Screening and management for breast cancer-related lymphoedema

The lymphoedema screening team at Gold Coast Private with the SOZO device, the latest technology for breast cancer-related lymphoedema. The photo includes from left to right: Ange Carle, Icon Gold Coast Private’s Clinical Lead Radiation Therapist, Sharra Artz, Gold Coast Private’s Breast Care Nurse and Debra Miller, Lymphoedema Physiotherapist.

One in five breast cancer patients who undergo axillary lymph node dissection (ALND) will develop secondary lymphodema.¹

This risk is significantly increased when surgery is combined with radiation therapy and may also be increased by chemotherapy drugs, either alone or in combination with radiation.^2,3 The primary healthcare practitioner plays an important role in the management of breast cancer patients, as lymphoedema can develop weeks, months or years following treatment.

Importance of early detection and intervention

Clinical lymphoedema is preceded by a subclinical or latent stage, where the lymphatic system is impaired, but swelling is not yet obvious. As there is no cure for established clinical lymphoedema, the earlier lymphoedema is detected in a sub-clinical stage, the better it can be managed to prevent progression to clinical signs and symptoms.

International research has shown that regular screening, education, early detection and intervention of lymphoedema can assist in reducing the long-term impacts caused by the progression of the condition and improve a patient’s commitment to self-care. ^4,5 When detected early, the implementation of education, short term compression therapy and exercise can reduce progression of lymphoedema by 95%⁷. This demonstrates the importance of increasing access to lymphoedema screening and management for the local community.

Screening for breast cancer-related lymphoedema

Bioimpedance spectroscopy (BIS) is a recent advancement in lymphoedema screening and offers a non-invasive approach. BIS uses resistance to electrical currents to measure a patient’s total body water, extracellular and intracellular fluid volumes – informing a baseline L-Dex score and allowing clinicians to monitor lymphoedema progression.⁶

Local Radiation Oncologist Dr Dominic Lunn says the recent introduction of a SOZO device in the region, which uses BIS technology, means patients can now access baseline screening to identify their risk of developing lymphoedema and follow-up monitoring.

“I believe the key to managing lymphoedema and improving long-term outcomes for patients is early detection. That is why I am pleased to offer complimentary lymphoedema screening at Icon Cancer Centre Gold Coast Private Hospital and referral to an accredited lymphoedema therapist should subclinical lymphoedema be detected. In this way, I remain committed to supporting our local Gold Coast community to live well during cancer treatment and beyond.”

Multidisciplinary support for breast cancer patients

The optimal management of patients with breast cancer requires the expertise of multidisciplinary specialists, including general practitioners. Through your clinical practice, general practitioners can have a significant impact on the incidence and progression of breast cancer-related lymphoedema through patient education on the importance of early detection and support in accessing lymphoedema screening and early intervention services.

For further information about lymphoedema screening in the Gold Coast, please visit https://iconcancercentre.com.au/treatment/lymphoedema/. Please note, a referral is not required to access the lymphoedema screening service and patients can contact Icon Cancer Centre directly.

References

1. DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol. 2013;14(6):500-515. doi:10.1016/S1470-2045(13)70076-7
2. Boyages, John & Vicini, Frank & Shah, Chirag & Koelmeyer, Louise & Nelms, Jerrod & Ridner, Sheila. (2020). The Risk of Subclinical Breast Cancer–Related Lymphedema by the Extent of Axillary Surgery and Regional Node Irradiation: A Randomized Controlled Trial. International Journal of Radiation Oncology*Biology*Physics. 109. 10.1016/j.ijrobp.2020.10.024.
3. Zhu W, Li D, Li X, et al. Association between adjuvant docetaxel-based chemotherapy and breast cancer-related lymphedema. Anticancer Drugs. 2017;28(3):350-355. doi:10.1097/CAD.0000000000000468
4. Koelmeyer LA, Borotkanics RJ, Alcorso J, Prah P, Winch CJ, Nakhel K, et al. (2019) Early surveillance is associated with less incidence and severity of breast cancer–related lymphedema compared with a traditional referral model of care. Cancer. 125(6):854–62.
5. National Comprehensive Cancer Network. (2020). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Breast Cancer and Survivorship. Retrieved 20 August 2021 https://www.impedimed.com/wp-content/uploads/2021/01/PM-104-Rev-G-NCCN_flashcard_DIGITAL.pdf
6. Warren AG, Janz BA, Slavin SA, Borud LJ. The use of bioimpedance analysis to evaluate lymphedema. Ann Plast Surg. 2007 May;58(5):541-3. doi: 10.1097/01.sap.0000244977.84130.cf. PMID: 17452840.
7. Ridner, Sheila H., Mary S. Dietrich, Koelmeyer, L, John Boyages et al. (2019). A randomized trial evaluating bioimpedance spectroscopy versus tape measurement for the prevention of lymphedema following treatment for breast cancer: interim analysis. Annals of surgical oncology 26, no. 10: 3250-3259.