Monitoring women with breast cancer via a technique called bioimpedance spectroscopy, coupled with the use of conservative, patient-administered therapies, can improve outcomes for those patients at risk for lymphedema, researchers reported.
Those researchers found that use of this technique, along with the administration of this conservative therapeutic regimen, resulted in clinically persistent rates of breast cancer-related lymphedema (BCRL) of 6%, reported Lyndsey Kilgore, MD, of the University of Kansas Cancer Center in Kansas City, and colleagues, during a press briefing at the American Society of Breast Surgeons annual meeting in Orlando.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Breast cancer-related lymphedema is a chronic, progressive disease that sometimes occurs after the removal of axillary lymph nodes. According to the researchers, lymphedema rates for this group of patients have historically ranged from 20%-40%, impacting the quality of life of these women and adding a significant cost burden to both patients and the health system.
National Comprehensive Cancer Network lymphedema guidelines call for baseline measurements of breast cancer patients, followed by serial post-operative measurements, the authors pointed out. Bioimpedance spectroscopy (BIS) is a newer technique used to evaluate lymphedema and measures tissue resistance to an electric current in order to determine extracellular fluid volume.
Kilgore said it is critical to detect those patients at risk for lymphedema before they present with symptoms that are so severe it requires the use of complex, costly interventions, or even results in a condition that can't be reversed.
Her group wanted to determine whether a baseline measurement with BIS, followed by postoperative monitoring, detected lymphatic impairment early enough to allow conservative, patient-administered therapies to reduce the incidence of clinical BCRL.
In this study, 146 patients with unilateral breast cancer were prospectively evaluated from November 2014 to December 2017. These patients underwent treatments considered to be high risk for BCRL, including axillary lymph node dissection with regional modal irradiation and/or taxane chemotherapy.
Each patient received BIS baseline measures prior to surgery, followed by serial post-operative surveillance and at least two follow-up visits. Patients with an elevated BIS score of two standard deviations above baseline were diagnosed with subclinical BCRL and started on patient-administered interventions consisting of a compression sleeve and patient-directed self-massage for a period of 4-6 weeks, after which measurements were taken to assess improvement.
Of the 146 patients in the study, 49 (34%) developed subclinical lymphedema as detected by elevated BIS scores and initiated self-directed treatment. Of these 49 patients, 40 (82%) saw their elevated BIS scores return to a normal range (as determined by baseline), while just nine (6%) continued to have elevated measurements requiring referral for outpatient complete decongestive therapy.
Kilgore's group determined that all patients with stage 0 lymphedema resolved, while two patients with stage 1 died secondary to their breast cancer prior to resolution. No patients with stage 2 or 3 lymphedema had resolution.
"The majority of patients with persistent lymphedema were obese compared to only 48% of the group that had resolution," Kilgore added. "And patients with persistent lymphedema also had significantly more positive lymph nodes on final surgical pathologies, with eight of the nine having N2 or N3 disease."
Six of those nine patients have since died secondary to breast cancer, she pointed out, suggesting that persistent BCRL may be a negative predictor for survival.
"Early detection using BIS with easy patient self-directed interventions for early stage lymphedema can significantly improve patient outcomes and decrease the development of persistent lymphedema," Kilgore concluded, adding that prospective surveillance programs focusing on comprehensive education, and early identification and intervention can have a high success rate for reducing BCRL.
"Lymphedema remains a significant clinical problem, although rates are decreasing as fewer full axillary node dissections are performed," observed Sarah Blair, MD, of the University of California San Diego, who was not involved in the study.
"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," she stated. "These results are encouraging and should pave the way for larger studies with longer follow-up to examine this early detection and intervention paradigm."
Disclosures
Kilgore and co-authors disclosed no relevant relationships with industry.
Primary Source
American Society of Breast Surgeons
Kilgore L, et al "Reducing breast cancer related lymphedema (BCRL) through prospective surveillance monitoring using bioimpedance spectroscopy (BIS) and patient directed self-interventions" ASBrS 2018; Abstract 404018.