Reducing Breast Cancer-Related Lymphedema (BCRL) Through Prospective Surveillance Monitoring Using Bioimpedance Spectroscopy (BIS) and Patient Directed Self-Interventions

Kilgore, Lyndsey J.; Korentager, Sabrina S.; Hangge, Amanda N.; Amin, Amanda L.; Balanoff, Christa; Larson, Kelsey E.; Mitchell, Melissa; Chen, John G.; Burgen, Emily; Khan, Qamar J.; O’Dea, Anne; Nye, Lauren; Sharma, Priyanka; Wagner, Jamie L.

doi:10.1245/s10434-018-6601-8

Cited by 68 publications

(52 citation statements)

References 24 publications

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“…17,[21][22][23][24][25][26] When fluid accumulates and remains in the affected limb, inflammatory and hemodynamic changes increase in severity, 27 and early intervention may prevent or delay progression. Similarly, Kilgore and colleagues 30 reported that only 6% of 146 patients developed chronic lymphedema after early intervention, supporting the observations of Whitworth and colleagues. Similarly, Kilgore and colleagues 30 reported that only 6% of 146 patients developed chronic lymphedema after early intervention, supporting the observations of Whitworth and colleagues.…”

Section: Introductionsupporting

confidence: 56%

“…Indeed, Whitworth and colleagues 28,29 observed that, of 93 high-risk patients who underwent axillary lymph node dissection and were managed with prospective surveillance, only 3% required additional therapies or had evidence of chronic BCRL over a median 2 years of follow-up. Similarly, Kilgore and colleagues 30 reported that only 6% of 146 patients developed chronic lymphedema after early intervention, supporting the observations of Whitworth and colleagues.…”

Section: Introductionsupporting

confidence: 56%

“…Cancer March 15, 2019 observed that only 3% of 93 patients progressed from subclinical to clinical lymphedema. Iyigun and colleagues 35 reported that the detection of subclinical lymphedema in 22% of their cohort led to only 14% progressing to clinical lymphedema; and Kilgore and colleagues 30 also observed that only 6% of 146 high-risk patients developed persistent BCRL after early intervention. In our study, we noted that 10% of women who were diagnosed with lymphedema in the early surveillance group were diagnosed with subclinical lymphedema (stage 0) compared with only 1% of those in the traditional referral group, allowing for a greater proportion of women in the early surveillance group to access early intervention to prevent progression to clinical lymphedema.…”

Section: Discussionmentioning

confidence: 99%

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Early surveillance is associated with less incidence and severity of breast cancer–related lymphedema compared with a traditional referral model of care

Koelmeyer

Borotkanics

Alcorso

et al. 2018

Cancer

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Background Bioimpedance spectroscopy (BIS) has enabled the early identification of breast cancer‐related lymphedema. In this study, differences in health service metrics and in the incidence of breast cancer‐related lymphedema are evaluated in an early surveillance model of care compared with a traditional referral model of care. Methods In a retrospective analysis of data from 753 women who underwent BIS measures between January 1, 2007 and December 31, 2016, 188 women were assigned to the “early surveillance” group if they began lymphedema monitoring presurgery (n = 121) or within 90 days postsurgery (n = 67), and 285 women were assigned to the “traditional referral” group if they began monitoring after 90 days postsurgery. Health service metrics were calculated as the time to the first BIS measure after 90 days postsurgery, the median follow‐up, and the number of health care visits. Lymphedema was diagnosed based on BIS measures. Results Women in the early surveillance group received lymphedema care significantly earlier than those in the traditional referral group. However, there was no difference in the number of visits per year to the clinic between groups. Significantly more women in the traditional referral group were diagnosed with clinical lymphedema (stage I‐III, 39 % vs 14%; P < .001) and with greater severity (stage II‐III, 24%) compared with those in the early surveillance group (4%). Conclusions The current findings support the adoption of an early prospective surveillance model of care using BIS for the early detection and management of breast cancer–related lymphedema.

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Section: Introductionsupporting

confidence: 56%

Section: Introductionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

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Early surveillance is associated with less incidence and severity of breast cancer–related lymphedema compared with a traditional referral model of care

Koelmeyer

Borotkanics

Alcorso

et al. 2018

Cancer

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“…Other high-risk groups included populations receiving axillary node radiation and taxane chemotherapy. 22 , 23 In all PSM studies, interventions were initiated when subclinical lymphedema was detected either by BIS L-Dex scores of ≥10 22–25 or a 3% increase from preoperative volume using perometry ( Suppl. Tab.…”

Section: Prospective Surveillance Model and Identified Subclinical (Imentioning

confidence: 99%

Interventions for Breast Cancer–Related Lymphedema: Clinical Practice Guideline From the Academy of Oncologic Physical Therapy of APTA

et al. 2020

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A work group from the American Physical Therapy Association (APTA) Academy of Oncologic Physical Therapy developed a clinical practice guideline to aid clinicians in identifying interventions for people with breast cancer–related lymphedema, targeting volume reduction, beginning at breast cancer diagnosis and continuing through cancer treatments and survivorship. Following a systematic review of published studies and a structured appraisal process, recommendations were developed to guide physical therapists and other health care clinicians in their intervention selection. Overall, clinical practice recommendations were formulated based on the evidence for each intervention and were assigned a grade based on the strength of the evidence. The evidence for each specific intervention was synthesized and appraised by lymphedema stage, when the information was available. In an effort to make recommendations clinically applicable, they were presented by modality throughout the care trajectory. Methodology and research populations varied significantly across studies, and it will be important for future research to use standardized definitions for participant characteristics, diagnostic criteria, and interventions.

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“…A new standard of practice in cancer care is warranted because of the improvement in outcomes evident when exercise is integrated into cancer care from diagnosis through treatment. The value proposition of prospective personalized exercise clinical pathways in oncology is that they promote early detection of physical decline and prompt exercise interventions that mitigate or ameliorate many cancer treatment–related symptoms, reduce impairment and disability, 83,84 enhance return to work and social roles, 85,86 and positively influence health endpoints such as infection rates, hospitalization rates, and chemotherapy tolerability in some populations 87‐89 . The proposed 5 domains offer a framework for efficient and effective screening that enables exercise referrals best suited to an individual's existing and evolving needs.…”

Section: Integration To Practice: a Call To Actionmentioning

confidence: 99%

An exercise oncology clinical pathway: Screening and referral for personalized interventions

Stout

Brown

Schwartz

et al. 2020

Cancer

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INTRODUCTIONThere are approximately 17 million cancer survivors living in the United States, and by 2040, this estimate is predicted to increase to 26.1 million. 1 Exercise provides a myriad of health benefits to individuals during and after cancer treatment by reducing treatment-related symptoms, improving functional status and quality of life, and lowering the risk of disease recurrence. 2,3 Despite the established benefits, an individual's level of physical activity often decreases during treatment and does not return to prediagnosis levels after treatment completion. 4,5 Although exercise is regarded as safe and beneficial for individuals with cancer, promoting exercise for this population is complex. A patient-centered pathway is needed that can guide oncology and primary care professionals in the efficient assessment of an individual's condition and enable personalized referrals for exercise interventions that promote physical activity. The purpose of this article is to provide a framework for clinical decision making that enables personalized condition assessment, risk stratification, and referral to optimal settings for exercise promotion for cancer survivors. Implementation strategies are also offered to support the integration of this model into an oncology clinical workflow.With guidance from their medical provider, individuals are more likely to engage in exercise and maintain levels of physical activity during cancer treatments. 6 However, the number of individuals with cancer who report receiving exercise-specific guidance from their health care providers is low. 7 Of particular concern is the lack of knowledge and training among health care professionals about exercise prescription for this complex population. 8

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Reducing Breast Cancer-Related Lymphedema (BCRL) Through Prospective Surveillance Monitoring Using Bioimpedance Spectroscopy (BIS) and Patient Directed Self-Interventions

Cited by 68 publications

References 24 publications

Early surveillance is associated with less incidence and severity of breast cancer–related lymphedema compared with a traditional referral model of care

Early surveillance is associated with less incidence and severity of breast cancer–related lymphedema compared with a traditional referral model of care

Interventions for Breast Cancer–Related Lymphedema: Clinical Practice Guideline From the Academy of Oncologic Physical Therapy of APTA

An exercise oncology clinical pathway: Screening and referral for personalized interventions

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