Abstract
The potential impact of breast cancer-related lymphedema (LE) is quite extensive, yet it often remains under-diagnosed until the later stages. This project examines the effectiveness of prospective surveillance in post-surgical breast cancer patients. A retrospective analysis of 49 out of 100 patients enrolled in a longitudinal prospective study at a Midwestern breast center evaluates: (1) time required for completion of bilateral limb measurements and Lymphedema Breast Cancer Questionnaire (LBCQ); (2) referral to LE management with limb volume increase (LVI) and/or LBCQ symptoms; and (3) cost of LE management at lower LVI (≥5%–≤10%) versus traditional (≥10%). Findings revealed a visit timeframe mean of 40.3 min (range = 25–60); 43.6% of visits were ≤30-min timeframe. Visit and measurement times decreased as clinic staff gained measurement experience; measurement time mean was 17.9 min (range = 16.9–18.9). LBCQ symptoms and LVI were significantly (p < 0.001) correlated to LE referral; six of the nine patients referred (67%) displayed both LBCQ symptoms/LVI. Visits with no symptoms reported did not result in referral, demonstrating the importance of using both indicators when assessing early LE. Lower threshold referral provides compelling evidence of potential cost savings over traditional threshold referral with reported costs of: $3755.00 and $6353.00, respectively (40.9% savings).
Highlights
The American Cancer Society [1] estimates that there are more than 2.9 million women living with breast cancer in the United States and annually approximately 235,000 women will develop breast cancer
Data were extracted from 49 patient research charts, electronic medical records, and the institutional billing records in an attempt to determine the effectiveness and cost feasibility of implementation of a prospective surveillance model (PSM) for early identification of LE in a post-surgical breast cancer clinic follow-up setting
The time required for circumferential measurement (Figure 3) in minutes by frequency (n = 163) revealed the majority of measurements were completed in 20 min or less (76.7%), with a one-sample T-Test revealing a mean of 17.9 min with a significant change in per measurement time (p = 0.000)
Summary
The American Cancer Society [1] estimates that there are more than 2.9 million women living with breast cancer in the United States and annually approximately 235,000 women will develop breast cancer. With the improving breast cancer survival rate [1] and survivors being at a life-time risk for developing LE, there is a growing population of women at risk for the development of this complication [2,3], those patients who have undergone lymph node dissection and/or regional radiation [4]. Classified as either primary or secondary (acquired), it is caused by a disruption or malformation of the lymphatic system [5]. Primary LE has no known cause and develops from an insufficiency in the structure or function of the lymphatic system [4] and can be congenital, developing at the onset of puberty, or in adulthood potentially affecting all limbs and parts of the body [5]. Once LE manifests itself, it is considered to be a chronic and life-long condition [11], due to the permanent damage to various lymphatic components [12]
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