Today, as breast cancer therapy has continued to improve survival, the impact of long-term treatment complications has taken on greater significance. Lymphedema, a common consequence of cancer treatment, poses significant challenges in healthcare. While the risk of lymphedema varies by the type of cancer, and the type of treatment, operations that have removed lymph nodes, radiation to lymph nodes, and certain types of chemotherapy can all result in lymphedema.
Breast cancer-related lymphedema (BCRL) has significant quality of life and economic implications. A systematic review by Bian, et al. estimated that the two-year cost of treatment for lymphedema ranged from $14,877 to $23,167. Patients diagnosed with chronic lymphedema often experience a reduced quality of life—encompassing physical discomfort and limited mobility—and the loss of economic resources.
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The challenge of early BCRL detection
Identifying patients in the early stage of BCRL can be challenging. Currently, a diagnosis of BCRL is typically made after visible or clinically apparent changes or symptoms occur. Before these changes, subclinical disease occurs as indicated by an increase in extracellular fluid. Accurately identifying subclinical disease before it is symptomatic facilitates early intervention which can help prevent progression to chronic BCRL.
Strategies for BCRL detection
Patient education is an often-overlooked tool in prevention. Educating patients—even before initiating therapy that may increase the risk of lymphedema—about risk factors, early signs of lymphedema, and preventive measures is crucial.
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Healthcare providers can adopt several management approaches incorporating health technology, medical technology, and intervention protocols to reduce the risk of breast cancer-related lymphedema (BCRL) from becoming a chronic condition. Such strategies center on early detection, prevention, and efficient management of BCRL.
Traditional methods of BCRL detection typically involved volume measurements using circumferential tape measurements or volume displacement tanks. Perometry has also been utilized to gauge volume. Issues with volume-based methods were the variability in the measurements when utilizing tape measures, and the concerns that once volume was visibly different that chronic lymphedema may have already set in.
Bioimpedance spectroscopy: A key tool in BCRL detection & management
Bioimpedance spectroscopy (BIS) is a noninvasive, low-cost technology that can accurately measure a patient’s total body water, extracellular, and intracellular fluid volumes in a clinical setting. It works by sending a small electrical current through electrodes on the skin and measuring the impedance to the current. Since different tissues like cells, blood, and fluid conduct electricity differently, BIS can determine the makeup of the underlying tissues based on their electrical properties. This detailed data can help healthcare professionals with early detection, assessment, and interventions for chronic conditions.
BIS is the most advanced method of using bioimpedance measurements to assess fluid levels and tissue composition.
For lymphedema specifically, BIS can detect early fluid buildup before symptoms appear allowing for early intervention. This capability makes BIS an important tool for prevention and management of lymphedema as it allows intervention to start in the early stages of the disease.
Strategies for effective BCRL management
Customized exercise programs, delivered through digital platforms or in-person by trained therapists, can help maintain limb mobility and function, reducing the risk of lymphedema progression. Integration with health tech can track patient progress and adapt programs as needed.
Digital platforms can offer educational resources, exercise programs, and tools for self-monitoring, promoting adherence to lymphedema prevention and management practices. Advanced imaging techniques can visualize lymphatic function and structure, aiding in early diagnosis and the tailoring of individual treatment plans.
Compression garments remain a mainstay of lymphedema treatment. In subclinical lymphedema, even a short course of compression can often reverse lymphedema or prevent its progression to more severe stages of lymphedema. The use of BIS to monitor for the development of chronic lymphedema and to monitor for improvement can often motivate patients to follow through with their therapy.
Embracing comprehensive BCRL management strategies
As cancer survivorship increases, so does the importance of addressing long-term treatment complications like BCRL. The economic and quality-of-life impacts of BCRL necessitate a proactive approach in its management. By integrating advanced technologies such as BIS, compression devices, and digital health platforms, along with emphasizing patient education and customized care, multidisciplinary teams of healthcare providers can significantly improve early detection and prevention strategies.
These measures not only aim to prevent chronic BCRL but also support the overall well-being of cancer survivors. Embracing a comprehensive management strategy that centers the patient’s outcomes is essential in mitigating the risks and enhancing the quality of life for individuals at risk or affected by BCRL.
Photo: FatCamera, Getty Images
Steven Chen, MD, MBA, serves as the Chief Medical Officer of ImpediMed, a pioneer in the field of medical technology. Most recently, Dr. Chen was the Chief Medical Officer for Avelas Biosciences. He has also served as the Chief of Breast Surgery at UC Davis Medical Center, followed by a position as an Associate Professor of Surgery and as the associate program director of the surgical oncology training program at City of Hope National Medical Center in Duarte, California. Dr. Chen is a past President of the American Society of Breast Surgeons and serves on committees for a number of professional societies including the American Medical Association, the Society of Surgical Oncology, and the American College of Surgeons. He is also a practicing surgeon in San Diego, California, and the Director of Surgical Oncology at OasisMD.
