Lymphedema after breast cancer in a prospective cohort study

Abstract

20736 Background: Breast cancer-related lymphedema (BCRL) is a chronic, debilitating condition that may occur among breast cancer survivors after surgery and/or radiation therapy to the axilla. BCRL patients can experience overall decreased quality of life. Reports of the true incidence of lymphedema vary widely, and no large, population-based studies have been conducted with standardized diagnosis, measurement, and follow-up. Methods: In an ongoing, prospective study of recently-diagnosed breast cancer survivors at Kaiser Permanente Northern California (KPNC), we ascertained the incidence of BCRL based on electronic medical records. Cases were identified by ICD-9 code 4571.0, outpatient procedures for manual lymph drainage, or durable medical equipment orders after breast cancer diagnosis. We compared demographic, medical care utilization, and cancer characteristics among BCRL and non-BCRL women using Pearson’s chi- square test and Satterthwaite t-test. A brief questionnaire about BCRL education was administered at cohort entry among a sample of women. Results: As of 16 October 2007, 111 out of 1,176 breast cancer patients were diagnosed with BCRL (9.4% incidence with up to 22 months of follow-up). The mean time to diagnosis after cancer diagnosis was 6.2 months with the majority (37.9%) diagnosed in the first three months. BCRL patients were younger, had significantly more physical therapy and surgery visits, and had more advanced cancer stage than non-BCRL patients (p<0.05). No differences were observed by BMI at cancer diagnosis. Among 332 respondents, 67.8% reported having received BCRL educational materials from KPNC. Awareness of risk reduction strategies was poor, with only 60.5% and 57.8% reporting avoidance of trauma/injury and arm constriction, respectively. Suggestions for improving BCRL education included a discussion with the surgeon pre- and post-surgery and a mandatory physical therapy meeting post-surgery. Conclusions: Within a large HMO setting, BCRL remains an important health issue despite recent changes in surgical technique to remove positive lymph nodes. More improvements are needed for disseminating BCRL information to breast cancer patients due to mounting evidence that progression can be prevented through early treatment. No significant financial relationships to disclose.