Clinical Notes: Radiation & Lymphedema, Decline in Diabetic Foot Ulcers

Radiation and lymphedema

Radiation therapy doesn’t increase the incidence of lymphedema in patients with node-negative breast cancer, according to research presented at the American Society for Radiation Oncology’s 56th Annual Meeting held this fall.

The study consisted of a secondary analysis of the National Surgical Adjuvant Breast and Bowel Project B-32 trial. Researchers found no significant difference in standardized arm measurements or in patient reports of “bothersome” arm swelling during 3 years of follow-up.

Decline in diabetic foot ulcers may not be accurate

A study presented at the 2014 Interscience Conference on Antimicrobial Agents and Chemotherapy and reported in MedPage Today cautions that reports of the decline in diabetic foot ulcers may not be accurate.

According to “Diabetic foot infections fall—not!,” the incidence of diabetic foot infections decreased from every 2.3 of 100 diabetes-related discharges in the United States in 1996 to 1.1 of 100 diabetes-related discharges in the United states in 2010. However, the change may be more a result of changes in the definition of diabetes. Because more patients are now diag­nosed with diabetes, the percentage of patients with diabetic foot infections decreases.

The study found that the absolute number of diabetic foot infections has remained “fairly constant.”

Beehive protectant improves diabetic foot ulcer healing

A study published in the Journal of Diabetes and Its Complications and titled
Topical application of the bee hive protectant propolis is well tolerated and improves human diabetic foot ulcer healing in a prospective feasibility study” included 24 patients. Propolis is an anti-inflammatory bee-derived protectant resin.

The article concludes the pilot study indicates for the first time that topical propolis “may enhance wound closure in this setting when applied weekly” and suggests a multisite, randomized trial is warranted.

Lymphedema risk factors identified

Risk factors for self-reported arm lymphedema among female breast cancer survivors:
A prospective cohort study
” identified the following factors as increasing the risk of lymphedema: total or modified radical mastectomy, chemotherapy, hypertension, and prediagnostic body mass index of 30 kg/m2 or more. In addition, the risk of developing lymphedema increased by 5% for each lymph node removed.

The study, published in Breast Cancer Research, included 666 women, of whom 29% developed lymphedema. The researchers also noted that breast cancer survivors who are younger, have had more lymph nodes removed, or received chemotherapy are at a higher risk for developing late-onset lymphedema, so they should have long-term monitoring.

Mindfulness can reduce depression in patients with diabetes

A study in Diabetes Care has found that individual mindfulness-based cognitive therapy and individual cognitive behavior therapy can reduce depression in patients with type 1 and type 2 diabetes.

Individual mindfulness-based cognitive therapy and cognitive behavior therapy for treating depressive symptoms in patients with diabetes: Results of a randomized controlled trial” also reports positive effects on anxiety, well-being, and diabetes-related distress. There was no significant impact on HbA1c.

The study included 94 outpatients with diabetes and depressive symptoms. Patients were randomized to either therapy or a waiting-list control group.

Smoking increases risk of SSI after stomal reversal

Smoking increases the risk of surgical site infection (SSI) after stomal reversal surgery, according to a study in the Journal of Gastrointestinal Surgery. Smoking increased the risk by more than twofold.

Surgical site infections (SSIs) after stoma reversal (SR): Risk factors, implications, and protective strategies” studied 528 patients, 6.8% of whom developed an SSI. Patients with an SSI had increased lengths of stay and 30-day morbidities. The researchers conclude that smoking cessation should be an important strategy for reducing SSI risk.

Lab test predicts mortality in patients with diabetes

Diabetes Care has published the study, “Osteopontin is a strong predictor of incipient diabetic nephropathy, cardiovascular disease, and all-cause mortality in patients with type 1 diabetes.”

Objective osteopontin (OPN) is a protein that may play a role in the arterial disease of patients with type 2 diabetes. Researchers studied 2,145 adults with type 1 diabetes and without end-stage renal disease (ESRD).

Serum OPN was higher at baseline in patients who progressed to ESRD, experienced a cardiovascular event, or died during the follow-up, which had a mean of 10.5 years.

IOM report calls for improved end-of-life care

A report from the Institute of Medicine says the U.S. healthcare
system isn’t properly designed to meet the needs of patients nearing the end of life and those of their families, and major changes to the system are necessary,
Dying in America: Improving quality and honoring individual preferences near the end of life” calls for more advance care planning by individuals and improved training and credentialing for clinicians. It also calls for federal and state governments and private sectors to provide incentives to patients and clinicians to discuss issues, values, preferences, and appropriate services and care.

Disclaimer: The views expressed in this article are those of the author and do not necessarily represent the views of, and should not be attributed to, Wound Care Advisor. All clinical recommendations are intended to assist with determining the appropriate wound therapy for the patient. Responsibility for final decisions and actions related to care of specific patients shall remain the obligation of the institution, its staff, and the patients’ attending physicians. Nothing in this information shall be deemed to constitute the providing of medical care or the diagnosis of any medical condition. Individuals should contact their healthcare providers for medical-related information.

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One Thought to “Clinical Notes: Radiation & Lymphedema, Decline in Diabetic Foot Ulcers”

  1. Interesting article. It may decrease confusion by the patient and family.

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