Purpose: To provide an overview of the lymphatics, physiology of lymphedema (LE), incidence, risks, and costs as well as a guide for the primary care provider on how to recognize the symptoms of LE, a review of current published treatment recommendations, and advice about making a referral to appropriate LE specialists. Data sources: Selected studies on diagnosing and treating LE in breast cancer patients following mastectomy/lumpectomy and evidence-based treatment guidelines. Conclusions: LE is the most common complication related to breast cancer treatment with an occurrence estimated between 10% and 60% depending on the parameters used for measurement. Most commonly, LE occurs within the first 3 years after breast cancer treatment, but the remaining cases happen beyond this period of time and can occur after many years. This means that significant numbers of patients with LE can present to primary care clinicians. Implications for practice: A patient who is treated for breast cancer will be followed for a time by the oncology team, but eventually, that patient will be discharged from the oncology practice and will be seen in primary care. Risk factors for developing LE include treatment-related (number of nodes removed and radiation to axilla), disease-related (stage and location of tumor), and patient-related (younger age, obesity, and comorbid conditions) factors. A systematic evaluation of any patient presenting with LE will assure accurate diagnosis and prompt treatment.According to cancer statistics for 2008, the number of people with a new diagnosis of breast cancer was estimated to be 184,450, with breast cancer deaths of 40,930. Breast cancer continues to be the most commonly diagnosed malignancy for women and the second most common cancer death (second to lung cancer). Although the incidence of breast cancer appears fairly stable, deaths from breast cancer are declining. This is a result of increases in quality screening (mammography) and ability to detect breast cancer in earlier stages. With this difference in rates of survival and incidence, it stands to reason that more people will be breast cancer survivors (Jemal et al., 2008).

Myelosuppression, the reduction of platelets and red and white blood cells, is the most common side effect of chemotherapy. Filgrastim and pegfilgrastim are used to assist recovery in patients with low white blood cell counts. This article explores the dosing, efficacy, cost, and clinical considerations of filgrastim and pegfilgrastim in neutropenia care. Increased knowledge of the medications may contribute to positive patient outcomes. As the price of hospitalization increases, prophylactic dosing of filgrastim and pegfilgrastim becomes more cost effective. In addition, clinical outcomes are improved through a reduction in length of hospital stays and the need for IV antibiotic administration.