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 at the American Society of Breast Surgeons (ASBrS) 19th Annual Meeting (Abstract 404018). 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 pretreatment 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,” said researcher Lyndsey Kilgore, MD, of the 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 BIS 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 patients with breast cancer, Dr. Kilgore explained that generally lymphedema rates for similarly treated patients range from 20% to 40%. “Bioimpedance spectroscopy is a highly effective, fast and noninvasive 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.”
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