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Chance-Hetzler J, Armer J, Van Loo M, et al. Prospective Lymphedema Surveillance in a Clinic Setting. J Pers Med. 2015;5(3):311-25doi: 10.3390/jpm5030311.
Chance-Hetzler, J., Armer, J., Van Loo, M., Anderson, B., Harris, R., Ewing, R., & Stewart, B. (2015). Prospective Lymphedema Surveillance in a Clinic Setting. Journal of personalized medicine, 5(3), 311-25. https://doi.org/10.3390/jpm5030311
Chance-Hetzler, Janet, et al. "Prospective Lymphedema Surveillance in a Clinic Setting." Journal of personalized medicine vol. 5,3 (2015): 311-25. doi: https://doi.org/10.3390/jpm5030311
Chance-Hetzler J, Armer J, Van Loo M, Anderson B, Harris R, Ewing R, Stewart B. Prospective Lymphedema Surveillance in a Clinic Setting. J Pers Med. 2015 Aug 25;5(3):311-25. doi: 10.3390/jpm5030311. PMID: 26308061; PMCID: PMC4600150.
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J Pers Med. 2015 Aug 25;5(3):311-25. doi: 10.3390/jpm5030311.

Prospective Lymphedema Surveillance in a Clinic Setting.

Journal of personalized medicine

Janet Chance-Hetzler, Jane Armer, Maggie Van Loo, Blake Anderson, Robin Harris, Rebecca Ewing, Bob Stewart

Affiliations

  1. Sinclair School of Nursing, University of Missouri-Columbia, S235 School of Nursing Building, Columbia, MO 65211, USA.
  2. Sinclair School of Nursing, University of Missouri-Columbia, S235 School of Nursing Building, Columbia, MO 65211, USA. [email protected].
  3. Lymphedema Research Laboratory, Sinclair School of Nursing, University of Missouri, DC 116.05, Suite 408, Mizzou North Campus, Columbia, MO 65211, USA. [email protected].
  4. Ellis Fischel Cancer Center, One Hospital Drive, Columbia, MO 65212, USA. [email protected].
  5. Sinclair School of Nursing, University of Missouri-Columbia, S235 School of Nursing Building, Columbia, MO 65211, USA. [email protected].
  6. Sinclair School of Nursing, University of Missouri-Columbia, S235 School of Nursing Building, Columbia, MO 65211, USA. [email protected].
  7. Statistics Department, University of Missouri-Columbia, 23 Middlebush Hall, Columbia, MO 65211, USA. [email protected].
  8. Sinclair School of Nursing, University of Missouri-Columbia, S235 School of Nursing Building, Columbia, MO 65211, USA. [email protected].
  9. Lymphedema Research Laboratory, Sinclair School of Nursing, University of Missouri, DC 116.05, Suite 408, Mizzou North Campus, Columbia, MO 65211, USA. [email protected].

PMID: 26308061 PMCID: PMC4600150 DOI: 10.3390/jpm5030311

Abstract

The potential impact of breast cancer-related lymphedema (LE) is quite extensive, yet it often remains under-diagnosed until the later stages. This project examines the effectiveness of prospective surveillance in post-surgical breast cancer patients. A retrospective analysis of 49 out of 100 patients enrolled in a longitudinal prospective study at a Midwestern breast center evaluates: (1) time required for completion of bilateral limb measurements and Lymphedema Breast Cancer Questionnaire (LBCQ); (2) referral to LE management with limb volume increase (LVI) and/or LBCQ symptoms; and (3) cost of LE management at lower LVI (≥5%-≤10%) versus traditional (≥10%). Findings revealed a visit timeframe mean of 40.3 min (range = 25-60); 43.6% of visits were ≤30-min timeframe. Visit and measurement times decreased as clinic staff gained measurement experience; measurement time mean was 17.9 min (range = 16.9-18.9). LBCQ symptoms and LVI were significantly (p < 0.001) correlated to LE referral; six of the nine patients referred (67%) displayed both LBCQ symptoms/LVI. Visits with no symptoms reported did not result in referral, demonstrating the importance of using both indicators when assessing early LE. Lower threshold referral provides compelling evidence of potential cost savings over traditional threshold referral with reported costs of: $3755.00 and $6353.00, respectively (40.9% savings).

Keywords: cost; lymphedema; referral; surveillance

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