Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Mar 1;34(7):691-8.
doi: 10.1200/JCO.2015.61.5948. Epub 2015 Dec 7.

Impact of Ipsilateral Blood Draws, Injections, Blood Pressure Measurements, and Air Travel on the Risk of Lymphedema for Patients Treated for Breast Cancer

Chantal M Ferguson  1 , Meyha N Swaroop  1 , Nora Horick  1 , Melissa N Skolny  1 , Cynthia L Miller  1 , Lauren S Jammallo  1 , Cheryl Brunelle  1 , Jean A O'Toole  1 , Laura Salama  1 , Michelle C Specht  1 , Alphonse G Taghian  2
Affiliations

Impact of Ipsilateral Blood Draws, Injections, Blood Pressure Measurements, and Air Travel on the Risk of Lymphedema for Patients Treated for Breast Cancer

Chantal M Ferguson et al. J Clin Oncol. .

Abstract

Purpose: The goal of this study was to investigate the association between blood draws, injections, blood pressure readings, trauma, cellulitis in the at-risk arm, and air travel and increases in arm volume in a cohort of patients treated for breast cancer and screened for lymphedema.

Patients and methods: Between 2005 and 2014, patients undergoing treatment of breast cancer at our institution were screened prospectively for lymphedema. Bilateral arm volume measurements were performed preoperatively and postoperatively using a Perometer. At each measurement, patients reported the number of blood draws, injections, blood pressure measurements, trauma to the at-risk arm(s), and number of flights taken since their last measurement. Arm volume was quantified using the relative volume change and weight-adjusted change formulas. Linear random effects models were used to assess the association between relative arm volume (as a continuous variable) and nontreatment risk factors, as well as clinical characteristics.

Results: In 3,041 measurements, there was no significant association between relative volume change or weight-adjusted change increase and undergoing one or more blood draws (P = .62), injections (P = .77), number of flights (one or two [P = .77] and three or more [P = .91] v none), or duration of flights (1 to 12 hours [P = .43] and 12 hours or more [P = .54] v none). By multivariate analysis, factors significantly associated with increases in arm volume included body mass index ≥ 25 (P = .0236), axillary lymph node dissection (P < .001), regional lymph node irradiation (P = .0364), and cellulitis (P < .001).

Conclusion: This study suggests that although cellulitis increases risk of lymphedema, ipsilateral blood draws, injections, blood pressure readings, and air travel may not be associated with arm volume increases. The results may help to educate clinicians and patients on posttreatment risk, prevention, and management of lymphedema.

PubMed Disclaimer

Conflict of interest statement

Authors’ disclosures of potential conflicts of interest are found in the article online at www.jco.org. Author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
Univariate analysis of association between risk events and arm volume increases. RVC, relative volume change; WAC, weight-adjusted volume change.
Fig 2.
Fig 2.
Multivariate analysis of risk factors associated with arm volume increases. ALND, axillary lymph node dissection; BMI, body mass index (in lb/in2); RNLR, regional lymph node irradiation; RVC, relative volume change; WAC, weight-adjusted volume change.
See this image and copyright information in PMC

Comment in

  • Reply to J. Nudelman.
    Asdourian MS, Skolny MN, Brunelle C, Seward CE, Salama L, Taghian AG. Asdourian MS, et al. J Clin Oncol. 2016 Sep 1;34(25):3111-2. doi: 10.1200/JCO.2016.68.0967. Epub 2016 Jun 13. J Clin Oncol. 2016. PMID: 27298408 No abstract available.
  • Do No Harm: Lymphedema Risk Reduction Behaviors.
    Nudelman J. Nudelman J. J Clin Oncol. 2016 Sep 1;34(25):3109-10. doi: 10.1200/JCO.2016.67.9928. Epub 2016 Jun 13. J Clin Oncol. 2016. PMID: 27298412 No abstract available.
  • Debunking Lymphedema Risk-Reduction Behaviors: Risky Conclusions.
    Nudelman J. Nudelman J. Lymphat Res Biol. 2016 Sep;14(3):124-6. doi: 10.1089/lrb.2016.0027. Lymphat Res Biol. 2016. PMID: 27631581 No abstract available.

References

    1. American Cancer Society Lymphedema: What every woman with breast cancer should know—For women at risk for lymphedema. http://www.cancer.org/acs/groups/cid/documents/webcontent/002876-pdf.pdf.
    1. Indelicato DJ, Grobmyer SR, Newlin H, et al. Delayed breast cellulitis: An evolving complication of breast conservation. Int J Radiat Oncol Biol Phys. 2006;66:1339–1346. - PubMed
    1. Loudon L, Petrek J. Lymphedema in women treated for breast cancer. Cancer Pract. 2000;8:65–71. - PubMed
    1. National Lymphedema Network Supplement to NLN position breast cancer screening: Screening and early detection of breast cancer-related lymphedema—The imperative. http://www.lymphnet.org/pdfDocs/PP_Lymphedema_BC_Supplement.pdf.
    1. National Lymphedema Network Position statement of the National Lymphedema Network: Lymphedema risk reduction practices http://www.lymphnet.org/pdfDocs/nlnriskreduction.pdf.

Publication types