RESEARCH REPORT POSTER DISPLAY

EARLY DIAGNOSIS AND TREATMENT INTERVENTION FOR LYMPHEDEMA: A CASE CONTROL SERIES. Gergich N¹, Washington F², Pfalzer L³, McGarvey C⁴; ¹National Naval Medical Center, Bethesda, Maryland, USA. ²University of Maryland School of Medicine College Park, Maryland, USA. ³University of Michigan – Flint, Flint, Michigan USA. ⁴National Institutes of Health, Bethesda, Maryland, USA

PURPOSE: To investigate the efficacy of a prospective screening method to diagnose early stage lymphedema and an early intervention for lymphedema management in patients recently diagnosed and treated for breast cancer. RELEVANCE: The current incidence of breast cancer related lymphedema is approximately 15% of all breast cancer patients following axillary lymph node dissection (AXLND) and 33% of patients treated with AXLND and radiation therapy (RT) (Petrek 2000). Lymphedema impacts quality of life; range of motion (ROM), pain, and strength (Armer 2003, Box 2002). Methods used to measure LE have included circumferential limb girth using a tape measure (anthropometric), water displacement (volumetric), infrared optoelectronic, and most recently, bioimpedence. Traditionally these methods are employed after the condition becomes clinical apparent (visually detected), resulting in delayed diagnosis and treatment of an irreversible stage of LE which will require ongoing therapeutic management. Complete Decongestive Therapy is the current standard of care for lymphedema in advanced stages (ISL 2001). There is currently no evidence-based standard treatment outlined in the literature for early stages of lymphedema. PARTICIPANTS: A subset of eleven women with lymphedema, ages ranged from 51 to 73 with a mean of 60 years, identified from those enrolled in a prospective IRB approved study. METHODS: This was a case control study with the subjects unaffected arm designated as the control. Lymphedema was defined as a>3% limb volume change in their affected limb as compared to their pre-operative volume as measured by the optoelectronic volumeter (Perometer^®)at 1, 3, 6, 9, 12 month follow-up. Diagnosis of lymphedema was made by the PT at their regular follow up visit or when the patient presented with signs of lymphedema. Upon diagnosis of early stage lymphedema an intervention was instituted using a ready-made compression garment of 20 to 30mmHg, worn daily for 2 weeks. ANALYSIS: The data were analyzed using a 2-way Repeated ANOVA of limb volume with Arm and Time as repeated factors and mean values. RESULTS: At baseline no statistically significant difference was identified in limb volume within the group between the Unaffected arm (UA) and Affected arm (AA) (p = 0.349). Upon diagnosis of lymphedema a statistically significant difference in limb volume was identified between the subjects UA and AA (p = 0.001). From baseline to intervention the average duration was 8.2 months which was significant (p = 0.07). From diagnosis to Post-intervention a significant decrease in AA volume (p = 0.010) was noted. Post-intervention there was no statistically significant difference in limb volume between the UA and AA (p = 0.701) within the group. CONCLUSIONS: The compression garment provided a successful intervention for early stage lymphedema and, with future investigation, may emerge as a cost-effective standard of care. IMPLICATIONS: Pre-operative measurement and assessment of women diagnosed with breast cancer is imperative for the early detection and management of impairments including lymphedema. Conservative treatment interventions, such as ready-made garments, may be efficacious in managing early stage lymphedema. KEYWORDS: Lymphedema, case control, compression. FUNDING ACKNOWLEDGEMENTS: none. CONTACT: nlgergich@bethesda.med.navy.mil

ETHICS COMMITTEE: National Institutes of Health IRB and National Naval Medical Center IRB. Protocol # B01-52