Cancer-related lymphedema (CRL) lacks internationally accepted definition and diagnostic criteria. The accurate incidence of CRL is therefore a challenge and the condition is likely underreported. Patients treated for cancer can develop CRL as a result of surgery, chemotherapy, and/or radiotherapy, which can lead to considerable psychosocial and physical morbidity, and decreased quality of life. Determining CRL incidence is crucial to inform care access and resource allocation, to best support patients affected by this lifelong condition. This review aimed to provide the latest CRL incidence estimates. Using four core databases (MEDLINE, Embase, Web of Science Core Collection, Cochrane Library), a literature search was performed to capture publications dated between 2015 and 2023. A total of 48 articles (33 prospective studies, 15 systematic reviews) met inclusion criteria, providing a sample size of 234,079 cancer patients. Findings revealed CRL incidence across cancer types varied, reported 2–74

Non-cancer-related risk factors for secondary lymphedema were defined across four categories: co-morbidity, social determinants of health, behavioral factors, and environmental effectors. Based on rapid reviews of the literature and presentations at the ACS/LANA Lymphedema Summit, this working group categorized these risk factors according to the strength of evidence. Consensus agreement on level of evidence was achieved through one face-to-face working session and three follow-up virtual meetings. Findings elucidate strong evidence for co-morbidities, such as cardio/metabolic and vascular factors contributing to the risk for lymphedema. Evidence is low-to-moderate for social and behavioral factors and is lacking for environmental factors. Panel recommendations suggest a tailored approach to prospective surveillance when monitoring for secondary lymphedema that includes social determinants of health considering the growing awareness and evidence of these factors’ influence on cancer and cancer-related morbidity.

Lymphedema is an inflammatory condition caused by the accumulation of lymphatic fluid due to damage to the lymphatic system. There are 2 classifications of lymphedema: primary, which is caused by malformation of lymph vessels or nodes, and secondary, which is due to trauma, chronic lymphatic system

Le lymphœdème est un état inflammatoire causé par l’accumulation de liquide lymphatique à la suite de dommages au système lymphatique. Le lymphœdème se classe en 2 catégories : primaire, lorsqu’il est causé par une malformation des vaisseaux ou des ganglions lymphatiques, et secondaire

Objective: To create an evidence-based patient education resource to better support cancer patients with bone metastases in carrying out safe movements during activities of daily living, to maintain their bone health and reduce the risk of fractures. Methods: A quality improvement project was conducted in three phases: Development of the Resource, Preliminary Feedback and Revision, and French Canadian Translation. Results: The educational resource Living Safely with Bone Metastases focuses on safe movement, activities of daily living, and exercise, organized within the sections Move with care, Stay safe in different environments and Follow an exercise program prescribed by a physiotherapist. Translation yielded a Canadian French version Vivre en toute sécurité avec des métastases osseuses. Conclusion: Living Safely with Bone Metastases is an accessible online and paper resource for patients and healthcare professionals, in order to promote ongoing disease management of individuals with bone metastases. Innovation: Cancer patients with bone metastases are at high risk of pathological fractures however resources on fracture prevention are lacking. Living Safely with Bone Metastases is an innovative health education resource that fills an important gap in oncology practice and has the potential to reduce the occurrence of fractures.

Breast cancer treatment can affect estrogen levels leading to significant bone loss, osteoporosis, and risks for fracture. Although bone care guidelines are published, bone health interventions are often not routinely offered to at-risk individuals. This paper reports on the process of developing and implementing a nurse-led bilingual Breast and Bone Health Program (BBHP) in-person and online at a cancer centre in Montreal, Quebec (www.breastandbonehealth.ca, www.santeseinsetos.ca). The BBHP offers tailored bone health interventions (e.g., risk screening, information, rehabilitation, exercise prescriptions, nutritional counselling, and support for a health-promoting lifestyle). Over a two-year period, women treated for breast cancer (N = 430) took part in the program. Forty percent of surveyed participants (n = 97) initally reported being unaware that some breast cancer treatment could significantly affect bone health. Following the initial informational session with the BBHP nurse, self-reported bone health knowledge significantly increased, with 96% reporting sufficient information to manage their bone health. The BBHP offers both online and in-person risk assessment and bone health promotion activities and tools to both health care professionals and women with breast cancer. Herein, we review the background, BBHP development and implementation as well as preliminary program evaluation.

Le traitement du cancer du sein modifie les taux d’œstrogène et entraîne une importante perte osseuse, de l’ostéoporose et des risques de fracture. Bien qu’il existe des lignes directrices sur les soins des os soient, les personnes à risque ne bénéficient pas systématiquement des interventions en ce sens. Le présent article fait état du processus de conception et de mise en œuvre d’un Programme Santé seins et os (PSSO) bilingue et dirigé par des infirmières, offert en personne et en ligne dans un centre de cancérologie de Montréal, dans la province de Québec (https://santeseinsetos.ca/). Le PSSO propose des interventions personnalisées pour préserver la santé des os : évaluation des risques, information sur la réadaptation, prescription d’exercices, conseils nutritionnels et accompagnement pour l’adoption d’un mode de vie sain. Pendant 2 ans, des femmes traitées pour un cancer du sein (N = 430) ont pris part au programme. De ce nombre, 40 % (n = 97) ont dit au départ ignorer que certains traitements anticancéreux pouvaient fragiliser considérablement les os. À la suite de la première séance d’information avec l’infirmière responsable du PSSO, leurs connaissances autoévaluées à ce sujet se sont grandement améliorées, et 96 % ont dit en savoir suffisamment pour gérer leur santé osseuse. Le PSSO a été créé à l’intention des professionnels de la santé et des femmes atteintes de cancer du sein. Il offre une évaluation du risque en ligne et en personne ainsi que des activités et des outils visant à promouvoir la bonne santé des os. Le présent article décrit le contexte ayant mené à l’élaboration et à la mise en œuvre du PSSO, de même que l’évaluation préliminaire du programme.

BACKGROUND:The diagnosis of breast cancer in young women (aged 18-45 years) has been increasing. Women are commonly left coping with treatment-related disabilities of the upper limb that can persist for > 2 years postoperatively.PATIENTS AND METHODS:A total of 59 young breast cancer patients (29 in the intervention group and 30 in the control group) participated in a pilot prospective randomized controlled trial to determine whether a 12-week postradiation exercise program would improve long-term arm mobility, pain, and handgrip strength. During an 18-month period, range of motion, handgrip strength, and pain with shoulder movements were evaluated at 6 points.RESULTS:Although the differences were not statistically significant, external rotation and horizontal abduction of the shoulder improved in the intervention group immediately after the exercise intervention (3 months) and showed a trend toward less pain on movement. However, at 18 months after radiation the control and intervention groups both retained a residual loss of range and persistent pain with movement. Radiation to the axilla and/or chest wall yielded long-term (18 months) limitations in flexion and horizontal abduction compared with hypofractionation, which resulted in greater flexion and external rotation at 18 months. The median grip strength of the study participants corresponded to the 10th percentile of healthy aged-matched white women.CONCLUSION:The exercise intervention timed shortly after radiation improved short-term shoulder mobility and pain; however, these gains were not sustained at 18 months after radiation.

Purpose: Most of the breast cancer diagnoses are recommended for breast surgery. Unfortunately, many patients report preoperative anxiety, which can affect postoperative recovery. Preoperative teaching sessions have been shown to reduce anxiety and improve recovery for the patients with breast cancer. To better support the patients at our cancer center, a multidisciplinary preoperative teaching session was developed and delivered as a quality improvement initiative. Methods: Participants scheduled for breast surgery were invited to attend a group-delivered preoperative teaching session, either for breast-conserving surgery or mastectomy. The sessions were presented by a nurse, occupational therapist, and physiotherapist. Data were collected through a researcher-developed 2-item questionnaire administered before and after sessions to compare self-reported anxiety and knowledge levels, along with qualitative feedback. Results: A total of 94 participants attended the preoperative sessions, piloted over a year. The majority were scheduled for breast-conserving surgery. Wilcoxon signed rank tests showed that after session, self-reported levels of anxiety decreased, whereas levels of knowledge increased. Most participants found the session to be very helpful and would recommend it to other patients/families awaiting surgery. Conclusions: Patients awaiting surgery for breast cancer may be better supported through a multidisciplinary group teaching session by decreasing anxiety and improving knowledge related to the procedure. Future directions could explore the effect of specific session elements on anxiety, knowledge, and postoperative complications using psychometrically sound instruments and additional time points. Implications for cancer survivors: Standardization of these preoperative teaching sessions may enhance breast cancer care, reduce postoperative complications, and improve patient recovery.

Breast cancer (BC) diagnosis in young adults (YA) is rising, and both disease and treatments are aggressive in this population. Evidence supports the use of physical activity in reducing shoulder dysfunction, which is common among BC survivors. A pilot randomized clinical trial was performed to determine the effectiveness of a 12-week post-radiation exercise program in minimizing upper extremity dysfunction in YA with BC.

Background Persistent pain after treatment has been identified in breast cancer populations, with prevalence rates ranging from 25%-60%. Age, surgical procedure, axillary node dissection, and radiation therapy have shown correlation with chronic pain development. Objective To conduct a pilot randomized controlled trial targeting young breast cancer patients to determine the effectiveness of a 12-week exercise program on long-term levels of upper-limb pain, as measured by the Brief Pain Inventory-Short Form (BPI-SF), and pain measured by physical examination of specific shoulder movements. Methods Young adults (18-45 years of age) recently diagnosed with breast cancer consenting to participate in this study were randomly allocated to intervention or control groups. The exercise intervention group participated in a 12-week exercise program starting 3-4 weeks after the cessation of radiation therapy, and the control group received standard care consisting of encouragement for an active lifestyle and pamphlets on the benefits of exercise. The location and severity of pain and its interference with daily life were recorded at the following 6 time points: postsurgery and preradiation (T1, baseline), postradiation and preintervention (T2), and 4 points during an 18-month period postradiation (T3-T6 at 3, 6, 12, and 18 months). In addition, clinical physical assessment of range of motion and pain on active shoulder movements were recorded at each time point. Results 59 young breast cancer patients participated in the study (exercise group: n = 29; control group: n = 30). Over the course of the trial, there were no significant differences between study groups in the BPI-SF measures of pain interference and severity scores. Improvements in pain on shoulder movements were noted in the intervention group at 3 and 6 months postintervention (T3 and T4) but were not sustained over time (by T6, 18 months postradiation). Shoulder girdle-chest wall pain improved at 12 and 18 months postradiation in both groups but persisted despite exercise intervention. Recordings of shoulder pain on physical examination of range showed a distinct pattern of temporal improvement (T3-T5), followed by low levels of pain recurrence at 18 months postradiation (T6) in both groups. Limitations Stringent exclusion criteria, including the absence of any shoulder pathology or pre-existent medical comorbidities impacting upper limb function, long-term follow-up, and the relatively small population of breast cancer patients in this age demographic, limited and prolonged recruitment for this study. In addition, the general activity levels of the young breast cancer survivors who agreed to participate in this exercise intervention study may have had an impact on the significance of results. Conclusion Transient improvements in shoulder pain can be attributed to a 12-week exercise program, but they did not translate to long-term benefits. Moreover, the BPI-SF did not capture shoulder pain and limitations related to upper-limb disability in this study, in contrast with the findings on physical examination.

Many young women with breast cancer (BC) are treated with radiation therapy, which can result in radiation fibrosis and reduced functional movements with a resulting decline in quality of life. Most are treated with an additional boost of aggressive radiation therapy (RT) contributing to shoulder dysfunction. We hypothesized that a 12-week post radiation exercise program would reduce the time to full recovery and would minimize radiation fibrosis and/or residual functional disabilities including upper quadrant pain and limb restrictions, which prevent return to normal activities. We conducted a randomized controlled trial in an urban hospital in Montreal, Canada among 18 to 45 year old women with stage 1 to 3 BC who received RT. A physiotherapist evaluated the participants at six different time points (to 18 months post-RT). The exercise intervention was administered within one month of completion of RT. Fifty-nine women were recruited (30 control, 29 exercise intervention), mean age of 40, 83% invasive BC, 71% ER+/PR+, 17% HER2-positive, 19% triple-negative; 80% had lumpectomies versus 20% mastectomies; 37% also received RT to the axilla, 88% received a RT boost, and 78% of women reported comorbidities at baseline. Preliminary data to 6 months from start of RT shows the exercise intervention resulted in an almost two-fold statistically significantly increased level of exercise (22.1 metabolic-hours/week [MET-hours/week, a measure of physical activity] vs 12.7 MET-hours/week among control participants). In the exercise arm, women reported statistically significantly fewer restrictions in mobility compared to the control arm, across multiple shoulder range of motion measures. Although not statistically significant, women in the exercise arm reported less pain in both sitting and supine horizontal abduction movements (reporting pain: 5.9% vs 26.7%). Our physical therapist designed exercise program resulted in a dramatic improvement in physical activity levels. The exercise intervention yielded a significant improvement in shoulder mobility, which in turn may lead to a decline in long-term shoulder dysfunction. The decline in reported pain suggests that exercise improved the mobility of the pectoral muscle, which is most likely to be affected by intense radiation treatment. We believe it is important to begin the exercise program within one month after the patient’s RT to yield long-term benefits.