title: Impact of Ipsilateral Blood Draws, Injections, Blood Pressure Measurements, and Air Travel on the Risk of Lymphedema for Patients Treated for Breast Cancer.
abstract: OBJECTIVE
  The goal of this study was to investigate the association between blood draws, injections, blood pressure readings, trauma, cellulitis in the at-risk arm, and air travel and increases in arm volume in a cohort of patients treated for breast cancer and screened for lymphedema.
  
  
  METHODS
  Between 2005 and 2014, patients undergoing treatment of breast cancer at our institution were screened prospectively for lymphedema. Bilateral arm volume measurements were performed preoperatively and postoperatively using a Perometer. At each measurement, patients reported the number of blood draws, injections, blood pressure measurements, trauma to the at-risk arm(s), and number of flights taken since their last measurement. Arm volume was quantified using the relative volume change and weight-adjusted change formulas. Linear random effects models were used to assess the association between relative arm volume (as a continuous variable) and nontreatment risk factors, as well as clinical characteristics.
  
  
  RESULTS
  In 3,041 measurements, there was no significant association between relative volume change or weight-adjusted change increase and undergoing one or more blood draws (P = .62), injections (P = .77), number of flights (one or two [P = .77] and three or more [P = .91] v none), or duration of flights (1 to 12 hours [P = .43] and 12 hours or more [P = .54] v none). By multivariate analysis, factors significantly associated with increases in arm volume included body mass index ≥ 25 (P = .0236), axillary lymph node dissection (P < .001), regional lymph node irradiation (P = .0364), and cellulitis (P < .001).
  
  
  CONCLUSIONS
  This study suggests that although cellulitis increases risk of lymphedema, ipsilateral blood draws, injections, blood pressure readings, and air travel may not be associated with arm volume increases. The results may help to educate clinicians and patients on posttreatment risk, prevention, and management of lymphedema.
authors.affiliation: All authors: Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Chantal M
authors.initials: CM
authors.lastname: Ferguson
authors.affiliation: All authors: Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Meyha N
authors.initials: MN
authors.lastname: Swaroop
authors.affiliation: All authors: Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Nora
authors.initials: N
authors.lastname: Horick
authors.affiliation: All authors: Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Melissa N
authors.initials: MN
authors.lastname: Skolny
authors.affiliation: All authors: Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Miller
authors.affiliation: All authors: Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Lauren S
authors.initials: LS
authors.lastname: Jammallo
authors.affiliation: All authors: Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Brunelle
authors.affiliation: All authors: Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Jean A
authors.initials: JA
authors.lastname: O'Toole
authors.affiliation: All authors: Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Laura
authors.initials: L
authors.lastname: Salama
authors.affiliation: All authors: Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Specht
authors.affiliation: All authors: Massachusetts General Hospital, Harvard Medical School, Boston, MA. ataghian@partners.org.
authors.forename: Alphonse G
authors.initials: AG
authors.lastname: Taghian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064870:Air Travel; D001134:Arm Injuries / Q000150:complications; D001795:Blood Pressure Determination / Q000009:adverse effects; D001943:Breast Neoplasms / Q000601:surgery*; D002481:Cellulitis / Q000150:complications*; D005260:Female; D006801:Humans; D007267:Injections / Q000009:adverse effects; D008209:Lymphedema / Q000209:etiology*; D008875:Middle Aged; D018962:Phlebotomy / Q000009:adverse effects; D011446:Prospective Studies; D012307:Risk Factors