Diagnosis and treatment of lymphedema after breast cancer: a population-based study. PM R 2013 Nov;5(11):915-23
Date
05/21/2013Pubmed ID
23684778Pubmed Central ID
PMC3889213DOI
10.1016/j.pmrj.2013.05.005Scopus ID
2-s2.0-84888016216 (requires institutional sign-in at Scopus site) 15 CitationsAbstract
OBJECTIVE: To examine factors associated with variations in diagnosis and rehabilitation treatments received by women with self-reported lymphedema resulting from breast cancer care.
DESIGN: A large, population-based, prospective longitudinal telephone survey.
SETTING: California, Florida, Illinois, and New York.
PARTICIPANTS: Elderly (65+ years) women identified from Medicare claims as having had an incident breast cancer surgery in 2003.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Self-reported incidence of lymphedema symptoms, formal diagnosis of lymphedema, treatments for lymphedema.
RESULTS: Of the 450 breast cancer survivors with lymphedema who participated in the study, 290 (64.4%) were formally diagnosed with the condition by a physician. An additional 160 (35.6%) reported symptoms consistent with lymphedema (ie, arm swelling on the side of surgery that is absent on the contralateral arm) but were not formally diagnosed. Of those who reported being diagnosed by a physician, 39 (13.4%) received complete decongestive therapy that included multiple components of treatment (ie, manual lymphatic drainage, bandaging with short stretch bandages, the use of compression sleeves, skin care, and remedial exercises); 24 (8.3%) were treated with manual lymphatic drainage only; 162 (55.9%) used bandages, compression garments, or a pneumatic pump only; 8 (2.8%) relied solely on skin care or exercise to relieve symptoms; and 65 (22.4%) received no treatment at all. Multivariate regressions revealed that race (African American), lower income, and lower levels of social support increased a woman's probability of having undiagnosed lymphedema. Even when they were formally diagnosed, African American women were more likely to receive no treatment or to be treated with bandages/compression only rather than to receive the multimodality, complete decongestive therapy.
CONCLUSIONS: Lymphedema is a disabling chronic condition related to breast cancer treatment. Our results suggest that a substantial proportion of persons reporting symptoms were not formally diagnosed with the condition, thereby reducing their opportunity for treatment. The variation in rehabilitation treatments received by women who were formally diagnosed with the condition by a physician suggests that lymphedema might not have been optimally addressed in many cases despite the availability of effective interventions.
Author List
Sayko O, Pezzin LE, Yen TW, Nattinger ABAuthors
Ann B. Nattinger MD, MPH Associate Provost, Professor in the Medicine department at Medical College of WisconsinLiliana Pezzin PhD, JD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Tina W F Yen MD, MS Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Breast Neoplasms
Demography
Female
Humans
Incidence
Longitudinal Studies
Lymphedema
Medicare
Postoperative Complications
Prospective Studies
Risk Factors
United States
