Implementation of a lymphoedema surveillance program (LSP) in the Ballarat Health Services(BHS) surgical breast clinic (SBC) - 18 month follow-up.

Abstract

Background

Breast cancer is the most common cancer to affect women in Australia and up to 30% of these patients will develop lymphoedema. The Australasian Lymphology Association endorses early detection and management of sub-clinical lymphoedema to reduce long-term physical, functional and psychological effects. This pilot project involved the implementation of a Lymphoedema Surveillance Program (LSP) within the Surgical Breast Clinic (SBC).

Objectives/Aims

To investigate the acceptability and feasibility of implementing a LSP in the BHS SBC for patients and staff

Method

Setting: The BHS SBC is a surgical clinic conducted weekly in outpatients to assess breast related conditions. All new breast cancer patients are assessed in this clinic. Participants: All new breast cancer patients who were recommended for surgery as a first line treatment were invited to participate. Exclusion criteria included those referred for nee-adjuvant therapy. Intervention: Training of an advanced practice AHA to perform circumferential measures and bio-impedance analysis as baseline measures and provide simple education. Data collection: Patients and staff in the SBC completed satisfaction surveys. Objective baseline measures, as described above, were collected, along with demographic and relevant health data for patients seen between October 2016 and March 2018.

Results

35 patients were included in the project. Most patients (30/32, 94%) indicated they preferred to have their assessment completed on the day in the Breast Clinic and (29/31) 94% rated the overall experience as 5/5. Most staff (8/9, 89%) strongly agreed with the statement "I support the implementation of the LSP". Follow up results included 34/35 patients were adherent with the program, 13/34(34%) had/have lymphedema, 4/13 resolved and 2/12 continue to have significant lymphoedema.

Implications/Outcomes for Planned Research Project

The LSP secured recurrent funding and patients who were included in the pilot project will continue to be followed up to further analyse the impact of early diagnosis. Data review indicates excellent adherence and positive outcomes for the management of lymphoedema at 12-18 months in this cohort. A research article has been completed and is due for publication.

Final Thoughts

The success of this program in breast cancer patients reinforces the need to extend the program to other tumour streams.