Lymphedema Prophylaxis in Breast Cancer Survivors Who Show Early Evidence of High-risk Status

• New development of lymphedema by bioimpedance spectroscopy [ Time Frame: 36 months ] [ Designated as safety issue: No ]
  
• To prospectively assess the presence of newly developing lymphedema in each study subgroup through serial assessment of segmental interstitial fluid content by multiple frequency bioimpedance [ Time Frame: 3 years of semi-annual follow-up ] [ Designated as safety issue: No ]
  

• new increases in limb volume [ Time Frame: 36 months ] [ Designated as safety issue: No ]
  
• To evaluate the preventive interventions in a prospective, randomized fashion, contrasting the responses of equivalent numbers of patients randomized to 2 experimental arms and the control arm of the study [ Time Frame: 3 years ] [ Designated as safety issue: No ]
  
• To correlate the bioimpedance findings with concurrently derived, serial assessments of limb volume [ Time Frame: 3 years ] [ Designated as safety issue: No ]
  

Device: Flexitouch
Standard of Care
Other Names:
• Tactile Systems Technology, Inc.
• biocompression

The current investigation is designed to prospectively evaluate the potential for simple, effective lymphedema prophylaxis in breast cancer survivors who show early evidence of high-risk status. There is growing evidence that the mechanisms of lymphatic repair after injury are mediated through lymphatic flow. Accordingly, we propose that physical measures designed to prophylactically augment lymphatic flow after surgical interventions for breast cancer will reduce the incidence and degree of lymphatic stagnation when compared to patients who receive conventional 'watch and wait' interventions.

The specific aims of the study are

1. to prospectively assess the presence of newly developing lymphedema in each study subgroup through serial assessment of segmental interstitial fluid content by multiple frequency bioimpedance
2. to evaluate the preventive interventions in a prospective, randomized fashion, contrasting the responses of equivalent numbers of patients randomized to 2 experimental arms and the control arm of the study
3. to correlate the bioimpedance findings with concurrently derived, serial assessments of limb volume

Recent advances in our comprehension of the biological processes of lymphatic development and repair suggest that these mechanisms may be able to be manipulated to enhance the regenerative responses in the lymphatic vasculature following injury. Breast cancer-associated lymphedema is a prototype of such an acquired form of lymphatic vasculature insufficiency. Clinically, this poses a substantial clinical problem. It is estimated at one woman in four who survives a breast cancer intervention will develop lymphedema, often progressively. The appearance of lymphedema has documented adverse effects on physical and psychologically well-being. Our new insights into lymphatic repair suggest that such mechanisms can be employed in a prophylactic fashion to forestall or eliminate the development of lymphedema. This proposal is designed to investigate this hypothesis in a prospective fashion, using a randomized trial design in 80 patients enrolled at the time of breast cancer surgery. If the investigation documents a beneficial effect of preventive measures, it could have a profound impact on subsequent breast cancer care. These measures are simple and cost-effective and, could help to eliminate the impact of a substantial detractor to the improved longevity and health that breast cancer survivors otherwise may expect to enjoy.