Assessment of breast cancer-related arm lymphoedema

Abstract

Breast cancer-related lymphoedema (BCRL) affects the quality of life of many women. Clinical assessment enables early detection and intervention for women at risk of BCRL, and evaluation of progression and treatment response in women with established lymphoedema. The broad aim of this thesis was to improve clinical assessment and ongoing evaluation. In the first study, the reliability and measurement error of methods of clinically assessing BCRL were evaluated and the relationship among physical measurement methods and self-report explored. The standard error of measurement of each assessment method was also determined. The physical measurement tools were found to be highly reliable but not interchangeable. The second study assessed the ability of bioimpedance spectroscopy (BIS) to detect localised lymphoedema by comparing BIS and volume measures of arm segments. This provided preliminary data that BIS is able to detect localised regions of swelling; further research has now developed normative-based thresholds. The normal fluctuation of BCRL over a period of six months and response to weather conditions was explored in the third study. Established BCRL was relatively stable over six months, supporting the current clinical review practice. The effect of the weather, at least in temperate climates, was minimal. The fourth study assessed the distribution of soft tissue changes in the arms of women affected by BCRL with dual energy x-ray absorptiometry (DXA). The proximal forearm region was found to have the highest median inter-limb fat difference. Clinical tools to assess tissue compositional change; tissue dielectric constant (TDC) and spot bioimpedance, were evaluated in the fifth study. Overlap between measures of women with and without BCRL suggest these tools may be better suited for monitoring over time than for diagnosis. Comparison with imaging is necessary to provide further insight into what these devices are quantifying.