Advertisement

Air Travel and Postoperative Lymphedema—A Systematic Review

  • Michael Co
    Affiliations
    Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region
    Search for articles by this author
  • Judy Ng
    Affiliations
    Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region
    Search for articles by this author
  • Ava Kwong
    Correspondence
    Address for correspondence: Ava Kwong, FRCS (Edin), Department of Breast Surgery, The University of Hong Kong, K1401, Queen Mary Hospital, Hong Kong, Hong Kong Special Administrative Region
    Affiliations
    Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region
    Search for articles by this author
Published:October 19, 2017DOI:https://doi.org/10.1016/j.clbc.2017.10.011

      Abstract

      Lymphedema is not uncommon after axillary dissection for breast cancer. Improved survival of patients with breast cancer from advances in adjuvant therapy has resulted in increased awareness of the quality of life for long-term survivors. Air travel has been postulated as 1 of the risk factors of lymphedema exacerbation. In the present systematic review, we sought to critically evaluate the current data on this topic. The present study was registered in the Research Registry. A systematic review of lymphedema and air travel was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. The Medline, EMBASE, CINAHL, and Cochrane databases were searched for English-language studies up to June 2017 with a predefined strategy. The retrieved studies were independently screened and rated for relevance. Data were extracted by 2 of us. A total of 55 studies were identified using predefined keywords; 12 studies were included using the criteria stated in the study protocol. A pooled analysis of 2051 patients with a history of air travel revealed that ≤ 14.5% developed lymphedema after air flight. However, a subsequent analysis of 4 studies with a control arm showed that 107 of 1189 patients (9%) with a documented history of air travel developed lymphedema compared with 204 of 2356 patients (8.7%) who had not flown (χ2 test; P = .80). Two studies (1030 patients) evaluated the effect of lymphedema on patients' air travel patterns. Of the 1030 patients, 141 (13.7%) had totally avoided air travel after the development of lymphedema. However, air travel was not adversely associated with the development of lymphedema.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Breast Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Földi M.
        • Földi E.
        • Kubik S.
        Textbook of Lymphology: For Physicians and Lymphedema Therapists.
        Urban & Fischer, San Francisco, CA2006
        • Cormier J.N.
        • Askew R.L.
        • Mungovan K.S.
        • et al.
        Lymphedema beyond breast cancer: a systemic review of cancer-related secondary lymphedema.
        Cancer. 2010; 116: 5138-5149
        • International Society of Lymphology
        The diagnosis and treatment of peripheral lymphedema: 2009 consensus document of the International Society of Lymphology.
        Lymphology. 2009; 42: 51-60
        • Pillai P.R.
        • Sharma S.
        • Ahmad S.Z.
        • et al.
        Study of incidence of lymphedema in Indian patients undergoing axillary dissection for breast cancer.
        Indian J Surg Oncol. 2010; 1: 263-269
        • Norman S.A.
        • Localio A.R.
        • Potashnik S.L.
        • et al.
        Lymphedema in breast cancer survivors: incidence, degree, time course, treatment, and symptoms.
        J Clin Oncol. 2009; 27: 390-397
        • Swenson K.
        • Nissen M.
        • Ceronsky C.
        • et al.
        Comparison of side effects between sentinel lymph node and axillary lymph node dissection for breast cancer.
        Ann Surg Oncol. 2009; 9: 745-753
        • Schijven M.
        • Vingerhoets A.
        • Rutten H.
        • et al.
        Comparison of morbidity between axillary lymph node dissection and sentinel node biopsy.
        Eur J Surg Oncol. 2003; 29: 341-350
        • Greenberg P.A.
        • Hortobagyi G.N.
        • Smith T.L.
        • et al.
        Long-term follow-up of patients with complete remission following combination chemotherapy for metastatic breast cancer.
        J Clin Oncol. 1996; 14: 2197-2205
        • Pluchart H.
        • Jacquet E.
        • Charlety D.
        • et al.
        Long-term survivor with intrathecal and intravenous trastuzumab treatment in metastatic breast cancer.
        Target Oncol. 2016; 11: 687-691
        • International Air Transport Association (IATA)
        IATA Forecasts Passenger Demand to Double Over 20 Years.
        (Press release no. 59, Oct 18, 2016. Available at:) (Accessed: September 1, 2017)
        • Vasigh B.
        • Fleming K.
        Introduction to Air Transport Economics: From Theory to Applications.
        2nd ed. Routledge Publishing, New York, NY2016
        • International Air Transport Association (IATA)
        60th Edition of IATA World Air Transport Statistics.
        (Released July 5, 2016. Available at:) (Accessed: September 1, 2017)
        • Pendleton L.D.
        Staying alive.
        AOPA Pilot. 2002; 45: 121-122
        • Niren L.
        • Nagda M.D.
        Review of studies on flight attendant health and comfort in airliner cabins.
        Aviat Space Environ Med. 2003; 74: 101-109
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.
        BMJ. 2009; 339: b2700
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • et al.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        BMJ. 2009; 339: b2535
        • Casley-Smith J.R.
        Lymphedema initiated by aircraft flights.
        Aviat Space Environ Med. 1996; 67: 52-56
        • Graham P.H.
        Compression prophylaxis may increase the potential for flight-associated lymphedema after breast cancer treatment.
        Breast. 2002; 11: 66-71
        • Hayes S.
        • Cornish B.
        • Newman B.
        Comparison of methods to diagnose lymphedema among breast cancer survivors: 6-month follow-up.
        Breast Cancer Res Treat. 2005; 89: 221-226
        • McLaughlin S.A.
        • Wright M.J.
        • Morris K.T.
        • et al.
        Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: patient perceptions and precautionary behaviors.
        J Clin Oncol. 2008; 26: 5220-5226
        • Ward L.C.
        • Battersby K.J.
        • Kilbreath S.L.
        Airplane travel and lymphedema: a case study.
        Lymphology. 2009; 42: 139-145
        • Swenson K.K.
        • Nissen M.J.
        • Leach J.W.
        • et al.
        Case-control study to evaluate predictors of lymphedema after breast cancer surgery.
        Oncol Nurs Forum. 2009; 36: 185-193
        • Mak S.S.
        • Yeo W.
        • Lee Y.M.
        • et al.
        Risk factors for the initiation and aggravation of lymphoedema after axillary lymph node dissection for breast cancer.
        Hong Kong Med J. 2009; 15: 8-12
        • Kilbreath S.L.
        • Ward L.C.
        • Lane K.
        • et al.
        Effect of air travel on lymphedema risk in women with history of breast cancer.
        Breast Cancer Res Treat. 2010; 120: 649-654
        • Showalter S.L.
        • Brown J.C.
        • Cheville A.L.
        • et al.
        Lifestyle risk factors associated with arm swelling among women with breast cancer.
        Ann Surg Oncol. 2013; 20: 842-849
        • Ahn S.
        • Port E.R.
        Lymphedema precautions: time to abandon old practices?.
        J Clin Oncol. 2016; 34: 655-658
        • Ferguson C.M.
        • Swaroop M.N.
        • Horick N.
        • et al.
        Impact of ipsilateral blood draws, injections, blood pressure measurements, and air travel on the risk of lymphedema for patients treated for breast cancer.
        J Clin Oncol. 2016; 34: 691-698
        • Kilbreath S.L.
        • Refshauge K.M.
        • Beith J.M.
        • et al.
        Risk factors for lymphoedema in women with breast cancer: a large prospective cohort.
        Breast. 2016; 28: 29-36