{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T18:01:48Z","timestamp":1791223308408,"version":"4.1.0"},"reference-count":27,"publisher":"Wiley","issue":"14","license":[{"start":{"date-parts":[[2020,6,1]],"date-time":"2020-06-01T00:00:00Z","timestamp":1590969600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005440","name":"Center for Scientific Review","doi-asserted-by":"publisher","award":["NIH\/NCATS UL1 TR000445"],"award-info":[{"award-number":["NIH\/NCATS UL1 TR000445"]}],"id":[{"id":"10.13039\/100005440","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Study objectives were to examine: (a) biomarker trajectories (change from presurgical baseline values of Lymphedema index (L\u2010Dex) units and arm volume difference) and symptom cluster scores 24\u00a0months after breast cancer surgery and (b) associations of these objective biomarkers and symptom cluster scores. Patient\/treatment characteristics influencing trajectories were also evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A secondary analysis of data from the published interim analysis of a randomized parent study was undertaken using trajectory analysis. Five hundred and eight participants included in the prior analysis with 24\u00a0months of postsurgical follow\u2010up were initially measured with bioelectric impedance spectroscopy (BIS) and tape measure (TM) and completed self\u2010report measures. Patients were reassessed postsurgery for continuing eligibility and then randomized to either BIS or TM groups and measured along with self\u2010report data at regular and optional* visits 3, 6,12,15*,18, 21*, and 24\u2010months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Three subclinical trajectories were identified for each biomarker (decreasing, stable, increasing) and symptom cluster scores (stable, slight increase\/decrease, increasing). Subclinical lymphedema was identified throughout the 24\u2010month period by each biomarker. An L\u2010Dex increase at 15\u00a0months in the BIS group was noted. The self\u2010report sets demonstrated contingency coefficients of 0.20 (LSIDS\u2010A soft tissue, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.031) and 0.19 (FACTB+4, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.044) with the L\u2010Dex unit change trajectories.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>These data support the need for long\u2010term (24\u00a0months) prospective surveillance with frequent assessments (every 3\u00a0months) at least 15\u00a0months after surgery. Statistically significant convergence of symptom cluster scores with L\u2010Dex unit change supports BIS as beneficial in the early identification of subclinical lymphedema.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.3188","type":"journal-article","created":{"date-parts":[[2020,6,2]],"date-time":"2020-06-02T06:34:50Z","timestamp":1591079690000},"page":"5164-5173","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["L\u2010Dex, arm volume, and symptom trajectories 24 months after breast cancer surgery"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3847-7405","authenticated-orcid":false,"given":"Sheila H.","family":"Ridner","sequence":"first","affiliation":[{"name":"Vanderbilt University School of Nursing Nashville TN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chirag","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Taussig Cancer Institute Cleveland Clinic Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Boyages","sequence":"additional","affiliation":[{"name":"Australian Lymphoedema Education, Research, and Treatment (ALERT) Program Faculty of Medicine &amp; Health Sciences Macquarie University Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2736-2330","authenticated-orcid":false,"given":"Louise","family":"Koelmeyer","sequence":"additional","affiliation":[{"name":"ALERT Program Faculty of Medicine &amp; Health Sciences Macquarie University Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Ajkay","sequence":"additional","affiliation":[{"name":"Breast Surgical Oncology University of Louisville Louisville KY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah M.","family":"DeSnyder","sequence":"additional","affiliation":[{"name":"Department of Breast Surgical Oncology The University of Texas MD Anderson Cancer Center Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah A.","family":"McLaughlin","sequence":"additional","affiliation":[{"name":"Surgery Mayo Clinic Jacksonville FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary S.","family":"Dietrich","sequence":"additional","affiliation":[{"name":"Vanderbilt University School of Nursing and Vanderbilt University School of Medicine Nashville TN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,6]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(13)70076-7"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.23494"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-019-07344-5"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.31873"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-017-5982-4"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/tbj.13618"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/COH.0b013e32833ed177"},{"key":"e_1_2_9_9_1","unstructured":"INCHEM.Biomarkers and risk assessment: concepts and principles.www.inchem.org\/documents\/ehc\/ehc\/ehc155.htm#SectionNumber:1.2. 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