Grants Funded

Abstract

Project Summary: Developing interventions that prevent or reduce the incidence of breast cancer-related lymphedema (BCRL) is an important biomedical need that will impact the care and quality of life of breast cancer survivors. More than 1 in 3 women who undergo axillary lymph node dissection (ALND) for breast cancer treatment develop lymphedema of the arm—a chronic, progressive, and painful swelling that results in decreased ability to perform activities of daily living. Numerous validated patient-reported outcome studies show that BCRL is also a cause of anxiety, depression, and impaired quality of life among breast cancer survivors. Despite the devastating physical, functional, and psychological sequelae of BCRL, there is no curative treatment. Lifelong palliative treatment with tight compressive garments and physiotherapy, often not covered by medical insurance, leads to high non-compliance rates and rapid disease progression. We propose a prospective cohort study to examine the efficacy of a new comprehensive lymphedema prevention program that combines preoperative (educational session, risk reduction), intraoperative (immediate lymphatic reconstruction), and postoperative (self-directed physiotherapy, compression garments, physical therapy) interventions to reduce BCRL rates following ALND. Aim 1 will assess objective measurements of BCRL development at 18 months after ALND using arm volume (primary measure) as well as bioimpedance and ICG lymphangiography (secondary measures). Aim 2 will assess subjective symptoms of lymphedema at 18 months after ALND using 2 validated PROMs: the upper limb lymphedema 27 (ULL-27) and the Lymphedema Quality of Life (LYMQOL). Our study will not only be the first to provide information on the combined utilization of preoperative, intraoperative, and postoperative interventions to reduce BCRL, but will also help identify optimal candidates, develop standardized methods for outcome analysis, and provide valuable insights into practical constraints limiting widespread adoption of this new program for the prevention of BCRL.

Impact Statement: Breast cancer-related lymphedema (BCRL) is a serious risk facing a large proportion of women undergoing axillary lymph node removal for the treatment of breast cancer. Chronic BCRL is irreversible, debilitating, and requires lifelong and labor-intensive treatment. High-quality data on the efficacy of a new comprehensive lymphedema prevention program that combines preoperative (education/risk reduction), intraoperative (immediate lymphatic reconstruction), and postoperative (self-directed lymphedema physiotherapy, compression garments, physical therapy) interventions to reduce or prevent BCRL would be a paradigm shift in current practice and could be used routinely in patients at high risk for BCRL.

Biography
Michelle Coriddi, MD, is Assistant Attending in the Plastic and Reconstructive Surgery Service in the Department of Surgery at Memorial Sloan Kettering Cancer Center (MSK), with a joint appointment as Assistant Professor of Surgery at Weill Cornell Medical College. Dr. Coriddi specializes in reconstruction following surgery for breast cancer, head and neck cancers, and sarcomas, and the prevention and treatment of lymphedema. Her research focuses primarily on lymphedema—a chronic, debilitating disorder that develops among some cancer patients who undergo lymph node dissection—and patient-reported surgical outcomes to improve care and quality of life. After receiving her medical degree from the University of Rochester School of Medicine and Dentistry, she completed a plastic and reconstructive surgery residency at The Ohio State University and a microsurgery fellowship at MSK. Dr. Coriddi has distinguished herself with numerous honors and awards, including induction into the Alpha Omega Alpha Medical Honor Society. As a resident, her work won her recognition for research excellence form the American Society of Plastic Surgeons, American Association of Plastic Surgeons, and American Society for Reconstructive Microsurgery. In 2021, Dr. Coriddi was awarded a one-year Pilot Research Grant from the Plastic Surgery Foundation for a pilot study on patient-reported outcome measures as predictive tools for breast cancer-related lymphedema.