Aggressive Management of Lymphedema Improves Quality of Life for Breast Cancer Survivors

A new study shows how noninvasive measurement and conservative treatment can dramatically improve outcomes for breast cancer survivors experiencing lymphedema.

Lymphedema is caused when lymph vessels are blocked or disabled, preventing excess lymphatic fluid from returning to the bloodstream. It’s a common side effect of lymph node dissection associated with breast cancer surgery, but it can begin many years after surgery. Its chronic swelling may lead to pain in the affected arm, decreased range of motion and infection, significantly lowering a woman’s quality of life.

Thanks to advances in treatment, the number of long-term survivors of breast cancer is increasing. Patients who have passed the acute phase of treatment may no longer be seeing a breast surgeon regularly. Early signs of lymphedema can easily be missed.

A study conducted by researchers at The University of Kansas Cancer Center has found that early, ongoing screening of lymphatic function and immediate patient-administered therapies are highly effective in improving outcomes for women at high risk. National rates for lymphedema are 7% after sentinel lymph node dissection and 30% after axillary dissection. Our rates at the cancer center are 1% for sentinel node dissection and 5% for axillary dissection.

The key to our success is bioimpedance spectroscopy (BIS). This technology uses electrical currents to assess the body fluid distribution and is highly effective in identifying lymphedema at early stages prior to the onset of clinical symptoms. It is far superior to using a tape measure. The procedure is being covered by about 60% of payers today, and more insurance programs are getting on board.

Our study used BIS to establish a baseline measurement before surgery. We 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.

Even without a presurgery benchmark, however, we can now act aggressively when we first notice swelling and can reverse its progress. That means the slightest signs of swelling, heaviness, pain or infection in the affected arm of a breast cancer survivor should be investigated and treated more assertively.

We believe in the power of strong partnerships with our patients' primary care providers and proactively coordinate care with referring providers. Our team at The Women's Cancer Center at The University of Kansas Cancer Center wants to deliver the very best care available, and we can do that only by working collaboratively.

Dr. Wagner's clinical practice is focused on breast surgery and treatment of malignant and benign diseases of the breast. Her specialties include oncology, oncoplastics and second opinions in breast surgery.