Cancer-related lymphedema (CRL) lacks internationally accepted definition and diagnostic criteria. The accurate incidence of CRL is therefore a challenge and the condition is likely underreported. Patients treated for cancer can develop CRL as a result of surgery, chemotherapy, and/or radiotherapy, which can lead to considerable psychosocial and physical morbidity, and decreased quality of life. Determining CRL incidence is crucial to inform care access and resource allocation, to best support patients affected by this lifelong condition. This review aimed to provide the latest CRL incidence estimates. Using four core databases (MEDLINE, Embase, Web of Science Core Collection, Cochrane Library), a literature search was performed to capture publications dated between 2015 and 2023. A total of 48 articles (33 prospective studies, 15 systematic reviews) met inclusion criteria, providing a sample size of 234,079 cancer patients. Findings revealed CRL incidence across cancer types varied, reported 2–74% in breast, 8–45% in gynecological and urological, 71–90% in head and neck and 2–29% in melanoma cancers. CRL incidence varied between 3 and 21% in preventative lymphedema surgery patients. Projected increases in cancer incidence and improved survival rates are expected to further escalate CRL incidence. Healthcare systems and professionals alike must therefore prepare to meet the growing needs of CRL patients.

There is limited knowledge on non-invasive lymphedema risk-reduction strategies for women with gynecological cancer. Understanding factors influencing the feasibility of randomized controlled trials (RCTs) can guide future research. Our objectives are to report on the design and feasibility of a pilot RCT examining a tailored multidimensional intervention in women treated for gynecological cancer at risk of lymphedema and to explore the preliminary effectiveness of the intervention on lymphedema incidence at 12 months. In this pilot single-blinded, parallel-group, multi-centre RCT, women with newly diagnosed gynecological cancer were randomized to receive post-operative compression stockings and individualized exercise education (intervention group: IG) or education on lymphedema risk-reduction alone (control group: CG). Rates of recruitment, retention and assessment completion were recorded. Intervention safety and feasibility were tracked by monitoring adverse events and adherence. Clinical outcomes were evaluated over 12 months: presence of lymphedema, circumferential and volume measures, body composition and quality of life. Fifty-one women were recruited and 36 received the assigned intervention. Rates of recruitment and 12-month retention were 47% and 78%, respectively. Two participants experienced post-operative cellulitis, prior to intervention delivery. At three and six months post-operatively, 67% and 63% of the IG used compression ≥42 h/week, while 56% engaged in ≥150 weekly minutes of moderate-vigorous exercise. The cumulative incidence of lymphedema at 12 months was 31% in the CG and 31.9% in the IG (p = 0.88). In affected participants, lymphedema developed after a median time of 3.2 months (range, 2.7–5.9) in the CG vs. 8.8 months (range, 2.9–11.8) in the IG. Conducting research trials exploring lymphedema risk-reduction strategies in gynecological cancer is feasible but challenging. A tailored intervention of compression and exercise is safe and feasible in this population and may delay the onset of lymphedema. Further research is warranted to establish the role of these strategies in reducing the risk of lymphedema for the gynecological cancer population.

Physician-administered euthanasia (Medical-Aid-in-Dying or MAiD) has been legally available in Canada since 2016, with ever-widening indications. Most palliative care physicians in Canada do not provide MAiD themselves but will refer to colleagues who provide this procedure. The author was involved in a qualitative research project on MAiD, looking at the views of Montreal-based palliative care physicians regarding their role. One interesting finding from that project is that our own individual personal views (i.e., what I would want for myself when I will inevitably face my own death) versus my professional views as a palliative care physician (i.e., the kind of end-of-life care that I am ready to provide, or what I think patients should receive) may radically differ. We teach our trainees (and the community beyond) that dying can have meaning up to the end of one’s natural life. Patients facing terminal illness commonly express a fear of becoming a burden to others. Yet we teach that this sentiment is often not well-founded, based on the expressed views of the patient’s loved ones. And yet dying can be difficult, even when patients receive the best available palliative care. Our professional view of what constitutes a dignified end-of-life and what patients and families (and I, eventually) will experience may be different. This presentation will spark reflection regarding this dichotomy. What feelings might this inner split provoke, when our professional and personal views conflict with each other? Am I being a dishonest physician? And yet…

Little is known about skeletal muscle thickness, echogenicity, and muscle quality (handgrip strength /muscle thickness) in breast cancer-related lymphedema (BCRL). Using B-mode ultrasound, we recorded the raw radiofrequency data of the affected (AA) and unaffected (UA) arms of women (n=20) with BCRL, and in 20 control women with no lymphedema (CA). The data were converted into images and measurements of skin, subcutaneous fat and muscle thickness were obtained. Within a designated region of interest, muscle echo-intensity was assessed using computer graded grey scale and muscle thickness was measured using ImageJ2. Handgrip strength was measured using standard dynamometry. We found that forearm muscle thickness was similar among AA, UA, and CA. When compared to the unaffected and control arms, the affected arm had a significantly higher (p 0.013) muscle echo-intensity. When compared to the AA, handgrip strength was similar to UA (p 0.401) but lower than CA (p 0.05). We conclude that the use of B-mode ultrasound is a reliable method to assess muscle thickness and EI in BCRL. When comparing AA to UA, the elevated levels of muscle EI in AA did not influence strength or muscle quality. The elevated EI in AA is a marker of abnormal health that needs to be further explored.