Originally published as JCO Early Release 10.1200/JCO.2009.22.5664 on May 4 2009

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Reply to S.C. Hayes et al

Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania; Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA

Sheryl L. Potashnik, Heather A. Simoes Torpey, Michael J. Kallan, Anita L. Weber

Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA

Linda T. Miller

Breast Cancer Physical Therapy Center, Haddonfield, NJ

Angela DeMichele

Center for Clinical Epidemiology and Biostatistics; Department of Medicine, Division of Hematology/Oncology, University of Pennsylvania, Philadelphia, PA

Lawrence J. Solin

Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA

We wholeheartedly agree with Hayes et al¹ on the need for studies of the effectiveness and optimal timing of treatment for breast cancer–related lymphedema. Our study of the incidence and time course of lymphedema was not designed to evaluate lymphedema treatment.² Although we described the extent to which women talked with providers regarding perceived size differences between their limbs and the categories of treatments they received, we did not obtain specifics of treatment regimens. It is likely there was great variability among the study participants in treatments offered, and in adoption and adherence to treatment, precluding conclusions about the efficacy of treatment in slowing the progression of lymphedema.

Progress in evaluating treatment for lymphedema has been slowed by strongly held and disparate views on how to diagnose lymphedema and the best methods to treat it,³ as well as the difficulty and expense of conducting studies of treatment efficacy. Ideally, studies would be randomized controlled trials, with standardized methods to evaluate the presence and degree of lymphedema, as well as standard treatment protocols and close monitoring for adherence to treatment. Multicenter studies would likely be required, with sufficient size and length of follow-up to identify enough lymphedema to evaluate efficacy of treatments.

We are heartened that the brief questionnaire that we developed and validated to assess the presence and degree of lymphedema is very easy to use in large studies of demographically diverse populations^2,4 and could provide an inexpensive, standardized approach to measuring lymphedema in future studies of treatment efficacy. Building on the foundation of our study, upcoming treatment studies could focus on patients with breast cancer most at risk for developing moderate or severe lymphedema, such as those with mild lymphedema.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The author(s) indicated no potential conflicts of interest.

REFERENCES

1. Hayes SE, Janda M, Cornish B, et al: Lymphedema following breast cancer. J Clin Oncol 27:2890; 2009.[Free Full Text]

2. Norman SA, Localio AR, Potashnik SL, et al: Lymphedema in breast cancer survivors: Incidence, degree, time-course, treatment, and symptoms. J Clin Oncol 27:390–397, 2009.[Abstract/Free Full Text]

3. Rockson SG, Miller LT, Senie R: Diagnosis and management of lymphedema. Cancer 83:2882–2885, 1998.[CrossRef][Medline]

4. Norman SA, Miller LT, Erikson HB, et al: Development and validation of a telephone questionnaire to characterize lymphedema in women treated for breast cancer. Phys Ther 81:1192–1205, 2001.[Abstract/Free Full Text]

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• Lymphedema Following Breast Cancer
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• Lymphedema Following Breast Cancer
  Sandra C. Hayes, Monika Janda, Bruce Cornish, and Beth Newman
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