Clinician awareness and knowledge of breast cancer-related lymphedema in a large, integrated health care delivery setting

Abstract

Breast cancer survivors have reported dissatisfaction regarding their education on risk of breast cancer-related lymphedema (BCRL) from clinicians. We describe clinician knowledge and treatment referral of patients with BCRL among active oncologists, surgeons, and primary care physicians in the Kaiser Permanente Northern California Medical Care Program. A total of 887 oncologists, surgeons, and primary care clinicians completed a 10-minute web survey from May 2, 2010 to December 31, 2010 on BCRL knowledge, education, and referral patterns. A knowledge score of BCRL was calculated based on clinician responses. Multivariable regression models were used to determine the associations of selected covariates with BCRL knowledge score and clinician referral, respectively. Compared with primary care clinicians, oncologists had the highest mean score followed closely by surgeons (P < 0.0001). In multivariable analyses, being female, an oncologist or surgeon, and recently receiving BCRL materials were each significantly associated with higher BCRL knowledge scores. About 44% of clinicians (n = 381) indicated they had ever made a BCRL referral (100% oncologists, 79% surgeons, and 36% primary care clinicians). Clinicians with a higher knowledge score were more likely to make referrals. In stratified analyses by specialty, the significant associated factors remained for primary care but became non-significant for oncology and surgery. These results can inform educational interventions to strengthen clinician knowledge of the clinical management of BCRL, especially among primary care clinicians. With the growing number of breast cancer survivors, increasing clinician education about BCRL across all specialties is warranted.

Patient compliance with a health care provider referral for an occupational therapy lymphedema consult

“…Further, health care providers (e.g., surgeons, oncologists, and nurses) play a vital role in cancer rehabilitation through referring patients to see an OT lymphedema specialist. Tam and colleagues [14] found that 100 % of oncologists, 79 % of surgeons, and 36 % of primary care clinicians in their study reported having ever made a referral for breast cancer-related lymphedema.…”

Breast Cancer-Related Lymphedema (BCRL)

“…Foreign substances such as bacteria and toxins are filtered and destroyed in the nodes. The lymph vessels finally open into large ducts-the thoracic duct and right lymphatic duct-and then drain into the neck veins [1][2][3][4].…”

“…The debilitating pain, anguish, suffering, and disfiguring swelling of LE can cause physical and emotional distress. Women who develop LE face a lifetime of treatment [2][3][4][5]. BCRL symptoms can develop any time after breast cancer treatment.…”

“…Although BCRL has largely been neglected by healthcare professionals, there have recently been significant improvements in the awareness, clinical diagnosis, and management of BCRL [4][5][6][7].…”

“…In addition to the day garments used in Phase II, some patients with more severe forms of LE will need night garments or advanced day garments to maintain the reductions obtained in Phase I. These include VELCRO ® brand closure garments and specialized foam compression garments [3][4][5].…”