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6. Lymphatic Pain in Breast Cancer Survivors.

Author

Fitzgerald Jones, Katie, Fu, Mei, McTernan, Melissa, Ko, Eunjung, Yazicioglu, Simay, Axelrod, Deborah, Guth, Amber, Conley, Yvette, Wood, Lisa, Wang, Yao, and Miaskowski, Christine

Subjects
activities of daily living, breast cancer, limb volume, lymph fluid, lymph fluid accumulation, lymphatic pain, lymphedema, pain, Humans, Female, Breast Neoplasms, Cancer Survivors, Activities of Daily Living, Quality of Life, Lymphedema, Survivors, Pain
Abstract

Background: Breast cancer survivors who report chronic pain in the affected ipsilateral upper limb or body are nearly twice as likely to develop lymphedema. Little is known about lymphatic pain, defined as co-occurring pain and swelling in the affected ipsilateral upper limb or body. The study aimed to examine the predictors and effects of lymphatic pain on breast cancer survivors activities of daily living (ADLs). Materials and Methods: A sample of 568 patients was recruited in a metropolitan cancer center in the United States. Demographic and clinical data were collected. Body mass index (BMI) and limb volume were measured using infra-red perometer. Lymphatic pain and ADLs were measured by the Lymphedema and Breast Cancer Symptom Experience Index. Parametric and nonparametric tests and generalized linear models were used to analyze data. Results: Lymphatic pain affected 33% of survivors. Significant predictors of lymphatic pain included younger age, higher BMI, financial hardship, and a diagnosis of lymphedema. Patients with a diagnosis of lymphedema had 9.68 odds (confidence interval [CI]: 5.78-16.63; p 5% and >10% compared to patients with only pain and no symptom. Conclusion: This study is the first to report that in a large sample of patients, 33.1% experienced lymphatic pain and that lymphatic pain was associated with significant impairments in ADLs. Findings suggest that lymphatic pain may be due to abnormal accumulation of lymph fluid. Research is needed to ascertain the physiological mechanisms that underlie lymphatic pain and determine whether strategies to prevent and treat lymphedema can decrease lymphatic pain.

Published
2022

9. Co-occurring Fatigue and Lymphatic Pain Incrementally Aggravate Their Negative Effects on Activities of Daily Living, Emotional Distress, and Overall Health of Breast Cancer Patients

Author

Fu, Mei Rosemary, McTernan, Melissa L, Qiu, Jeanna M, Miaskowski, Christine, Conley, Yvette P, Ko, Eunjung, Axelrod, Deborah, Guth, Amber, Somers, Tamara J, Wood, Lisa J, and Wang, Yao

Subjects
Health Services and Systems, Biomedical and Clinical Sciences, Nursing, Health Sciences, Pain Research, Cancer, Rehabilitation, Mind and Body, Prevention, Breast Cancer, Clinical Research, Behavioral and Social Science, Chronic Pain, Management of diseases and conditions, 7.1 Individual care needs, Activities of Daily Living, Breast Neoplasms, Cross-Sectional Studies, Fatigue, Female, Humans, Pain, Psychological Distress, Quality of Life, activities of daily living, breast cancer, emotional distress, fatigue, health, lymphatic, pain, Complementary and Alternative Medicine, Oncology and Carcinogenesis, Complementary & Alternative Medicine, Oncology and carcinogenesis, Traditional, complementary and integrative medicine
Abstract

BackgroundFatigue and lymphatic pain are the most common and debilitating long-term adverse effects of breast cancer treatment. Fatigue and pain independently have negative effects on quality of life, physical functions, and cancer recurrence-free survival. The interactions between fatigue and pain may aggravate their negative effects.ObjectivesExamine the effects of co-occurring fatigue and lymphatic pain on activities of daily living (ADLs), emotional distress, and overall health of breast cancer patients.MethodsA cross-sectional and observational design was used to enroll 354 breast cancer patients. Valid and reliable instruments were used to assess fatigue, lymphatic pain, ADLs, emotional distress, and overall health. Descriptive statistics and multivariable regression models were used for data analysis.ResultsAfter controlling for demographic and clinical factors, patients with co-occurring fatigue and lymphatic pain had higher odds of having impaired ADLs (OR = 24.43, CI = [5.44-109.67], P

Published
2022

13. The Effects of Kinect-Enhanced Lymphatic Exercise Intervention on Lymphatic Pain, Swelling, and Lymph Fluid Level

Author

Fu, Mei R, McTernan, Melissa L, Qiu, Jeanna M, Ko, Eunjung, Yazicioglu, Simay, Axelrod, Deborah, Guth, Amber, Fan, Zhipeng, Sang, Anna, Miaskowski, Christine, and Wang, Yao

Subjects
Health Services and Systems, Biomedical and Clinical Sciences, Health Sciences, Rehabilitation, Clinical Trials and Supportive Activities, Pain Research, Cancer, Clinical Research, Chronic Pain, Breast Neoplasms, Edema, Exercise Therapy, Female, Humans, Lymphedema, Pain, lymphatic, pain, swelling, lymphedema, lymph fluid, breast cancer, symptoms, Complementary and Alternative Medicine, Oncology and Carcinogenesis, Complementary & Alternative Medicine, Oncology and carcinogenesis, Traditional, complementary and integrative medicine
Abstract

BackgroundThe-Optimal-Lymph-Flow (TOLF) intervention aims to promote lymph flow through therapeutic lymphatic exercises to relieve lymphatic pain, swelling, lymphedema symptoms, and to decrease lymph fluid levels among breast cancer survivors. To enhance the efficacy of the TOLF intervention, an innovative, intelligent, Kinect-enhanced lymphatic exercise intervention (Kinect-TOLF) was developed to teach patients to perform the lymphatic exercises correctly.ObjectivesThis feasibility trial aimed to determine the feasibility, usability, and effects of the Kinect-TOLF on lymphatic pain, swelling, lymphedema symptoms, and lymph fluid levels.MethodsA single-arm feasibility trial with a pre- and post-test design was employed to recruit 30 breast cancer survivors with persistent lymphatic pain or swelling. Patients received a single training session to learn how to perform the lymphatic exercises using the Kinect-TOLF program. Descriptive statistics, Wilcoxon signed-rank tests, t-test, Spearman's rank correlation coefficients, linear regressions, and Cohen's d were performed for data analysis. Qualitative data were assessed for common themes.ResultsThe Kinect-TOLF was effective in training patients to perform the lymphatic exercises correctly with high user satisfaction. Significant reductions were found in scores of lymphatic pain (MedΔ = -1.00, CI = [-1.5, -0.1], P = .004), arm/hand swelling (MedΔ = -1.00, CI = [-1.5, -0.5], P = .004), total swelling (MedΔ = -1.5, CI = [-2.0, -1.0], P = .003), number of lymphedema symptoms (MΔ = -3.8, CI = [-5.5, -2.1], P

Published
2021

15. A radiation therapy contouring atlas for delineation of the level I-II axilla in the prone position: a single institution experience

Author

Purswani, Juhi M., primary, Goldberg, Eliana, additional, Cahlon, Oren, additional, Schnabel, Freya, additional, Axelrod, Deborah, additional, Guth, Amber, additional, Perez, Carmen A., additional, Shaikh, Fauzia, additional, Tam, Moses, additional, Formenti, Silvia, additional, Reig, Bea, additional, and Gerber, Naamit K, additional

Published
2024
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29. Supplementary Table 1 from Topical TLR7 Agonist Imiquimod Can Induce Immune-Mediated Rejection of Skin Metastases in Patients with Breast Cancer

Author

Adams, Sylvia, primary, Kozhaya, Lina, primary, Martiniuk, Frank, primary, Meng, Tze-Chiang, primary, Chiriboga, Luis, primary, Liebes, Leonard, primary, Hochman, Tsivia, primary, Shuman, Nicholas, primary, Axelrod, Deborah, primary, Speyer, James, primary, Novik, Yelena, primary, Tiersten, Amy, primary, Goldberg, Judith D., primary, Formenti, Silvia C., primary, Bhardwaj, Nina, primary, Unutmaz, Derya, primary, and Demaria, Sandra, primary

Published
2023
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30. Supplementary Figure 1 from Topical TLR7 Agonist Imiquimod Can Induce Immune-Mediated Rejection of Skin Metastases in Patients with Breast Cancer

Author

Adams, Sylvia, primary, Kozhaya, Lina, primary, Martiniuk, Frank, primary, Meng, Tze-Chiang, primary, Chiriboga, Luis, primary, Liebes, Leonard, primary, Hochman, Tsivia, primary, Shuman, Nicholas, primary, Axelrod, Deborah, primary, Speyer, James, primary, Novik, Yelena, primary, Tiersten, Amy, primary, Goldberg, Judith D., primary, Formenti, Silvia C., primary, Bhardwaj, Nina, primary, Unutmaz, Derya, primary, and Demaria, Sandra, primary

Published
2023
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31. Supplementary Figure Legend from Topical TLR7 Agonist Imiquimod Can Induce Immune-Mediated Rejection of Skin Metastases in Patients with Breast Cancer

Author

Adams, Sylvia, primary, Kozhaya, Lina, primary, Martiniuk, Frank, primary, Meng, Tze-Chiang, primary, Chiriboga, Luis, primary, Liebes, Leonard, primary, Hochman, Tsivia, primary, Shuman, Nicholas, primary, Axelrod, Deborah, primary, Speyer, James, primary, Novik, Yelena, primary, Tiersten, Amy, primary, Goldberg, Judith D., primary, Formenti, Silvia C., primary, Bhardwaj, Nina, primary, Unutmaz, Derya, primary, and Demaria, Sandra, primary

Published
2023
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33. Single-Dose of Postoperative Ketamine for Postoperative Pain After Mastectomy: A Pilot Randomized Controlled Trial

Author

Doan, Lisa V, primary, Li, Anna, additional, Brake, Lee, additional, Ok, Deborah, additional, Jee, Hyun Jung, additional, Park, Hyung, additional, Cuevas, Randy, additional, Calvino, Steven, additional, Guth, Amber, additional, Schnabel, Freya, additional, Hiotis, Karen, additional, Axelrod, Deborah, additional, and Wang, Jing, additional

Published
2023
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34. Abstract OT3-20-01: Ketamine Analgesia for Long Lasting Pain Relief after Surgery (KALPAS) Study

Author

Doan, Lisa, primary, Perez, Raven, additional, Chun, Jeana, additional, Cuevas, Randy, additional, Miah, Pabel, additional, Guth, Amber, additional, Hiotis, Karen, additional, Schnabel, Freya, additional, Curatolo, Michele, additional, Edwards, Robert, additional, Park, Hyung, additional, Rotrosen, John, additional, Axelrod, Deborah, additional, and Wang, Jing, additional

Published
2023
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35. Single-Dose of Postoperative Ketamine for Postoperative Pain After Mastectomy: A Pilot Randomized Controlled Trial

Author

Doan,Lisa V, Li,Anna, Brake,Lee, Ok,Deborah, Jee,Hyun Jung, Park,Hyung, Cuevas,Randy, Calvino,Steven, Guth,Amber, Schnabel,Freya, Hiotis,Karen, Axelrod,Deborah, Wang,Jing, Doan,Lisa V, Li,Anna, Brake,Lee, Ok,Deborah, Jee,Hyun Jung, Park,Hyung, Cuevas,Randy, Calvino,Steven, Guth,Amber, Schnabel,Freya, Hiotis,Karen, Axelrod,Deborah, and Wang,Jing

Abstract

Lisa V Doan,1 Anna Li,1 Lee Brake,1 Deborah Ok,1 Hyun Jung Jee,1 Hyung Park,2 Randy Cuevas,1 Steven Calvino,1 Amber Guth,3 Freya Schnabel,3 Karen Hiotis,3 Deborah Axelrod,3 Jing Wang1,4 1Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Grossman School of Medicine, New York, NY, USA; 2Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA; 3Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA; 4Department of Neuroscience and Physiology, New York University Grossman School of Medicine, New York, NY, USACorrespondence: Lisa V Doan, Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Grossman School of Medicine, 240 E 38th St, 14th Floor, New York, NY, 10016, USA, Tel +1 212201-1004, Email Lisa.Doan@nyulangone.orgBackground and Objectives: Perioperative ketamine has been shown to reduce opioid consumption and pain after surgery. Ketamine is most often given as an infusion, but an alternative is single-dose ketamine. Single-dose ketamine at up to 1 mg/kg has been shown to reduce symptoms of depression, and a wide range of dosages has been used for pain in the emergency department. However, limited data exists on the tolerability and efficacy of a single-dose of ketamine at 0.6 mg/kg for pain when administered immediately after surgery. We conducted a pilot study of single-dose ketamine in patients undergoing mastectomy with reconstruction, hypothesizing that a single-dose of ketamine is well tolerated and can relieve postoperative pain and improve mood and recovery.Methods: This is a randomized, single-blind, placebo-controlled, two-arm parallel, single-center study. Thirty adult women undergoing mastectomy with reconstruction for oncologic indication received a single-dose of ketamine (0.6mg/kg) or placebo after surgery in the post-anesthesia care unit (PACU). Patients were followed through postoperative day (POD) 7

Published
2023

39. Effectiveness and toxicity of re-irradiation after breast conserving surgery for recurrent or new primary breast cancer: a multi-institutional study

Author

Abeloos, Camille Hardy, primary, Xiao, Julie, additional, Oh, Cheongeun, additional, Barbee, David, additional, Perez, Carmen A, additional, Oratz, Ruth, additional, Schnabel, Freya, additional, Axelrod, Deborah, additional, Guth, Amber, additional, Braunstein, Lior, additional, Khan, Atif, additional, Choi, Isabelle, additional, and Gerber, Naamit, additional

Published
2022
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40. Changes in Breast Cancer Presentation during COVID-19: Experience in an Urban Academic Center

Author

Diskin, Brian, Pourkey, Nakisa, Schnabel, Freya, Miah, Pabel, DiMaggio, Charles, Axelrod, Deborah, Shapiro, Richard, and Guth, Amber A.

Abstract

The COVID-19 pandemic strained healthcare systems worldwide, delaying breast cancer screening and surgery. In 2019, approximately 80% of breast cancers in the U.S. were diagnosed on screening examinations, with 76.4% of eligible Medicare patients undergoing screening at least every two years. Since the start of the pandemic, many women have been reluctant to seek elective screening mammography, even with the lifting of pandemic-related restrictions in access to routine healthcare. We describe the effect of the COVID-19 pandemic on breast cancer presentation at a tertiary academic medical center greatly impacted by the pandemic.

Published
2023
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46. Nivolumab with chemotherapy as neoadjuvant treatment for inflammatory breast cancer.

Author

Kwa, Maryann J., primary, Novik, Yelena, additional, Speyer, James L., additional, Snuderl, Matija, additional, Cotzia, Paolo, additional, Miller, Kathy, additional, Newton, Erin V., additional, Oratz, Ruth, additional, Meyers, Marleen Iva, additional, Schnabel, Freya Ruth, additional, Axelrod, Deborah M., additional, Joseph, Kathie-Ann P., additional, Hiotis, Karen, additional, Troxel, Andrea, additional, McCoy, Sabrina, additional, Schneider, Robert, additional, and Adams, Sylvia, additional

Published
2022
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