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. 2024 Feb 2:68:102441.
doi: 10.1016/j.eclinm.2024.102441. eCollection 2024 Feb.

Multinational Association of Supportive Care in Cancer (MASCC) clinical practice guidance for the prevention of breast cancer-related arm lymphoedema (BCRAL): international Delphi consensus-based recommendations

Henry C Y Wong  1 , Matthew P Wallen  2 , Adrian Wai Chan  3 , Narayanee Dick  2 , Pierluigi Bonomo  4 , Monique Bareham  5   6 , Julie Ryan Wolf  7 , Corina van den Hurk  8 , Margaret Fitch  9 , Edward Chow  10 , Raymond J Chan  2 ; MASCC BCRAL Expert Panel and the Oncodermatology and Survivorship Study Groups
Collaborators, Affiliations

Multinational Association of Supportive Care in Cancer (MASCC) clinical practice guidance for the prevention of breast cancer-related arm lymphoedema (BCRAL): international Delphi consensus-based recommendations

Henry C Y Wong et al. EClinicalMedicine. .

Abstract

Background: Developing strategies to prevent breast cancer-related arm lymphoedema (BCRAL) is a critical unmet need because there are no effective interventions to eradicate it once it reaches a chronic state. Certain strategies such as prospective surveillance programs and prophylactic lymphatic reconstruction have been reported to be effective in clinical trials. However, a large variation exists in practice based on clinician preference, organizational standards, and local resources.

Methods: A two-round international Delphi consensus process was performed from February 27, 2023 to May 25, 2023 to compile opinions of 55 experts involved in the care and research of breast cancer and lymphoedema on such interventions.

Findings: Axillary lymph node dissection, use of post-operative radiotherapy, relative within-arm volume increase one month after surgery, greater number of lymph nodes dissected, and high body mass index were recommended as the most important risk factors to guide selection of patients for interventions to prevent BCRAL. The panel recommended that prospective surveillance programs should be implemented to screen for and reduce risks of BCRAL where feasible and resources allow. Prophylactic compression sleeves, axillary reverse mapping and prophylactic lymphatic reconstruction should be offered for patients who are at risk for developing BCRAL as options where expertise is available and resources allow. Recommendations on axillary management in clinical T1-2, node negative breast cancer patients with 1-2 positive sentinel lymph nodes were also provided by the expert panel. Routine axillary lymph node dissection should not be offered in these patients who receive breast conservation therapy. Axillary radiation instead of axillary lymph node dissection should be considered in the same group of patients undergoing mastectomy.

Interpretation: An individualised approach based on patients' preferences, risk factors for BCRAL, availability of treatment options and expertise of the healthcare team is paramount to ensure patients at risk receive preventive interventions for BCRAL, regardless of where they are receiving care.

Funding: This study was not supported by any funding. RJC received investigator grant support from the Australian National Health and Medical Research Council (APP1194051).

Keywords: Breast cancer related arm lymphoedema; Delphi consensus; Prevention.

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Conflict of interest statement

Elizabeth Dylke received support to attend Australasian Lymphology Association Symposium 2022 and 2023, and is the President and Director of Australasian Lymphology Association and Secretary of the Council of the Deans of Physiotherapy Australia and New Zealand; Yuichiro Kikawa received payment or honoraria for lectures, presentations, speaker bureaus, manuscript writing or education events from Eisai, Lilly, Chugai, Pfizer, Daiichi Sankyo and Novartis; Michael Lock received consulting fees from Bayer and Tersera, payment or honoraria for lectures, presentations, speaker bureaus, manuscript writing or education events from Knight Therapeutics, Abbvie and Eisai, and have stock options from Myovant; Icro Meattini received honoraria for lectures from Eli Lily, AstraZeneca, SeaGen, Gilead, Daiichi, Sankyo, Pfizer and Novartis; Tammy Mondry received consulting fees from Teladoc Health, and payment for honoraria from Klose Training; Abram Recht received grants or contracts from the Joint Centre for Radiation Therapy Foundation paid to his institution, received consulting fees from eviCore healthcare and EXACT Sciences Corporation, and has stock ownership of Imagine Scientific, Inc.; Jolien Robijns received grants or contracts from Kom op Tegen Kanker and Limburgs Kankerfonds paid to Hasselt University. All other authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Modified Delphi consensus process. Abbreviations: n = number of participants.
See this image and copyright information in PMC

References

    1. DiSipio T., Rye S., Newman B., Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol. 2013;14(6):500–515. - PubMed
    1. McDuff S.G.R., Mina A.I., Brunelle C.L., et al. Timing of lymphedema after treatment for breast cancer: when are patients most at risk? Int J Radiat Oncol. 2019;103(1):62–70. - PMC - PubMed
    1. Cemal Y., Pusic A., Mehrara B.J. Preventative measures for lymphedema: separating fact from fiction. J Am Coll Surg. 2011;213(4):543–551. - PMC - PubMed
    1. Togawa K., Ma H., Smith A.W., et al. Self-reported symptoms of arm lymphedema and health-related quality of life among female breast cancer survivors. Sci Rep. 2021;11(1) - PMC - PubMed
    1. Fu M.R., Ridner S.H., Hu S.H., Stewart B.R., Cormier J.N., Armer J.M. Psychosocial impact of lymphedema: a systematic review of literature from 2004 to 2011: psychosocial impact of lymphedema. Psycho Oncol. 2013;22(7):1466–1484. - PMC - PubMed

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