Chirag Shah MD, Presenter: Nothing to Disclose

Chad Ermis, Abstract Co-Author: Nothing to Disclose

Justin Riutta MD, Abstract Co-Author: Nothing to Disclose

Frank A. Vicini MD, Abstract Co-Author: Nothing to Disclose

To evaluate the impact of the development of a breast-cancer related lymphedema (BCRL) program on the management of women with breast cancer.

In 2004, a BCRL program was developed at William Beaumont Hospital (WBH) in order to increase awareness regarding BCRL among physicians and patients and to have more patients evaluated by a BCRL expert electively rather than after developing significant morbidity. This program focused on education-oriented measures to help eliminate patient, physician, and institutional barriers. Indications for patient referral and therapies recommended were evaluated and compared during a 5-year time interval.

At inception, the majority of cases seen in the clinic focused on existing BCRL (86%) with no patients seen electively and the second most common complaint being related to shoulder/rotator cuff complaints (11.5%). 91% of all patients had clinically evident lymphedema at presentation regardless of chief complaint. 70% of patients with BCRL were managed with complex decongestive physiotherapy at inception. With regards to shoulder dysfunction, 24 patients (27.6%) had decreased range of motion at presentation while 65 (74.7%) had some form of shoulder weakness. Five-years after inception, 25% of all new breast cancers diagnosed at WBH were seen electively in the clinic and over 20% of new clinic consults were for prospective surveillance. Compared with historical controls, significantly more patients with BCRL were referred to the BCRL clinic.

Five years following the inception of a BCRL clinic that focused on physician and patient education, significant increases in elective BCRL visits and overall referrals were seen. In order to be an effective program, BCRL programs must focus on related morbidities especially shoulder and rotator cuff complaints. Combined with recent improvements in the early diagnosis of BCRL, a decrease in the incidence of the later stages of the disease is anticipated with longer follow-up.

This analysis shows that organized BCRL programs can improve elective assessment of BCRL potentially reducing morbidity.

Shah, C, Ermis, C, Riutta, J, Vicini, F, Implementation of a Breast Cancer-related Lymphedema Management Program.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11009664.html