Breast Cancer Lymphedema Pilot Program: July 2017 Update

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Breast Cancer Lymphedema Pilot Program: July 2017 Update

26-Jul-2017

The Breast Cancer Lymphedema Pilot Program provides assessment, education and service information to patients, both male and female, who are at risk of developing or currently suffering from breast cancer related lymphedema. These patients have undergone mastectomy, lumpectomy with or without immediate reconstruction and lymph node dissection.

They may also be undergoing curative or palliative chemotherapy and/or radiation.  The program was developed in collaboration with the Ministry of Health, Regina Qu’Appelle Health Region, Saskatchewan Cancer Agency, HealthLine 811 and patient advisors.  It was officially launched on February 16, 2016. 

Lymphedema is a condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system, which normally returns interstitial fluid to the thoracic duct, then the bloodstream.  It is a direct result of the modalities used to treat breast cancer, not the cancer itself.  Lymphedema has obvious individual, social and occupational costs.  There is also a significant health care cost associated with treatment.  Studies have demonstrated that women who develop lymphedema following treatment for breast cancer have significantly higher health care costs than those who do not.  The cost of treatment is covered by Saskatchewan Health if a patient is seen through a regional lymphedema service.  Treatment costs are not covered if patients are using private lymphedema services.  Patients may be able to recover some of the costs through their private insurance if applicable. The costs below are average costs indicating the cost of the garments and treatment sessions.

Stage Zero:

Stage 0

Symptoms

Treatment

Cost

-no visible swelling

-sensory complaints

-risk reduction practices

-lymphedema education

-self- Manual Lymphatic Drainage (MLD) as indicated

-exercise

$115-320/year (these costs were supplied by RQHR Physiotherapy Dept.)

Stage Three:

Stage 3

Signs and Symptoms

Treatment

Cost

-progressive swelling with fibrosis

-pain/sensory changes

-limited mobility

-risk of/recurrent infections (cellulitis)

-moderate functional limitations (ADL/work)

-psychosocial implications

-Complex Decongestive Therapy (CDT)

-ongoing Manual Lymphatic Drainage (MLD) treatment/ self-MLD/pump to manage exacerbations

-lymphedema/self-care education

-exercise

-compression garments (day) and night garment

-cellulitis management if indicated

$7,581/year (these costs were supplied by RQHR Physiotherapy Dept.), this does not include the cost of drug therapy and hospitalization if patient admitted with cellulitis

Once an individual is diagnosed with lymphedema it becomes a chronic condition with no “cure”.  Early intervention and treatment programs have been shown to reduce disease progression and improve overall symptom management. 

Typically two calls are made to the patient from the HealthLine Breast Cancer Lymphedema Pilot Program.  The calls are made by Registered Nurses who have had training related to breast cancer lymphedema and post-operative surgical problems that may arise.  The first call is to ensure that the individual, who has had surgery, has access to all the necessary services they require post-operatively.  Some general information on lymphedema and cording are given to the patient at that time.  More detailed information related to lymphedema and treatments are provided during the second call.  The patient is then discharged from the program, unless a third call is requested.  Patients are encouraged to call HealthLine 811 if they have any concerns.

Patients are referred to the program in one of four ways:

  • Referred by the Day-Surgery and In-Patient Units at the Regina General Hospital or Pasqua Hospital post mastectomy or lumpectomy with lymph node dissection. These referrals are made by the nurse working with the patient.
  • Referred by the Saskatchewan Cancer Agency while receiving radiation or chemotherapy treatments. These referrals are made by the radiation therapist or nurse working with the patient.
  • Referral from the Physiotherapy Department at the Pasqua Hospital. If the Physiotherapy Department receives a referral and the patient has not accessed HealthLine, they will redirect to the program. This referral is made by the physiotherapist.
  • Self-referral. Breast cancer patients may self-refer at any time if they live within the Regina Qu’Appelle Health Region.  This referral is made by the patient.

The program has had difficulty obtaining referrals from our referring partners.  From February 16 to December 31, 2016, HealthLine received 108 referrals.  HealthLine has worked extensively to increase the number of referrals that the program is receiving.  From January 1 to March 31, 2017, 38 referrals were received by HealthLine.  HealthLine continues to investigate opportunities to increase the referral volume.  

The feedback HealthLine has received from patients through client satisfaction surveys has been positive.  Patients have enjoyed receiving calls and are grateful for the information that was provided to them; the program has not replaced their health care providers, but it has provided a valuable link to information to support them along the way. 

Submitted by:  Robert Horner, MD, CCFP(EM), ACBOM, Tracy Gardikiotis, BScPT, CLT, CCES, Michelle Fisher, RN CON(C)