2018 Annual Meeting

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Jeanne-Marie PhillipsSharon Grutman
HealthFlash MarketingThe American Society of Breast Surgeons
203-561-3038sgrutman@breastsurgeons.org
jphillips@healthflashmarketing.com

Preventing Breast Cancer Related Lymphedema:

New Study Finds Early Detection and Intervention Effective for At-Risk Women

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

 

Orlando, May 3, 2018--Early, ongoing screening of lymphatic function and immediate patient-administered therapies as needed are highly effective in improving outcomes for women at high risk for breast cancer-related lymphedema (BCRL).  These were the findings of a new study presented this week at the annual meeting of the American Society of Breast Surgeons. Using bioimpedance spectroscopy (BIS) to measure extracellular fluid, the study found that 82% of women identified at an early stage of lymphatic impairment returned to their normal pre-treatment measurements following therapy. The conservative home treatment program combined compression sleeve garments and self-directed massage.

 

 “This study shows that early intervention is crucial in addressing lymphatic changes before they reach clinically apparent levels that are likely to become permanent,” says researcher Lyndsey Kilgore, MD, University of Kansas Cancer Center. 

 

She explains that BIS technology uses electrical current to assess the body fluid volume and is highly effective in capturing the impact of early stage lymphedema on arm lymphatic drainage.  “Identifying the appropriate patients at the appropriate time is imperative. After the disease has progressed, more complex, costly interventions are necessary with less potential for resolving to the baseline measurements.”

 

A chronic swelling of the arm, lymphedema is a debilitating disease that is linked to certain breast cancer therapies involving the lymph nodes under the arm.  Frequently it is not diagnosed until in clinical presentation when the condition cannot be reversed. Lymphedema’s chronic swelling may lead to decreased arm range of motion and potentially infection, significantly lowering a woman’s quality of life.   

The new study focused on 146 women under treatment for unilateral cancer from 2014 to 2017.  Patients received axillary lymph node dissection, nodal radiation and/or Taxane chemotherapy, which frequently leads to scarring and altered lymphatic flow.  A baseline BIS reading was taken prior to surgery.  Following surgery, 49 patients (34%) were identified with developing subclinical lymphedema, which was defined as a reading two standard deviations above their baseline assessment.

 

After a home therapy program, elevated BI measurements resolved in 40 of these women (82%).  They remained elevated in 9 patients (6%).  These patients were referred for more comprehensive complete decongestive therapy, which typically involves physical and occupational therapy, to address their persistent condition.  Notably, this group had cancers that were characterized by more extensive lymph node involvement, including 8 (89%) with N2 or N3 disease.

 

Emphasizing that this study is good news for breast cancer patients, Dr. Kilgore explains that generally lymphedema rates for similarly treated patients range from 20 to 40%.  “Bioimpedance spectroscopy is a highly effective, fast and non-invasive objective tool in monitoring lymph fluid retention... We hope this study will help usher in a new protocol involving precise, highly controlled monitoring and immediate intervention to reverse early lymphatic changes prior to damage that leads to chronic, irreversible lymphedema.”  

 

 

Expert Commentary:

“Lymphedema remains a significant clinical problem, although rates are decreasing as fewer full axillary node dissections are performed.  This study utilizes bioimpedance spectroscopy, a relatively new but promising technology, to detect early changes in fluid retention and demonstrates a benefit with a simple intervention that patients can do at home. These results are encouraging and should pave the way for larger studies with longer follow up to examine this early detection and intervention paradigm.”

 

Sarah Blair, MD

Breast Surgeon, University of California San Diego and Vice Chair, ASBrS Publications Committee

 

 

Abstract, Official Proceedings

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

Presenter: Lyndsey Kilgore, MD

Institution: University of Kansas Health System

Objective: Breast cancer related lymphedema (BCRL) is a chronic progressive disease that can result from necessary nodal surgery for breast cancer staging and treatment and can cause significant impact in quality of life as well as a profound cost burden to the patient and health care industry. Current NCCN guidelines support baseline measurements with prospective assessment of breast cancer patients to allow for early diagnosis and treatment of BCRL. We sought to determine if baseline measurement with Bioimpedance spectroscopy (BIS) followed by serial postoperative evaluations provide early detection that is amenable to conservative interventions providing a reduction in BCRL.

Methods: Breast cancer patients from a single institution were prospectively evaluated from November 2014 to December 2017, with unilateral disease undergoing treatments high-risk for BCRL. High-risk treatments were defined as axillary lymph node dissection (ALND) with regional nodal irradiation (RNI) and/or Taxane chemotherapy. All patients received baseline BIS measurements prior to surgery followed by serial post-operative measurements in a routine surveillance model, with all individuals having at least 1 year post-operative follow-up. Patients with subclinical lymphedema diagnosed by a BIS result of 2 standard deviations above baseline from preoperative assessment (10+points) were started on at home conservative interventions of a compression sleeve garment and patient directed self-massage for a period of 4-6 weeks. Post-intervention measurements were taken to assess for improvement.

Results: One hundred forty-six patients undergoing high-risk treatment for the development of BCRL were evaluated. A total of 49 (34%) patients developed subclinical lymphedema by elevated BIS scores with self-directed treatment initiated. Of these, 40 (82%) had resolution of elevated measurements (return to normal range for their baseline) at last follow-up. Nine patients had continued elevated measurements that required referral to outpatient complete decongestive therapy (CDT) for a clinically persistent BCRL incidence of 6%. Patients with persistent BCRL had significant nodal burden on final surgical pathology with 8 of the 9 (89%) having N2 or N3 disease. Of these 9 patients, 6 have since died secondary to breast cancer.

Conclusions: Our results demonstrate that prospective monitoring utilizing BIS elevation with conservative early intervention results in significantly lower rates of BCRL requiring CDT in a high-risk group of breast cancer patients. Historically, rates of clinical BCRL in these patients have ranged from 20-40%. These findings support early prospective screening and intervention for BCRL. Early detection with patient directed interventions for subclinical and early lymphedema can improve patient outcomes and decrease the risk of chronic irreversible lymphedema.