Cancer-related lymphedema can be prevented, but only if it’s caught early. Surgeons,
you are the patient's best advocate.
To prevent lymphedema, patients need to be identified early and placed on a compression sleeve protocol before they develop symptoms. By the time they experience swelling, the condition is typically irreversible. As a surgeon, you’re uniquely positioned to identify these patients early, before they begin treatment.
Tools like tape measures and perometry lack the accuracy and objective data that are necessary to detect subclinical lymphedema consistently. These technologies rely on significant fluid accumulation to detect measurable increases in limb circumference, and increases in fat and soft tissue that may further complicate interpretation. And when you factor in human variability, these instruments become unreliable.
Today, the only reliable tool we have to spot subclinical lymphedema is bioimpedance spectroscopy (L-Dex®), which measures extracellular fluid. The L-Dex score represents the difference in the amount of extracellular fluid in an at-risk limb compared to an unaffected limb. It uses noninvasive bioimpedance spectroscopy (BIS), which is capable of detecting fluid changes as small as 2.4 tablespoons (36ml).
Discover how using L-Dex has helped Dr. Pat Whitworth and Dr. Laura Lawson, surgeons at the Nashville Breast Center in Nashville, TN detect and prevent lymphedema.
It’s not possible to predict which patients will develop lymphedema. The L-Dex score, however, was shown in the PREVENT trial to detect lymphedema early enough to treat and prevent it1. That’s why every patient should be tested.
Once a patient has been diagnosed with breast cancer, melanoma, or pelvic area cancers, they will be tested by a member of your staff to record a baseline L-Dex score. The test itself takes less than 30 seconds and provides an immediate reading. After cancer surgery, patients should get tested every 3 months for the first 3 years, every 6 months for years 4 and 5, and annually thereafter2.
Evidence shows that if a patient’s L-Dex score increases 6.5 or more from the baseline, that’s a “trigger” to evaluate the patient and initiate intervention1.
Treatment for patients diagnosed with early lymphedema, including standard compression garments worn at home for 4 weeks, 12 hours per day, has been shown to reduce the progression of lymphedema by 95% in breast cancer patients1.
As your patients’ best advocate, you are the best hope for early detection and prevention. All you really need to do is support a prevention program. The basics of lymphedema education and testing can be performed easily by your staff. Ready to take the lead? Then watch the video below to discover how to implement a lymphedema prevention program in your practice.
1. Ridner SH, et al. A Randomized Trial Evaluating Bioimpedance Spectroscopy Versus Tape Measurement for the Prevention of Lymphedema Following Treatment for Breast Cancer: Interim Analysis. Ann Surg Oncol 2019; https://doi.org/10.1245/s10434-019-07344-5.
2. Shah C, et al. Bioimpedance Spectroscopy for Breast Cancer Related Lymphedema Assessment: Clinical Practice Guidelines. The Breast Journal 2016;DOI: 10.1111/tbj.12647.