A team of investigators at the Massachusetts General Hospital in Boston, Massachusetts, described a screening program for breast cancer-related lymphedema (BCRL) established at their hospital in a report published in the Journal of Personalized Medicine. The program was designed to identify patients with breast cancer who were at increased risk for developing BCRL.

“The risk of developing BCRL remains for a lifetime and it is one of the most feared side effects among breast cancer survivors,” the investigators reported. Research has suggested prospective surveillance is a useful tool for approaching BCRL.

The center’s lymphedema studies program began in 2005, and one of its purposes was to provide access to prospective screening for patients with breast cancer. This program also enabled research regarding incidence, risk factors, and management of the condition. The program has grown to involve a multidisciplinary group that includes oncologists, certified lymphedema therapists, nurse practitioners, and patient advocates. In 2005, the program also acquired a horizontal perometer for measuring patient limb volume.


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At the time of the program’s creation, knowledge on how to screen for BCRL was limited. The group determined that an initial lymphedema screening during preoperative consultation for newly diagnosed breast cancer would serve as the baseline measurement. Patients are usually screened at approximately 6-month intervals to assess changes. The clinical team noted that BCRL appears within a median time of 18 to 24 months.

To screen patients for lymphedema, the team developed a standardized measurement protocol, including pre- and postoperative as well as ongoing regular follow-up measurements; a formula based on patient arm volume to evaluate changes over time; and a risk-based protocol for managing transient edemas that may not require treatment. Although interruption of workflow had been raised as a concern, perometry was integrated well into patient care workflow. Eventually, the team was able to conduct a prospective clinical trial evaluating arm volume changes and patient quality of life.

An additional component of lymphedema screening is patient information, which is initially provided in the form of an information packet explaining BCRL screening. Members of the care team also explain why BCRL screening is performed and features they assess when evaluating for BCRL. Further education regarding BCRL is provided at later visits.

The investigators noted learning from mistakes along the way to optimizing their program. Among the lessons learned, adherence to a strict measurement protocol involving longitudinal assessments was key, as well as paying attention to individual patient risks for developing BCRL.

The team determined that their prospective lymphedema screening program was feasible and sustainable. “We hope that, by sharing our experience of our struggles and success, we can help other institutions establish BCRL screening programs that ultimately contribute to improving BCRL detection and the quality of life of breast cancer survivors,” the clinical team concluded.

Reference

Brunelle C, Skolny M, Ferguson C, Swaroop M, O’Toole J, Taghian AG. Establishing and sustaining a prospective screening program for breast cancer-related lymphedema at the Massachusetts General Hospital: lessons learned. J Pers Med. 2015;5(2):153-64. doi:10.3390/jpm5020153