Early surveillance is associated with less incidence and severity of breast cancer–related lymphedema compared with a traditional referral model of care

Abstract

Background Bioimpedance spectroscopy (BIS) has enabled the early identification of breast cancer‐related lymphedema. In this study, differences in health service metrics and in the incidence of breast cancer‐related lymphedema are evaluated in an early surveillance model of care compared with a traditional referral model of care. Methods In a retrospective analysis of data from 753 women who underwent BIS measures between January 1, 2007 and December 31, 2016, 188 women were assigned to the “early surveillance” group if they began lymphedema monitoring presurgery (n = 121) or within 90 days postsurgery (n = 67), and 285 women were assigned to the “traditional referral” group if they began monitoring after 90 days postsurgery. Health service metrics were calculated as the time to the first BIS measure after 90 days postsurgery, the median follow‐up, and the number of health care visits. Lymphedema was diagnosed based on BIS measures. Results Women in the early surveillance group received lymphedema care significantly earlier than those in the traditional referral group. However, there was no difference in the number of visits per year to the clinic between groups. Significantly more women in the traditional referral group were diagnosed with clinical lymphedema (stage I‐III, 39 % vs 14%; P < .001) and with greater severity (stage II‐III, 24%) compared with those in the early surveillance group (4%). Conclusions The current findings support the adoption of an early prospective surveillance model of care using BIS for the early detection and management of breast cancer–related lymphedema.

Interventions for Breast Cancer–Related Lymphedema: Clinical Practice Guideline From the Academy of Oncologic Physical Therapy of APTA

“…Using this model of care, 34% of the population was found to have subclinical BCRL, of which 82% could be managed with this conservative treatment alone. According to Koelmeyer et al, 24 identification of BCRL with BIS occurred significantly earlier in a PSM group than a traditional referral group. Although they found no reduction in the number of treatment sessions between groups when BCRL did occur, the traditional referral group was more likely to be diagnosed with lymphedema of greater severity (stages II and III, 24% traditional vs 4% PSM).…”

The Development and Treatment of Lymphatic Dysfunction in Cancer Patients and Survivors

“…A number of studies report classification systems derived from lymphangiography, lymphoscintigraphy, BIS, or ICG lymphography [87][88][89][90]. Because accurate and early LE diagnosis and treatment result in significantly improved outcomes and quality of life [91,92], our work has focused on early diagnosis of lymphatic dysfunction by NIRF-LI, often prior to onset of clinical symptoms.…”

Recognition and management of adults with Turner syndrome: From the transition of adolescence through the senior years

“…Young adult women can be educated about lymphedema before the onset of brawny and fibrotic changes, but most tend to view this as a minor annoyance not requiring treatment. With early intervention, including manual lymphatic drainage, compression socks, stockings, and hosiery (which can be obtained without prescription), and when severe, pneumatic compression therapy, lymphedema outcome is improved (Koelmeyer et al, ; Stout Gergich et al, ). Providers should be aware, however, that the latter treatment, though effective, requires the patient to be seated for several hours a day, perpetuating a sedentary lifestyle that should avoided.…”