Standardization of lower extremity quantitative lymphedema measurements and associated patient-reported outcomes in gynecologic cancers

doi:10.1016/j.ygyno.2020.10.026

Review

. 2021 Feb;160(2):625-632.

doi: 10.1016/j.ygyno.2020.10.026. Epub 2020 Nov 4.

Standardization of lower extremity quantitative lymphedema measurements and associated patient-reported outcomes in gynecologic cancers

Sandra Russo¹, Joan L Walker², Jay W Carlson³, Jeanne Carter⁴, Leigh C Ward⁵, Allan Covens⁶, Edward J Tanner 3rd⁷, Jane M Armer⁸, Sheila Ridner⁹, Sandi Hayes¹⁰, Alphonse G Taghian¹¹, Cheryl Brunelle¹², Micael Lopez-Acevedo¹³, Brittany A Davidson¹⁴, Mark V Schaverien¹⁵, Sharad A Ghamande¹⁶, Michael Bernas¹⁷, Andrea L Cheville¹⁸, Kathleen J Yost¹⁹, Kathryn Schmitz²⁰, Barbara Coyle²¹, Jeannette Zucker²², Danielle Enserro²³, Stephanie Pugh²⁴, Electra D Paskett²⁵, Leslie Ford²⁶, Worta McCaskill-Stevens²⁷

Affiliations

¹ National Cancer Institute, Division of Cancer Prevention, 9609 Medical Center Drive, Rockville, MD 20892-9785, USA. Electronic address: sandra.russo@nih.gov.
² Stephen Cancer Center, OUHSC, Oklahoma City, OK 73104, USA. Electronic address: joan-walker@ouhsc.edu.
³ Cancer Research for Ozarks, 1235 E. Cherokee, Springfield, MO 65804, USA. Electronic address: jay.carlson@mercy.net.
⁴ Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY, 10022, USA. Electronic address: carterj@mskcc.org.
⁵ University of Queensland, St Lucia, Brisbane, QLD 4072, Australia. Electronic address: l.ward@uq.edu.au.
⁶ University of Toronto and Sunnybrook Health Science Centre, Toronto, ON M4N 3M5, Canada. Electronic address: al.covens@sunnybrook.ca.
⁷ Northwestern Medicine, Feinberg School of Medicine, Prentice Women's Hospital, 250 E Superior, Chicago, IL 60611, USA. Electronic address: edward.tanner@nm.org.
⁸ Sinclair School of Nursing, University of Missouri Health, DC 116.05, Ellis Fischel Cancer Center, 115 Business Loop 70 West, Columbia, MO 65203, USA. Electronic address: armer@missouri.edu.
⁹ Vanderbilt University School of Nursing, 461 21st Ave South, Nashville, TN 37240, USA. Electronic address: sheila.ridner@vanderbilt.edu.
¹⁰ Queensland University of Technology, School of Public Health and Biomedical Innovation, Queensland, Australia. Electronic address: sc.hayes@qut.edu.au.
¹¹ Harvard Medical School/Massachusetts General Hospital, Radiation Oncology, Boston, MA 02114, USA. Electronic address: ataghian@mgh.harvard.edu.
¹² Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: cbrunelle@mgh.harvard.edu.
¹³ The George Washington University Hospital, School of Medicine and Health Sciences, 2150 Pennsylvania Ave, NW, Washington, DC 20037, USA. Electronic address: mlopezacevedo@mfa.gwu.edu.
¹⁴ Duke University School of Medicine, Duke Cancer Center, 20 Duke Medical Center, Durham, NC 27710, USA. Electronic address: brittany.davidson@duke.edu.
¹⁵ The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA. Electronic address: mvschaverien@mdanderson.org.
¹⁶ Augusta University, Augusta Oncology, 3696 Wheeler Road, Augusta, GA 30909, USA. Electronic address: sghamande@augusta.edu.
¹⁷ TCU and UNTHSC School of Medicine, Forth Worth, TX 76207, USA. Electronic address: mbernas@tcu.edu.
¹⁸ Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. Electronic address: cheville.andrea@mayo.edu.
¹⁹ Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. Electronic address: yost.kathleen@mayo.edu.
²⁰ Penn State Cancer Institute, 400 University Drive, Hershey, PA 17033, USA. Electronic address: kzs95@psu.edu.
²¹ Patient Advocate, Lymphedema Advocacy Group, Minneapolis, MN, USA.
²² National Lymphedema Network, 411 Lafayette Street, 6th Floor, New York, NY 10003, USA. Electronic address: jeannette.zucker@lymphnet.org.
²³ NRG Oncology Statistics and Data Management Center, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA. Electronic address: enserrod@nrgoncology.org.
²⁴ NRG Oncology Statistics and Data Management Center, 1600 JFK Blvd, Suite 1020, Philadelphia, PA 1903, USA. Electronic address: pughs@nrgoncology.org.
²⁵ The Ohio State University, 1590 N High Street, Suite 525, Columbus, OH 43210, USA. Electronic address: electra.paskett@osumc.edu.
²⁶ National Cancer Institute, Division of Cancer Prevention, 9609 Medical Center Drive, Rockville, MD 20892-9785, USA. Electronic address: fordl@mail.nih.gov.
²⁷ National Cancer Institute, Division of Cancer Prevention, 9609 Medical Center Drive, Rockville, MD 20892-9785, USA. Electronic address: wm57h@nih.gov.

PMID: 33158510
PMCID: PMC7946397
DOI: 10.1016/j.ygyno.2020.10.026

Review

Standardization of lower extremity quantitative lymphedema measurements and associated patient-reported outcomes in gynecologic cancers

Sandra Russo et al. Gynecol Oncol. 2021 Feb.

. 2021 Feb;160(2):625-632.

doi: 10.1016/j.ygyno.2020.10.026. Epub 2020 Nov 4.

Authors

Affiliations

¹ National Cancer Institute, Division of Cancer Prevention, 9609 Medical Center Drive, Rockville, MD 20892-9785, USA. Electronic address: sandra.russo@nih.gov.
² Stephen Cancer Center, OUHSC, Oklahoma City, OK 73104, USA. Electronic address: joan-walker@ouhsc.edu.
³ Cancer Research for Ozarks, 1235 E. Cherokee, Springfield, MO 65804, USA. Electronic address: jay.carlson@mercy.net.
⁴ Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY, 10022, USA. Electronic address: carterj@mskcc.org.
⁵ University of Queensland, St Lucia, Brisbane, QLD 4072, Australia. Electronic address: l.ward@uq.edu.au.
⁶ University of Toronto and Sunnybrook Health Science Centre, Toronto, ON M4N 3M5, Canada. Electronic address: al.covens@sunnybrook.ca.
⁷ Northwestern Medicine, Feinberg School of Medicine, Prentice Women's Hospital, 250 E Superior, Chicago, IL 60611, USA. Electronic address: edward.tanner@nm.org.
⁸ Sinclair School of Nursing, University of Missouri Health, DC 116.05, Ellis Fischel Cancer Center, 115 Business Loop 70 West, Columbia, MO 65203, USA. Electronic address: armer@missouri.edu.
⁹ Vanderbilt University School of Nursing, 461 21st Ave South, Nashville, TN 37240, USA. Electronic address: sheila.ridner@vanderbilt.edu.
¹⁰ Queensland University of Technology, School of Public Health and Biomedical Innovation, Queensland, Australia. Electronic address: sc.hayes@qut.edu.au.
¹¹ Harvard Medical School/Massachusetts General Hospital, Radiation Oncology, Boston, MA 02114, USA. Electronic address: ataghian@mgh.harvard.edu.
¹² Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: cbrunelle@mgh.harvard.edu.
¹³ The George Washington University Hospital, School of Medicine and Health Sciences, 2150 Pennsylvania Ave, NW, Washington, DC 20037, USA. Electronic address: mlopezacevedo@mfa.gwu.edu.
¹⁴ Duke University School of Medicine, Duke Cancer Center, 20 Duke Medical Center, Durham, NC 27710, USA. Electronic address: brittany.davidson@duke.edu.
¹⁵ The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA. Electronic address: mvschaverien@mdanderson.org.
¹⁶ Augusta University, Augusta Oncology, 3696 Wheeler Road, Augusta, GA 30909, USA. Electronic address: sghamande@augusta.edu.
¹⁷ TCU and UNTHSC School of Medicine, Forth Worth, TX 76207, USA. Electronic address: mbernas@tcu.edu.
¹⁸ Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. Electronic address: cheville.andrea@mayo.edu.
¹⁹ Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. Electronic address: yost.kathleen@mayo.edu.
²⁰ Penn State Cancer Institute, 400 University Drive, Hershey, PA 17033, USA. Electronic address: kzs95@psu.edu.
²¹ Patient Advocate, Lymphedema Advocacy Group, Minneapolis, MN, USA.
²² National Lymphedema Network, 411 Lafayette Street, 6th Floor, New York, NY 10003, USA. Electronic address: jeannette.zucker@lymphnet.org.
²³ NRG Oncology Statistics and Data Management Center, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA. Electronic address: enserrod@nrgoncology.org.
²⁴ NRG Oncology Statistics and Data Management Center, 1600 JFK Blvd, Suite 1020, Philadelphia, PA 1903, USA. Electronic address: pughs@nrgoncology.org.
²⁵ The Ohio State University, 1590 N High Street, Suite 525, Columbus, OH 43210, USA. Electronic address: electra.paskett@osumc.edu.
²⁶ National Cancer Institute, Division of Cancer Prevention, 9609 Medical Center Drive, Rockville, MD 20892-9785, USA. Electronic address: fordl@mail.nih.gov.
²⁷ National Cancer Institute, Division of Cancer Prevention, 9609 Medical Center Drive, Rockville, MD 20892-9785, USA. Electronic address: wm57h@nih.gov.

PMID: 33158510
PMCID: PMC7946397
DOI: 10.1016/j.ygyno.2020.10.026

Abstract

Practice changing standardization of lower extremity lymphedema quantitative measurements with integrated patient reported outcomes will likely refine and redefine the optimal risk-reduction strategies to diminish the devastating limb-related dysfunction and morbidity associated with treatment of gynecologic cancers. The National Cancer Institute (NCI), Division of Cancer Prevention brought together a diverse group of cancer treatment, therapy and patient reported outcomes experts to discuss the current state-of-the-science in lymphedema evaluation with the potential goal of incorporating new strategies for optimal evaluation of lymphedema in future developing gynecologic clinical trials.

Keywords: Gynecologic cancers; Lymphedema; Oncologic surgical treatment; Patient reported outcomes; Quantitative measurements.

Published by Elsevier Inc.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest Dr. Walker, Dr. Carlson, Dr. Carter, Dr. Covens, Dr. Tanner, Dr. Amer, Dr. Hayes, Dr. Lopez-Acevedo, Dr. Davidson, Dr. Schaverien, Dr. Ghamande, Dr. Cheville, Dr. Yost, Dr. Schmitz, Dr.Ford and Michael Bernas report no conflicts of interest. Dr. Russo and Dr. McCaskill-Steven report grants from government to support this workshop. Dr. Ward reports personal fees from Impedimed Inc., outside the submitted work. Dr. Ridner reports grants from Impedimed, during the conduct of the study. Dr. Taghian reports consultancy with PureTech Health, previous consultancy with VisionRT, grants from Adele McKinnon Research Fund for Breast Cancer-Related Lymphedema, grants from The Heinz Family Foundation, grants from The Olayan-Xefos Family Fund for Breast Cancer Research, grants from National Cancer Institute Award Number P50CA08393, grants from National Cancer Institute Award Number R01CA139118, non-financial support from Impedimed outside the submitted work. Cheryl. Brunelle is on the Scientific Advisory Board for PureTech Health outside the submitted work. Dr. Davidson reports speaking honorarium from Tesaro outside the submitted work. Dr. Ghamande reports consultancy/speaker with GSK/Tesaro outside the submitted work. Dr. Enserro reports grants from NRG Oncology NCORP, grants from NRG Oncology SDMC during the conduct of the study, outside the submitted work. Dr. Pugh reports other from Pfizer, other from Millennium outside the submitted work. Dr. Paskett reports grants from Merck Foundation, grants from Pfizer, other from Pfizer, grants from Komen Columbus Foundation, grants from Ohio Department of Health, grants from Breast Cancer Research Foundtaion, grants from NIH, other from FoxConn, grants from Social Impact Fund, grants from Komen Foundation, grants from PICORI outside the submitted work.

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References

1. O’Toole J, Jammallo LS, Miller CL, Skolny MN, Specht MC, Taghian AG. Screening for breast cancer-related lymphedema: the need for standardization. The Oncologist, 2013; 18(4): 350–352. 10.1634/theoncologist.2012-0387 - DOI - PMC - PubMed
1. Bankhead C Lower leg lymphedema common after gyn surgery. MedPage Today. 2018. https://www.medpagetoday.org/meetingcoverage/sgo/72069
1. Carlson JW, Kauderer J, Hutson A, Carter J, Armer J, Lockwood S, Nolte S, Stewar BR, Wenzel L, Walker J, Fleury A, Bonebrake A, Soper J, Mathews C, Zivanovic O, Richards WE, Tan A, Albert DS, Barakat RR. GOG 244 - The lymphedema and gynecologic cancer (LEG) study: Incidence and risk factors in newly diagnosed patients. Gynecol Oncol. 2020; 256(2): 467–474. 10.1016/j.ygyno.2019.10.009 - DOI - PMC - PubMed
1. Watson CH, Lopez-Acevedo M, Broadwater G., Kim AH, Ehrisman J, Davidson BA, Lee PS, Valea F, Berchuck A, Havrilesky LJ. A pilot study of lower extremity lymphedema, lower extremity function, and quality of life in women after minimally invasive endometrial cancer staging surgery. Gynecol Oncol. 2019;153(2):399–404. https://doi:0.1016/j.ygyno.2019.02.021 - PubMed
1. Ward L, Winall A, Isenring E, Hills A, Czerniec S, Dylke E, Kilbreath S. Assessment of bilateral limb lymphedema by bioelectrical impedance spectroscopy. International Journal of Gynecological Cancer, 2011; 21(2): 409–418. 10.1097/IGC.0b013e31820866e1 - DOI - PubMed

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[1] O’Toole J, Jammallo LS, Miller CL, Skolny MN, Specht MC, Taghian AG. Screening for breast cancer-related lymphedema: the need for standardization. The Oncologist, 2013; 18(4): 350–352. 10.1634/theoncologist.2012-0387 - DOI - PMC - PubMed

[2] O’Toole J, Jammallo LS, Miller CL, Skolny MN, Specht MC, Taghian AG. Screening for breast cancer-related lymphedema: the need for standardization. The Oncologist, 2013; 18(4): 350–352. 10.1634/theoncologist.2012-0387 - DOI - PMC - PubMed

[3] Bankhead C Lower leg lymphedema common after gyn surgery. MedPage Today. 2018. https://www.medpagetoday.org/meetingcoverage/sgo/72069

[4] Bankhead C Lower leg lymphedema common after gyn surgery. MedPage Today. 2018. https://www.medpagetoday.org/meetingcoverage/sgo/72069

[5] Carlson JW, Kauderer J, Hutson A, Carter J, Armer J, Lockwood S, Nolte S, Stewar BR, Wenzel L, Walker J, Fleury A, Bonebrake A, Soper J, Mathews C, Zivanovic O, Richards WE, Tan A, Albert DS, Barakat RR. GOG 244 - The lymphedema and gynecologic cancer (LEG) study: Incidence and risk factors in newly diagnosed patients. Gynecol Oncol. 2020; 256(2): 467–474. 10.1016/j.ygyno.2019.10.009 - DOI - PMC - PubMed

[6] Carlson JW, Kauderer J, Hutson A, Carter J, Armer J, Lockwood S, Nolte S, Stewar BR, Wenzel L, Walker J, Fleury A, Bonebrake A, Soper J, Mathews C, Zivanovic O, Richards WE, Tan A, Albert DS, Barakat RR. GOG 244 - The lymphedema and gynecologic cancer (LEG) study: Incidence and risk factors in newly diagnosed patients. Gynecol Oncol. 2020; 256(2): 467–474. 10.1016/j.ygyno.2019.10.009 - DOI - PMC - PubMed

[7] Watson CH, Lopez-Acevedo M, Broadwater G., Kim AH, Ehrisman J, Davidson BA, Lee PS, Valea F, Berchuck A, Havrilesky LJ. A pilot study of lower extremity lymphedema, lower extremity function, and quality of life in women after minimally invasive endometrial cancer staging surgery. Gynecol Oncol. 2019;153(2):399–404. https://doi:0.1016/j.ygyno.2019.02.021 - PubMed

[8] Watson CH, Lopez-Acevedo M, Broadwater G., Kim AH, Ehrisman J, Davidson BA, Lee PS, Valea F, Berchuck A, Havrilesky LJ. A pilot study of lower extremity lymphedema, lower extremity function, and quality of life in women after minimally invasive endometrial cancer staging surgery. Gynecol Oncol. 2019;153(2):399–404. https://doi:0.1016/j.ygyno.2019.02.021 - PubMed

[9] Ward L, Winall A, Isenring E, Hills A, Czerniec S, Dylke E, Kilbreath S. Assessment of bilateral limb lymphedema by bioelectrical impedance spectroscopy. International Journal of Gynecological Cancer, 2011; 21(2): 409–418. 10.1097/IGC.0b013e31820866e1 - DOI - PubMed

[10] Ward L, Winall A, Isenring E, Hills A, Czerniec S, Dylke E, Kilbreath S. Assessment of bilateral limb lymphedema by bioelectrical impedance spectroscopy. International Journal of Gynecological Cancer, 2011; 21(2): 409–418. 10.1097/IGC.0b013e31820866e1 - DOI - PubMed

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Standardization of lower extremity quantitative lymphedema measurements and associated patient-reported outcomes in gynecologic cancers

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Standardization of lower extremity quantitative lymphedema measurements and associated patient-reported outcomes in gynecologic cancers

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