BREAST CANCER EDGE TASK FORCE OUTCOMES: Assessment Measures of Secondary Lymphedema in Breast Cancer Survivors

Abstract

Background: The Breast Cancer EDGE Task Force reviewed the published evidence on assessment techniques to clinically measure breast cancer related lymphedema (BCRL). In order to identify lymphedema in a timely manner and to objectively document response to interventions, physical therapists need valid and reliable assessment tools. To date, there are several assessment tools used by physical therapists; however, the advantages and disadvantages of each tool and which tool(s) is most appropriate is not well known. Breast cancer related lymphedema assessment tools include: circumferential measurement (CM), water displacement, bioelectrical impedance spectroscopy (BIS), perometry, tonometry, and self-report tools. Purpose: The purpose was to identify specific assessment techniques or tools that could be recommended for use in clinical practice to measure upper extremity secondary lymphedema in breast cancer survivors (BCS). Methods: A systematic literature review was used to appraise the evidence supporting the psychometric properties and clinical utility of assessment techniques in BCS with secondary lymphedema in the upper extremity. Results: Circumferential measurement, water displacement, and BIS received a recommendation of 4 (highly recommended), due to good reliability, validity, and clinical utility. Tonometry, perometry, the Lymphedema Breast Cancer Questionnaire (LBCQ) self-report tool and the Visual Analog Scale, received a recommendation of 2A, unable to recommend at this time due to limited evidence available and/or clinical utility. Conclusion: Breast Cancer EDGE Task Force recommends CM, water displacement, and BIS as routine physical therapy assessment tools for early detection of BCRL and/or to document response to interventions. Perometry is not recommended at this time due to poor clinical utility. Further research is needed to determine psychometric properties for tonometry, the LBCQ, and the Visual Analog Scale. Research is also needed to standardize the diagnostic criteria for each assessment tool to detect early onset of BCRL.