan White, and Paula Stewart A transcribed interview by Anna Kennedy with two of the authors (Julie Hunley and Cheryl Brunelle) of the corresponding papers.

Scan the QR code or visit the link: www.tinyurl.com/RiskCardBCRL to access the adapted pocket card from Massachusetts Hospital

Infection and skin trauma incrementally increase the risk of breast cancer-related lymphedema A Synopsis

By Mei Rosemary Fu A recent published study 3-5 in Annals of Surgical Oncology provided much-needed evidence regarding the daily-living risks of lymphedema and offers insights into targeted strategies to reduce the risk of lymphedema.This published article is available online (https://doi.org/10.1245/s10434-024-15946-x) or as a PDF https://link.springer.com/content/pdf/10.1245/s10434-024-15946-x.pdf. The synopsis of the study is in Spring Pathways.

REFERENCES 1.​ Shen A, Lu Q, Fu X, et al. Risk factors of unilateral breast cancer-related lymphedema: an updated systematic review and meta-analysis of 84 cohort studies. Support Care Cancer. 2022;31(1):18. Published 2022 Dec 14. doi:10.1007/s00520-022-07508-2 2.​ Cemal Y, Pusic A, Mehrara BJ. Preventative measures for lymphedema: separating fact from fiction. J Am Coll Surg. Oct 2011; 213(4):543-51.

3.​ Fu MR, Liu B, Qiu JM, et al. The Effects of Daily-Living Risks on Breast Cancer-Related Lymphedema. Ann Surg Oncol. 2024;31(12):8076-8085. doi:10.1245/s10434-024-15946-x.

4.​ Fu MR, Liu B, Qiu JM, et al. ASO Author Reflections: Infection and Skin Trauma Incrementally Increase the Risk of Breast Cancer-Related Lymphedema. Ann Surg Oncol. 2024;31(12):8110-8111. doi:10.1245/s10434-024-16078-y 5.​ Fu, M.R., Liu, B., Qiu, J.M. Sun, Y., Axelrod, D., Guth, A., Korth, S., Kremer, H.L., Wang, Y. (2024). ASO Visual Abstract: The Effects of Daily-Living Risks on Breast Cancer-Related Lymphedema. Ann Surg Oncol (2024).

Hints and Tips Exercise for your lymphedema In the past, individuals with lymphedema were advised to protect the limb with lymphedema in an effort to avoid worsening the swelling. 1 “Old school” thinking was that the increased blood flow to the limb from exercise would further compromise the lymphatic system’s ability to drain fluid. We now know that individuals with lymphedema can safely perform and benefit from properly prescribed exercise to help them self-manage their lymphedema, improve their health and quality of life. 2 References 1.​ Johansson, K., and S. Hayes. "A Historical Account of the Role of Exercise in the Prevention and Treatment of Cancer-Related Lymphedema." Lymphology 53, no. 2 (2020): 55-62.

2.​ Schmitz, K. H. "Balancing Lymphedema Risk: Exercise Versus Deconditioning for Breast Cancer Survivors."Exerc Sport Sci Rev 38, no. 1 (2010): 17-24.

3.​ Rockson, S. G., V. Keeley, S. Kilbreath, A. Szuba, and A. Towers. "Cancer-Associated Secondary Lymphoedema." Nat Rev Dis Primers 5, no.

1 (2019): 22.