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

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

Abstract

Background

Breast cancer-related lymphedema (BCRL) is a chronic progressive disease that results from breast cancer treatment and nodal surgery. NCCN guidelines support baseline measurements with prospective assessment for early diagnosis and treatment. We sought to determine if baseline measurement with bioimpedance spectroscopy (BIS) and serial postoperative evaluations provide early detection amenable to conservative interventions that reduce BCRL.

Methods

Breast cancer patients with unilateral disease high-risk for BCRL from a single institution were evaluated from November 2014 to December 2017. High risk was defined as axillary lymph node dissection with radiation and/or taxane chemotherapy. Patients received preoperative baseline BIS measurements followed by postoperative measurements with at least two follow-ups. Patients with BIS results that were 2 standard deviations above baseline (10 + points) started home conservative interventions for 4–6 weeks. Postintervention measurements were taken to assess improvement.

Result

A total of 146 patients high-risk for BCRL were included. Forty-nine patients (34%) developed early BCRL and started self-directed treatment. Forty patients (82%) had elevated BIS measurements return to normal baseline range. Nine (6%) patients had persistent BCRL requiring referral for advanced therapy. Patients with persistent BCRL had significant nodal burden on surgical pathology; eight (89%) had N2/N3 disease. Six (76%) with BCRL refractory to conservative measures died of their breast cancer.

Conclusion

Our results demonstrated that early conservative intervention for breast cancer patients high risk for BCRL who were prospectively monitored by utilizing BIS significantly lowers rates of BCRL. These findings support early prospective screening and intervention for BCRL. Early detection with patient-directed interventions improves patient outcomes and decreases the risk of persistent BCRL.

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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Lyndsey J. Kilgore
    • 1
  • Sabrina S. Korentager
    • 1
  • Amanda N. Hangge
    • 1
  • Amanda L. Amin
    • 1
  • Christa R. Balanoff
    • 1
  • Kelsey E. Larson
    • 1
  • Melissa P. Mitchell
    • 2
  • John G. Chen
    • 3
  • Emily Burgen
    • 3
  • Qamar J. Khan
    • 4
  • Anne P. O’Dea
    • 4
  • Lauren Nye
    • 4
  • Priyanka Sharma
    • 4
  • Jamie L. Wagner
    • 1
  1. 1.Division of Breast Surgery, Department of SurgeryUniversity of Kansas Cancer CenterKansas CityUSA
  2. 2.Department of Radiation OncologyUniversity of Kansas Cancer CenterKansas CityUSA
  3. 3.Office of Scholarly, Academic and Research MentoringUniversity of Kansas Cancer CenterKansas CityUSA
  4. 4.Department of Medical OncologyUniversity of Kansas Cancer CenterKansas CityUSA

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