Breast cancer-related lymphoedema (BCRL) – unpleasant swelling caused by a build-up of lymph fluid in the body between the skin and muscle – is a severe complication caused by breast cancer treatments such as radiation, node dissection that affects between 15% to 94% of survivors with breast cancer, both during and after treatment.
This chronic, progressive condition has significant physical, psychosocial and economic impacts on survivors, yet there is currently no consensus on how best to prevent, manage and treat BCRL.
The situation is complicated by current research evidence not being adequately presented in a delivery model framework, and Flinders University researchers are determined that this situation must change.
Narayanee (Yani) Dick, a research assistant at Flinders University’s Caring Future Institute, is working on three separate research studies as part of her PhD, with all of her research components trying to inform better understanding that will inform effective BCRL solutions.
“With a lack of consensus causing critical delays in care, there is a need for clear research-driven evidence to inform a cohesive model of care – and an agreed, effective form of standardised screening,” says Yani.
“The work within my PhD aims to provide recommendations for a BCRL care pathway, focusing on early detection and prevention. And, most importantly, we have been in contact with patient support groups and lymphoedema patient advocates since the inception of these studies, to ensure the voice of breast cancer patients is shaping the focus of our research.”
The first of Yani’s studies, a systematic review of the scope, effectiveness and implementation of Breast Cancer-Related Lymphoedema Models of Care, is currently being assessed. It aims to examine and compare all the evidence of effective BCRL models of care across the breast cancer care continuum.
“Introducing a standard model of care for BCRL needs to not only highlight the effectiveness of different models of care and the interventions within them, but also identify the benefits of different delivery characteristics within those models,” says Yani.
Findings from this study may inform future recommendations for a standardised BCRL care model that will form the basis of future implementation evaluations.
A second study which is currently in its screening stage will examine prospective screening and surveillance for lymphoedema and health-related quality of life in patients with breast cancer.
Current research suggests that a prospective surveillance model can potentially detect BCRL early, when there is still an opportunity to slow its progression or reduce the risk. However, despite emerging evidence advocating the use of prospective screening models that include symptoms, objective assessments and clinical examination, screening is not yet a standard of care.
The aim of this study is to examine the lymphoedema-related changes in symptoms being experienced by breast cancer survivors in South Australia. By using tools during pre-operative screening, this study will be the first prospective trial of its kind to comprehensively monitor BCRL-related changes in patients of all risk levels, adding a clinical examination tool in addition to standard fluid, volume and Quality of Life measurements.
A third study is still being finalised which will examine and identify barriers and facilitators to local implementation of standardised BCRL screening. “Because there are limited Australian practices currently using screening for early BCRL diagnosis and prevention, research is needed to explore the barriers that affect the uptake of standardised screening implementation,” says Yani.
“An international Delphi consensus, led by the Multinational Association in Supportive Care in Cancer, has been published in eClinicalMedicine (part of The Lancet Discovery Science) on measures to prevent breast cancer-related arm lymphoedema, but now we need to assess the barriers and facilitators to the implementation of these international guidelines.”
This study aims to explore and expose all of the relevant factors identified by breast cancer patients, health care providers and hospital management that facilitate or hinder the implementation of international consensus guidelines for preventing BCRL.