Authors (including presenting author) :
Wong KY(1), Wong SL(2), Lee WM(2), Lee MY(2), Chan WW(3), Wong KY(3)
Affiliation :
(1) Nursing Services Division, United Christian Hospital (UCH), (2) Kowloon East Cluster Breast Centre, UCH, (3) Surgical Department, UCH
Introduction :
Research indicates that 3-42% of patients who undergo breast cancer surgery develop lymphoedema.
Studies have shown advanced stage of upper limb lymphedema will present as irreversible enlargement of the affected arm, as a result, it will cause severe impairment in the patient's quality of life.
Prior 2021, KEC Breast Centre faced challenges such as a lack of systematic interdisciplinary collaboration, high workloads, and insufficient staffing to address the complexity of lymphoedema.
In 2021, a Multi-disciplinary Intensive Lymphedema Care Program was established, involving breast surgeons, breast specialist nurses, and physiotherapists to enhance health education on prevention, early detection, and management of lymphedema.
Objectives :
(1) To assess the incidence of lymphedema following breast cancer surgery;
(2) To evaluate the distribution of patients with different stages of lymphedema;
(3) To observe the number of cases that are discharged from the program following early treatment;
(4) To analysis the duration of symptoms that patients experience at different lymphedema stages;
(5) To monitor the recurrence of lymphedema recurrence following program discharge.
Methodology :
The study involved a retrospective review of the database for newly recruited lymphedema cases from January 2022 to December 2024.
The target population included breast cancer patients with post-operative lymphedema. Early detection of lymphedema was facilitated by three key strategies:
1. Education on risk factors and preventive methods of lymphedema, and encouraging them to report to breast specialist nurses if early signs/symptoms develop
2. Providing regular assessment by using L-Dex score by bioimpedance analysis and physical assessments at breast nurse clinic;
3. Providing physical assessment by breast surgeons in the surveillance clinic.
Early treatment was implemented according to the local guidelines based on the stage of lymphedema.
1. For stage 0-1, breast nurses provided early treatment of exercise, skin care, manual lymph drainage or kinesio taping.
2. For stage 2, physiotherapist will provide early treatment of compression pumps and self-bandage.
3. For stage 3, surgeons initiate comprehensive and intensive treatment. Patients can be discharged from the program when L-Dex score below 10 and no signs of swelling, heaviness, or discomfort in the affected limb.
Result & Outcome :
Total of 119 new cases of lymphoedema were reported from 2022 to 2024.
Incidence rate of lymphedema following breast surgery: 23.9% (47/196 x 100%), 14.4% (29/201 x100%) and 16.3% (43/263 x100%) in 2022 to 2024 respectively.
Percentage of subclinical cases (stage 0 and 1) was 85% (40/47 x 100%), 82.7% (24/29 x 100%) and 88.4% (38/43 x 100%) in 2022 to 2024 respectively.
Percentage of stage 2 lymphedema was 14.8% (7/47 x 100%), 17.2% (5/29 x 100%) and 11.6% (5/43 x 100%) in 2022 to 2024 respectively.
No stage 3 lymphedema cases were reported over 3 years.
Duration of symptoms for patients with stage 0 was a mean of 5.2 months (209/40), while a mean of 8.6 months (258/30) in stage I and a mean of 10 months (60/6) in stage 2.
Discharge rate was 86.9% (40/46 x 100%) in stage 0, 52.1% (24/46 x100%) in stage I and 35.2% (6/17 x 100%) in stage 2.
No recurrence record among discharged patients. To review the months of no recurrence observed after discharged from the program to Dec 2024: 20.2 months (588/29), 10.3 months (197/19) and 2.3 months (63/27) in 2022 to 2024 respectively.
No cellulitis cases were reported.
100% patient compliance rate is high including the program and home care lymphoedema prevention.
Conclusions
The data demonstrates the effectiveness of the program in managing lymphedema, particularly in its early stages.
The trend of incidence rate of lymphedema following breast cancer surgery was decreasing and apparently.
The percentage of subclinical cases is high under the early screening of lymphoedema. No stage 3 lymphoedema was reported.
Based on the results, patients experiencing subclinical lymphoedema can typically complete their treatment within 5 to 8 months due to the shorter duration of symptoms.
High discharge rates for subclinical and early-stage patients, along with the absence of reported recurrences, and high patient satisfaction rate demonstrate the program’s success in achieving favorable patient outcomes.
