A guest blog by Dr. Sheri Prentiss, Occupational Medicine Physician, Breast Cancer Survivor, Lymphedema Patient. Pictured above and at right.
The study, "The impact of monitoring techniques on progression to chronic breast cancer-related lymphedema: a meta-analysis comparing bioimpedance spectroscopy versus circumferential measurements," highlighted a key learning within the lymphedema treatment community: a surveillance model-of-care combined with bioimpedance spectroscopy (BIS) assessment technology, can make a difference.
Approximately 1 in 3 cancer patients are at risk of developing lymphedema post treatment1,2. Further, according to the American Cancer Society, 50% of cancer patients who develop lymphedema do so within 1-year after surgery3. Lymphedema is a prevalent issue and is one of the most feared consequences of cancer treatment among patients. Patients who are diagnosed with secondary lymphedema face a lifelong challenge of managing their condition, which can be complex, painful, and expensive.
New research published in Breast Cancer Research and Treatment has shed light on this issue. The meta-analysis exploring 50 lymphedema studies, including 67,000 cancer patients, found that incidence rates of chronic cancer-related lymphedema were reduced by 81% among patients who were monitored using bioimpedance spectroscopy (BIS) versus circumference (tape measure).
According to the study, among high-risk patients who underwent axillary lymph node dissection (ALND) and/or mastectomy, rates of chronic lymphedema were significantly lower for patients who were monitored with BIS versus circumferential monitoring technique. These statistically significant results were sustained in not only short-term (<2 years) follow-up but also long-term (>2 years) follow-up patients.
The study speaks to the growing body of evidence that early detection and intervention of at-risk cancer patients is key to avoiding chronic cancer-related lymphedema. The impact of monitoring techniques cannot be understated.
The Science of Routine Monitoring of Cancer-Related Lymphedema
The concept is simple. By measuring resistance to electrical current flow through a patient’s body, BIS gives a more objective and consistent representation of body composition, aiding in the assessment of subclinical breast cancer-related lymphedema earlier than standard methods4. And, if monitored and measured at regular intervals, the likelihood for a clinician to detect lymphedema early allows for immediate intervention and treatment – before the condition becomes chronic and irreversible. The study points out that while BIS does not directly reduce rates of chronic lymphedema, its role is to identify changes in fluid at the subclinical level, allowing for early intervention and is critical to reducing lymphedema incidence rates.
Clinical Practice Guidelines
Recent updates to clinical guidelines for oncology care call out the need for early detection and monitoring of lymphedema amongst cancer patients. The Academy of Oncologic Physical Therapy of APTA recommends a prospective surveillance model for patients using BIS to help assess for subclinical lymphedema5. The APTA guideline also recommends that monitoring can begin with a preoperative assessment. Lymphedema risk and care management start before a patient receives cancer treatment.
The NCCN (National Comprehensive Cancer Network), recognized as the standard for clinical policy, recommend that clinicians educate and monitor for early development of lymphedema to support the patient from diagnosis on through survivorship6. These guidelines recognize that lymphedema continues to be a serious side-effect of cancer treatment and clinical care must include a surveillance model for patients at-risk of lymphedema.
Shifting the Conversation to Prevention
As a physician, cancer survivor, lymphedema patient, and patient advocate, I embrace medical technology that can make a difference in a patient’s survivorship. Further, proven tools that can help a clinician make an objective, informed decision regarding the patient’s course of treatment is advancing the quality of care we deliver to patients. With our improved capabilities to monitor and help patients avoid secondary lymphedema, we can shift the conversation to PREVENTION rather than just treatment alone.
March is Lymphedema Awareness Month
As an advocate for better care of lymphedema patients, we are at an inflection point to make a difference. Here are 5-ways patients can get involved.
1. Educate yourself on risk factors, treatment, and prevention.
Cancer-related lymphedema is one of the most feared consequences of cancer treatment. When lymph nodes are damaged, the system can become disrupted, causing the lymphatic fluid to build up. This condition, called lymphedema, can lead to painful and sometimes debilitating swelling, as well as infections and hospitalizations. Make sure you understand these risk factors and start taking a proactive stance against lymphedema in your treatment plan.
2. Talk to your physician about risk factors, treatment, and prevention.
Incidence rates of lymphedema among cancer survivors can range from 6-50%, depending on your cancer treatment1. Discuss with your doctor lymphedema risk factors associated with your treatment, so together, you can take the appropriate measures to avoid progression of chronic, secondary lymphedema.
3. Find a provider and get your BIS testing early and often.
Advances in science and technology have made it possible for healthcare professionals to monitor patients at risk for secondary lymphedema. Inquire with your physician to learn more about what institutions in your local area are offering proactive monitoring.
4. Support the Lymphedema Treatment Act
Lymphedema Awareness Month is a great opportunity to drive legislative change to improve access to medically necessary and doctor-prescribed treatment including compression garments. Learn more about this important federal bill and get involved! Lymphedema Treatment Act >>
5. Get Involved!
Organizations like LE&RN have made a huge difference in advancing education and support to lymphedema patients. Join the community and become a member if you aren’t already.
References:
- Shaitelman SF, et al. Recent Progress in the Treatment and Prevention of Cancer-Related Lymphedema. CA Cancer J Clin. 2015;00:00–00.
- Brown JC, et al. The Prevalence of Lymphedema Symptoms among Long-Term Cancer Survivors with or at-risk for Lower Limb Lymphedema. Am J Phys Med Rehabil. 2013 March; 92(3): 223–231. doi:10.1097/PHM.0b013e31826edd97
- American Cancer Society’s Cancer Facts and Figures, 2019. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2019/cancer-facts-and-figures-2019.pdf
- Chirag Shah, et al. The impact of monitoring techniques on progression to chronic breast cancer-related lymphedema: a meta-analysis comparing bioimpedance spectroscopy versus circumferential measurements. Breast Cancer Research and Treatment. https://doi.org/10.1007/s10549-020-05988-6
- Claire Davies, et al. Interventions for Breast Cancer–Related Lymphedema: Clinical Practice Guideline From the Academy of Oncologic Physical Therapy of APTA. https://www.impedimed.com/wp-content/uploads/2021/01/APTA-BCRL-CPG_2020.pdf
- Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Breast Cancer V.3.2020. ©National Comprehensive Cancer Network, Inc 2020. All rights reserved Accessed February 5, 2020. To view the most recent and complete version of the guideline, go online to NCCN.org
LE&RN periodically publishes thought pieces on issues related to lymphatic diseases. These articles are meant to encourage discussion among the community and do not reflect the opinions of LE&RN.