Authors (including presenting author) :
Wong PS
Affiliation :
Breast Services Centre, Pok Oi Hospital
Introduction :
Lymphedema can result in disfigurement, limited mobility, anxiety, depression and social isolation, significantly diminishing a patient’s quality of life. Consequently, many breast cancer survivors are concerned about developing lymphedema after therapy. Therefore, appropriate counselling and early screening for lymphedema are necessary for breast cancer survivors. As a breast care nurse, we play a crucial role in managing lymphedema. Early detection and prevention of lymphedema can significantly enhance patients’ quality of life. Thus, evaluating patients for lymphedema is critical for early diagnosis. Moreover, educating patients about lymphedema and its associated risks is vital. In 2018, the lymphedema service at NTWC breast care was expanded, leading to the establishment of the Breast Care Nurse Lymphedema Clinic. A new measurement tool, L-Dex, utilizing bioimpedance spectroscopy, has also been implemented to detect early lymphedema.
Objectives :
-To enhance patient awareness of lymphedema through education -To provide preoperative L-Dex and upper limb girth measurements as baseline data for comparison with post operative measurements, aiding in the detection of clinical and subclinical lymphedema. -To initiate decongestive lymphatic therapy, including exercises, pressure garments, manual lymphatic drainage and skin care, as early as possible.
Methodology :
Patients diagnosed with breast cancer who undergo operation as their first definitive treatment are recruited as new case for the assessment clinic. Before operation, patients receive educational talk and nurses conduct baseline L-Dex measurement for each patient using bio-impedance spectroscopy devices. Follow-up appointments are scheduled after cancer treatments. Patients with an L-Dex units greater than 10 or an increase of more than 10 units from baseline are considered to have lymphedema, prompting the initiation of decongestive lymphatic therapy.
Result & Outcome :
From 2018 to 2022, A total of 704 new cases were recruited. During this period, 22 lymphedema cases were identified in nurse assessment clinic, with the majority having undergone axillary dissection. Over 70% were found to have early-stage lymphedema - Stage 0 (subclinical) and Stage 1. No patients presented with Stage 3 lymphedema. Decongestive lymphatic therapy was initiated upon detection. 32% experienced a reversal of their lymphedema condition from stage 1 to stage 0, with L-Dex scores returning to normal or stabilizing around 10. Additionally, 55% of patients in lymphedema symptomatic nurse clinic maintained in relatively stable condition - Stage 1 or early Stage 2 lymphedema with L-Dex score between 20 and 30. However, 9% experienced poorly controlled lymphedema and clinical deterioration, with L-Dex score rising to around 50, attributed to cellulitis and noncompliance with therapy.
