As cancer survival rates continue to improve, more attention must be paid to managing long-term complications associated with cancer treatment, such as lymphedema. Lymphedema, a condition characterized by the accumulation of protein-rich fluid in the interstitial space due to disrupted lymphatic drainage, is a prevalent but often underemphasized issue faced by many cancer survivors.

If left untreated, lymphedema can evolve into a chronic condition that weakens patients’ immune systems, elevates their risk of infection, and negatively impacts their physical functioning, ability to perform daily activities, and psychological well-being.
Breast cancer-related lymphedema (BCRL) is of particular concern, affecting approximately 20% of breast cancer patients, with incidence varying based on treatment type and intensity. BCRL can be caused by lymph node removal, radiation therapy to lymph nodes, certain chemotherapy regimens, and other factors. Beyond its physical and psychological toll, BCRL also carries significant financial implications. Studies estimate that the two-year cost of lymphedema treatment ranges from $14,877 to $23,167, imposing a substantial financial burden on patients diagnosed with late-stage BCRL.

Strategies for Lymphedema Prevention and Early Intervention

While treatment success is primarily measured by survival and recurrence rates, lymphedema risk should also be considered in treatment planning. Employing modern surgical strategies, such as sentinel node biopsies, avoiding axillary dissections in lower-risk patients, and utilizing lymphatic surgery techniques like reverse axillary mapping or lymphatic bypass, can help reduce lymphedema incidence. Additionally, careful consideration of radiation techniques and chemotherapy risks may further mitigate lymphedema risk. However, despite these advances, the risk of lymphedema can never be entirely eliminated.

Identifying patients with early-stage BCRL can be challenging, as the condition initially presents with few and often subtle symptoms before visible damage occurs. However, subclinical disease, characterized by increased extracellular fluid, can develop prior to these more apparent changes. Therefore, detecting subclinical disease before patients report symptoms is crucial for facilitating early intervention and potentially reversing the process before it becomes chronic.

Improving BCRL Detection and Risk Management

To minimize the risk of BCRL becoming a chronic condition, healthcare providers can implement various strategies focused on early detection, prevention, and efficient disease management. Detecting BCRL begins with carefully listening to patients’ concerns about arm feeling and function, supplemented by objective measurements of arm swelling. While volume measurements using circumferential tape measurements, displacement tanks, or perometry have historically been the backbone of lymphedema identification, they can be difficult to perform accurately, especially when done by different people at different times.

Bioimpedance Spectroscopy (BIS) offers a noninvasive and straightforward alternative for measuring total body water, extracellular, and intracellular fluids. By sending a small electrical current through skin electrodes and measuring the resulting voltage, BIS can differentiate between various tissue types based on their electrical properties. In the context of lymphedema, BIS has the potential to detect early fluid buildup before visible symptoms appear, enabling providers to intervene and treat the disease more quickly than traditional volume methods.

Following detection, intervention is crucial. Compression garments and devices that apply controlled pressure to the affected limb have been shown to effectively relieve symptoms and, when used early enough, can reverse lymphedema progression to the point where compression is no longer necessary. Customized exercise programs with trained therapists, delivered digitally or in-person, can also help maintain limb mobility and function, reducing the likelihood of disease progression. Digital platforms provide an efficient means of delivering educational resources, exercise programs, and self-monitoring tools, promoting greater adherence to lymphedema prevention and management practices.

Given the significant impact of BCRL on patients’ quality of life and financial well-being, a comprehensive management strategy is essential. This includes integrating advanced technologies like BIS, emerging digital platforms, innovative patient education approaches, and personalized care.

Collaboration among the entire multidisciplinary breast cancer team to identify lymphedema as early as possible and initiate treatment offers the best chance for patients to avoid long-term impacts. With early therapy being both important and cost-effective, all breast cancer patients should be informed about their risks, and all team members should play a role in addressing lymphedema concerns – making it a core component of the survivorship plan, just as we do for the long-term effects of other treatments.