Prospective surveillance model in the home for breast cancer-related lymphoedema: a feasibility study

Abstract

The aim of this study was to assess the feasibility of delivering a prospective surveillance model in the home over 6 months for women at high risk of developing lymphoedema. Methods A single-group, intervention study recruited 20 women who had surgical and medical treatment for confirmed node-positive invasive breast cancer and therefore at high risk of developing arm lymphoedema. Participants received a package including Bioimpedance Spectroscopy (BIS) monitoring, lymphoedema education and support to promote selfmanagement and physical activity. Results Participants adhered to BIS monitoring 74% of the time, and felt extremely confident in using the device. By 6 months, mean BIS L-Dex scores had increased from 3.5 (SD 5.6) to 8.4 (SD 11.1); five women (25%) who experienced > + 6.5 increase in L-Dex score were fitted with a compression garment. Self-reported symptoms and distress decreased by 0.4 out of 10 (95% CI 0.1 to 0.7); number of self-management strategies used increased by 0.6 (95% CI 0.1 to 1.2); and planned exercise increased by 2.8 h/week (95% CI 0.4 to 5.2). Conclusions These findings indicate a prospective surveillance model of care in the home with BIS is feasible and associated with increased self-management. A Phase II randomised trial is warranted as well as research exploring the costs associated with implementing this model of care for high-risk individuals.

Risk factors for breast cancer–related lymphedema in patients undergoing 3 years of prospective surveillance with intervention

“…More frequent assessments may have led to more interventions for the 39 patients who progressed between visits; however, it is unknown if those patients met the criteria for intervention and bringing patients into clinical settings for more frequent lymphedema monitoring assessments is problematic because of patient and clinic burden and cost. Overall, the BIS group in the parent study had statistically significant less progression to CDP compared with TM, 7 and preliminary research has established that lymphedema home‐based self‐monitoring is feasible using BIS technology 45,46 . Future research should explore the use of various forms of home monitoring as a component of a PSEI model of care for individuals at higher risk.…”

“…Overall, the BIS group in the parent study had statistically significant less progression to CDP compared with TM, 7 and preliminary research has established that lymphedema home-based self-monitoring is feasible using BIS technology. 45,46 Future research should explore the use of various forms of home monitoring as a component of a PSEI model of care for individuals at higher risk.…”

Patient education for breast cancer–related lymphedema: a systematic review

“…The BCRL educational content most consistently taught included definition of lymphedema, risk reduction practices, early signs and symptoms, and self-care management. Several low-quality studies in this review provided this information using previously developed BCRL educational material by the American Cancer Society Guidelines for Lymphedema, National Lymphedema Network, or Australian Cancer Council Lymphedema FACT Sheet [ 21 , 22 , 25 , 28 ]. This information varies widely in depth and breadth but provides a general overview of BCRL physiology, pathophysiology, risk reduction practices, and interventions.…”

A COVID-19 Rehabilitation Prospective Surveillance Model for Use by Physiotherapists

“…In physiotherapy, there are not many studies that have addressed problems this way, although there are some important PSMs in a population such as cancer. Regarding diagnosis and prevention, the implementation of these previous models has allowed researchers to detect early impairments or their severity and make an early intervention [ 16 , 17 , 18 , 19 ]. The same occurs in our PSM, which aims to address COVID-19 or long-COVID-19 sequelae and side effects derived from its management in the ICU and benefits from an early stage and suggest intervention.…”

“…Another example in ICU-admitted patients is a model that successfully predicted ARDS events to support early diagnosis and intervention to improve survival rates [ 15 ]. In patients with cancer, several similar prospective surveillance models (PSMs) for physiotherapy interventions have been developed [ 16 , 17 , 18 , 19 ]. These previous experiences led us to suggest that the implementation of this COVID-19 PSM would be feasible [ 18 ], may identify early impairment [ 18 , 19 , 20 ], predict the severity of possible impairments [ 16 , 17 ], allow early intervention [ 19 , 21 , 22 ] and potentially save resources [ 22 ].…”