Multidisciplinary preventive intervention for breast cancer‐related lymphedema: An international consensus

Abstract

Objective: To establish a consensus regarding the multidisciplinary prevention of breast cancer-related lymphedema (BCRL), taking into account the expert opinion of professional groups from across the world involved in the identification and treatment of breast cancers.Methods: International consensus study involving a modified nominal group and Delphi process. A total of 50 preventive strategies representing those used by a range of health disciplines involved in breast cancer care were identified by the nominal group. These strategies were categorised into four subgroups (general recommendations, therapeutic approach, rehabilitation medicine and physiotherapy and dietary recommendations) and presented in survey format to a multidisciplinary panel of experts in a two-round Delphi process. Eleven specialist areas and 15 countries were represented on the panel.Results: Twenty-seven experts responded to both Delphi rounds, and the mean overall agreement after Round 2 was 85.7%. Of the 50 proposed strategies for preventing BCRL, 48 yielded consensus among experts. Conclusion:We report an international consensus for the multidisciplinary prevention of BCRL, setting out recommendations aimed at systematising the care of women with breast cancer. The consensus could provide a platform for the development of standardised clinical guidelines.

Multinational Association of Supportive Care in Cancer (MASCC) clinical practice guidance for the prevention of breast cancer-related arm lymphoedema (BCRAL): international Delphi consensus-based recommendations

“…Compared to the international Delphi consensus led by Martinez-Jaimez et al., 13 all statements of our study were based on SRs and RCTs. Their team did not specify which study designs their statements were based on in their methods.…”

“…included recommendations on surgical and radiation techniques, physiotherapy, exercise and dietary recommendations for the prevention of BCRAL, while helpful, it did not cover details of how prospective surveillance programs should be implemented and whether prophylactic sleeves are recommended. 13 Characteristics of patients who should undergo prophylactic lymphatic reconstruction and axillary reverse mapping were also not defined. Healthcare professionals involved in the care of patients with breast cancer and lymphoedema may be uncertain whether these interventions should be adopted and how they should be implemented in their practice, especially when there are resource constraints.…”

Assessment, Treatment, and Follow-Up of Phlebitis Related to Peripheral Venous Catheterisation: A Delphi Study in Spain

“…There are limitations inherent to this type of study as it is exploratory in nature and relies on the response of experts. For reasons expressed in other studies [22], the experts are both a limitation and a strength of a Delphi method and the interventions that are reported should serve as a starting point for other clinical intervention studies.…”

“…A total of 47 professionals were invited to participate. The number initially invited took into consideration a possible loss of around 40% in accordance with data from other studies [22].…”

Advances in the prevention and treatment of breast cancer-related lymphedema

“…Efforts must be made to ensure individualized, patient-centric education—with touchpoints throughout their cancer care—is being provided and retained by the patient. Of note, an international consensus for preventive intervention for BCRL was recently published, which provides recommendations to assist in clinical guidelines development [ 53 ]. The recommendation of high consensus involved the critical importance of adequate patient education about lymphedema, ensuring the patient understands the information and is empowered to take an active approach.…”