Abstract PD4-5: Blood draws, injections, blood pressure readings in the at-risk arm, and flying might not be associated with increases in arm volume: A prospective study
Authors: Ferguson Chantal M , Miller Cynthia L , Horick Nora , Skolny Melissa N , Swaroop Meyha N , Jammallo Lauren S , O'Toole Jean A , Specht Michelle C , Taghian Alphonse G 
Published: May 2015

Abstract
Introduction:
Breast cancer related lymphedema (BCRL) is a swelling caused by compromise of the lymphatic system after breast cancer treatment. Commonly-cited risk factors include treatment related variables such as axillary lymph node dissection (ALND) and regional lymph node radiation (RLNR), and patient characteristics including BMI. Patients are often advised to avoid blood draws, injections, and blood pressure cuffs on their at-risk arm, airplane travel, and extensive exercise to reduce the risk of developing BCRL; however, data demonstrating the efficacy of such avoidance strategies do not exist. We sought to determine the impact of blood draws, injections, and blood pressure readings in the at-risk arm, and flying on increases in arm volume in a large, prospective cohort of patients.
Methods:
522 patients who underwent treatment for unilateral breast cancer between were included. Patients were prospectively screened for BCRL with Perometer arm measurements pre-operatively, post-operatively, and at 3-8 month intervals thereafter. At each measurement patients were asked to report number of blood draws, injections, and blood pressure readings in the at-risk arm, and number of flights since the last measurement, and their responses were assessed for association with relative volume change (RVC). RVC was analyzed as a continuous variable for association with risk factors.
Results:
522 patients with 2033 post operative measurements were included. Patients were followed for a median of 23 months and 4 post-operative measurements, with a minimum of 1 post-operative measurement and a maximum of 14. 5.56%. 76.8% (401/522) underwent lumpectomy, 23.2% (121/522) underwent mastectomy. 70% (366/522) underwent sentinel lymph node biopsy, and 19% (98/522) underwent ALND. 62.4% (352/521) received radiation to the breast/ chest wall only, and 21.5% (112/521) also received regional lymph node radiation. By univariate analysis, there was no significant association between RVC increase and undergoing one or more blood draws (p=0.36), blood pressure (p=0.88), injections (p=0.79), or number of flights (p=0.89). ALND was significantly associated with increases in arm volume (p=0.0017) by univariate analysis and older age at diagnosis was associated with increased RVC with borderline significance (p=0.059).
Number of assessments with and without risk events since last measurement# since last measurementBlood DrawBlood PressureInjectionNumber of flightsNone91.2% (1796/1969)83% (1633/1967)97.6% (1923/1969)72% (1461/2031)1 or more8.8% (173/1969)17% (334/1967)2.4% (46/1969)28% (570/2031)
Conclusions:
In our patient population, non-treatment related risk factors including blood draws, blood pressures, and injections in the at-risk arm, and flying were not significantly associated with increases in arm volume. This data can be used to help improve and refine patient education regarding the importance of risk-reducing practices after breast cancer treatment.
Citation Format: Chantal M Ferguson, Cynthia L Miller, Nora Horick, Melissa N Skolny, Meyha N Swaroop, Lauren S Jammallo, Jean A O'Toole, Michelle C Specht, Alphonse G Taghian. Blood draws, injections, blood pressure readings in the at-risk arm, and flying might not be associated with increases in arm volume: A prospective study [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr PD4-5.