Model-Based Patterns of Lymphedema Symptomatology: Phenotypic and Biomarker Characterization
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LYMPHEDEMA INCIDENCE, PREVENTION AND TREATMENT (J ARMER, SECTION EDITOR)
Model-Based Patterns of Lymphedema Symptomatology: Phenotypic and Biomarker Characterization Mei R. Fu 1,2 & Bradley E Aouizerat 3 & Gary Yu 4 & Yvette Conley 5 & Deborah Axelrod 6,7 & Amber A. Guth 6,7 & Jean-Pierre Gagner 8 & Jeanna M Qiu 9 & David Zagzag 10 Accepted: 4 November 2020 # The Author(s) 2020
Abstract Purpose of the Study More than 50% of breast cancer survivors without a diagnosis of lymphedema suffer daily from numerous and co-occurring lymphedema symptoms. This study aimed to identify lymphedema symptom patterns and the association of such patterns with phenotypic characteristics and biomarkers using latent class analysis (LCA). A prospective, descriptive, and repeated-measure design was used to enroll 140 women and collect data. Recent Findings LCA identified three distinct lymphedema symptom classes at 8 weeks and 12 months post-surgery: low, moderate, and severe symptom classes and associated phenotypic characteristics. Participants were more likely to be in the severe symptom classes at 12 months post-surgery if they had lower education level, cording, an axillary syndrome at 8 weeks post-surgery, neoadjuvant chemotherapy, and radiation. Summary Pre-surgery level of IL1-a, IL-6, IL-8, and VEGF was associated with the severe symptom class at 8 weeks postsurgery, suggesting that such biomarkers may be used to predict risk for lymphedema symptoms. Keywords Symptom . Lymphedema . Phenotype . Biomarkers . Latent class analysis . Limb volume . Bioimpedance . Symptom distress
Highlights • Multiple lymphedema symptoms occur concurrently following breast cancer surgery. • Latent class analysis can distinguish low, moderate, and severe lymphedema symptom classes. • The severe symptom class had the highest symptom distress and highest limb volume and lymph fluid level. • The moderate symptom class may indicate an early stage of arm lymphedema. • Biomarkers may be used to predict risk for lymphedema symptoms. This article is part of the Topical Collection on Lymphedema Incidence, Prevention and Treatment * Mei R. Fu [email protected] 1
William F. Connell School of Nursing, Boston College, Chestnut Hill, MA 02467, USA
2
The Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, MA 02114, USA
3
Bluestone Center for Clinical Research, Department of Oral and Maxillofacial Surgery, College of Dentistry, New York University, New York, NY, USA
4
Rory Meyers College of Nursing, New York University, New York, NY, USA
5
School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
6
Department of Surgery, New York University School of Medicine, New York, NY, USA
7
NYU Perlmutter Cancer Center, New York, NY, USA
8
Department of Pathology, Microvascular and Molecular Neuro-Oncology Laboratory, NYU Langone Health, New York, NY, USA
9
Harvard Medical School, Boston, MA, USA
10
Division of Neuropathology and Department of Neurosurgery, NYU Langone Health, New York, NY, USA
Curr Breast Cancer Rep
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