Reducing the Rate of Chronic Breast Cancer Related Lymphedema Through Prospective Surveillance Monitoring Using Bioimpedance Spectroscopy (BIS)
Association of Breast Surgery ePoster Library. Whitworth, MD P. 05/15/17; 166339; P079
Dr. Pat Whitworth, MD
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Abstract
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Introduction: Breast cancer related lymphedema (BCRL) represents a major chronic side effect of breast cancer treatment. Current guidelines support prospective assessment of BC patients for early diagnosis and treatment.
Materials & Methods: From 4-2010 thru 11-2016, 592 patients at high-risk features BCRL (SLNB or ALND, plus RT and/or Taxanes) were evaluated. All were followed prospectively w/L-Dex w/pre-op baseline and minimum of two post-op f/u assessments. Interventions initiated when patient's L-Dex increased by 10+ points in f/u compared to pre-op baseline and consisted of 4-6 weeks of off-the-shelf compression garment. Complete decongestive physiotherapy (CDP) was used as surrogate for development of clinically significant BCRL.
Results: A total of 72 (12.6%) patients w/median f/u of 48 months developed elevated L-Dex scores (>10+) and received treatment. Of these, 39 returned to baseline, while 7 were persistently elevated. These 7 remain subclinical and asymptomatic at last f/u (no progression to chronic/symptomatic BCRL). An additional 22 were diagnosed w/elevated L-Dex scores and currently undergoing treatment (compression garment). 4 were lost to f/u. At last f/u, 18 (3%) had unresolved clinically apparent BCRL requiring CDP.
Conclusions: Results demonstrate prospective monitoring w/intervention triggered by L-Dex elevation using a simple sleeve for 4 weeks resulted in only a 3% rate of chronic, clinically significant BCRL requiring CDP, in a high-risk group of patients. These findings validate recent guidelines supporting prospective screening/intervention for BCRL using BIS for early detection and patient directed interventions for subclinical/early reversible lymphedema to improve patient outcomes and the risk of chronic irreversible lymphedema.
Materials & Methods: From 4-2010 thru 11-2016, 592 patients at high-risk features BCRL (SLNB or ALND, plus RT and/or Taxanes) were evaluated. All were followed prospectively w/L-Dex w/pre-op baseline and minimum of two post-op f/u assessments. Interventions initiated when patient's L-Dex increased by 10+ points in f/u compared to pre-op baseline and consisted of 4-6 weeks of off-the-shelf compression garment. Complete decongestive physiotherapy (CDP) was used as surrogate for development of clinically significant BCRL.
Results: A total of 72 (12.6%) patients w/median f/u of 48 months developed elevated L-Dex scores (>10+) and received treatment. Of these, 39 returned to baseline, while 7 were persistently elevated. These 7 remain subclinical and asymptomatic at last f/u (no progression to chronic/symptomatic BCRL). An additional 22 were diagnosed w/elevated L-Dex scores and currently undergoing treatment (compression garment). 4 were lost to f/u. At last f/u, 18 (3%) had unresolved clinically apparent BCRL requiring CDP.
Conclusions: Results demonstrate prospective monitoring w/intervention triggered by L-Dex elevation using a simple sleeve for 4 weeks resulted in only a 3% rate of chronic, clinically significant BCRL requiring CDP, in a high-risk group of patients. These findings validate recent guidelines supporting prospective screening/intervention for BCRL using BIS for early detection and patient directed interventions for subclinical/early reversible lymphedema to improve patient outcomes and the risk of chronic irreversible lymphedema.
Introduction: Breast cancer related lymphedema (BCRL) represents a major chronic side effect of breast cancer treatment. Current guidelines support prospective assessment of BC patients for early diagnosis and treatment.
Materials & Methods: From 4-2010 thru 11-2016, 592 patients at high-risk features BCRL (SLNB or ALND, plus RT and/or Taxanes) were evaluated. All were followed prospectively w/L-Dex w/pre-op baseline and minimum of two post-op f/u assessments. Interventions initiated when patient's L-Dex increased by 10+ points in f/u compared to pre-op baseline and consisted of 4-6 weeks of off-the-shelf compression garment. Complete decongestive physiotherapy (CDP) was used as surrogate for development of clinically significant BCRL.
Results: A total of 72 (12.6%) patients w/median f/u of 48 months developed elevated L-Dex scores (>10+) and received treatment. Of these, 39 returned to baseline, while 7 were persistently elevated. These 7 remain subclinical and asymptomatic at last f/u (no progression to chronic/symptomatic BCRL). An additional 22 were diagnosed w/elevated L-Dex scores and currently undergoing treatment (compression garment). 4 were lost to f/u. At last f/u, 18 (3%) had unresolved clinically apparent BCRL requiring CDP.
Conclusions: Results demonstrate prospective monitoring w/intervention triggered by L-Dex elevation using a simple sleeve for 4 weeks resulted in only a 3% rate of chronic, clinically significant BCRL requiring CDP, in a high-risk group of patients. These findings validate recent guidelines supporting prospective screening/intervention for BCRL using BIS for early detection and patient directed interventions for subclinical/early reversible lymphedema to improve patient outcomes and the risk of chronic irreversible lymphedema.
Materials & Methods: From 4-2010 thru 11-2016, 592 patients at high-risk features BCRL (SLNB or ALND, plus RT and/or Taxanes) were evaluated. All were followed prospectively w/L-Dex w/pre-op baseline and minimum of two post-op f/u assessments. Interventions initiated when patient's L-Dex increased by 10+ points in f/u compared to pre-op baseline and consisted of 4-6 weeks of off-the-shelf compression garment. Complete decongestive physiotherapy (CDP) was used as surrogate for development of clinically significant BCRL.
Results: A total of 72 (12.6%) patients w/median f/u of 48 months developed elevated L-Dex scores (>10+) and received treatment. Of these, 39 returned to baseline, while 7 were persistently elevated. These 7 remain subclinical and asymptomatic at last f/u (no progression to chronic/symptomatic BCRL). An additional 22 were diagnosed w/elevated L-Dex scores and currently undergoing treatment (compression garment). 4 were lost to f/u. At last f/u, 18 (3%) had unresolved clinically apparent BCRL requiring CDP.
Conclusions: Results demonstrate prospective monitoring w/intervention triggered by L-Dex elevation using a simple sleeve for 4 weeks resulted in only a 3% rate of chronic, clinically significant BCRL requiring CDP, in a high-risk group of patients. These findings validate recent guidelines supporting prospective screening/intervention for BCRL using BIS for early detection and patient directed interventions for subclinical/early reversible lymphedema to improve patient outcomes and the risk of chronic irreversible lymphedema.
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