3.9 Review

Use of technology to facilitate a prospective surveillance program for breast cancer-related lymphedema at the Massachusetts General Hospital

Journal

MHEALTH
Volume 7, Issue 1, Pages -

Publisher

AME PUBLISHING COMPANY
DOI: 10.21037/mhealth-19-218

Keywords

Lymphedema; breast cancer; prospective surveillance; screening; technology

Funding

  1. National Cancer Institute [R01CA139118, P50CA08393]
  2. Adele McKinnon Research Fund for Breast Cancer-Related Lymphedema
  3. Heinz Family Foundation
  4. Olayan-Xefos Family Fund for Breast Cancer Research

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BCRL is a negative sequela of BC caused by trauma to the lymphatic system during surgery or radiation. Early diagnosis is crucial, necessitating comprehensive prospective screening using technology such as perometry and optical imaging. Objective data from technology informs diagnosis and treatment, with continued development of cost-effective and portable assessment methods essential for establishing BCRL screening as standard of care.
Breast cancer-related lymphedema (BCRL) is a negative sequela of breast cancer (BC) caused by trauma to the lymphatic system during surgery or radiation to the axillary lymph nodes. BCRL affects approximately one in five patients treated for BC, and patients are at a lifelong risk for BCRL after treatment. Early diagnosis of BCRL may prevent its progression and reduce negative effects on quality of life, necessitating comprehensive prospective screening. This paper provides an overview of technology that may be used as part of a BCRL screening program, including objective measures such as perometry, bioimpedance spectroscopy, tissue tonometry, and three-dimensional optical imaging. Furthermore, this paper comprehensively reviews the technology incorporated into the established prospective screening program at Massachusetts General Hospital. Our prospective screening program consists of longitudinal measurements via perometry, symptoms assessment, and clinical examination by a certified lymphedema therapist ( CLT) as needed. Discussion about use of perometry within the screening program and incorporation of arm volume measurements into equations to determine change over time and accurate diagnosis is included [relative volume change (RVC) and weight-adjusted change (WAC) equations]. Use of technology throughout the program is discussed, including a HIPPA-compliant online research database, the patient's electronic medical record, and incorporation of BCRL-related symptoms [BC and lymphedema symptom experience index (BCLE- SEI) survey]. Ultimately, both subjective and objective data are used to inform BCRL diagnosis and treatment by the CLT. In conclusion, the role of technology in facilitating BCRL screening is indispensable, and the continued development of objective assessment methods that are not only reliable and valid, but also cost-effective and portable will help establish BCRL screening as the standard of care for patients treated for BC.

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