Oncology Rehabilitation: Screening for Lymphedema Prevention

By Jana Tobin, PT, CLT, and Amy Litterini, PT, DPT

Lymphedema (lim-fi-dee-muh) is swelling caused by the build-up of fluid under your skin. This swelling can occur in an area around where lymph nodes were removed, or in an area that has been treated with radiation. MaineHealth offers an innovative program to reduce the impact of lymphedema in cancer survivors by using new technology. The program and equipment, available at the Breast Care Center in Scarborough and the Pen Bay Rehabilitation Center in Rockport, is intended for use with at-risk cancer survivors, including individuals with breast cancer.

Lymphedema is a leading post-treatment complication for many cancer survivors that costs the U.S. healthcare system an estimated $7 billion every year. Patients who undergo surgical, radiation, or certain chemotherapy treatments for breast, melanoma, or pelvic area cancers may have damage to the lymphatic drainage system in one or more limbs. There are 1.9 million newly diagnosed cancer survivors every year in the U.S., and 58% are at risk of developing limb lymphedema. It is estimated that one in three at-risk cancer survivors will develop lymphedema. Previously cancer survivors were not routinely monitored, but now there is new technology to aid in the early detection of lymphedema.

The lymphedema prevention program at Maine Medical Center and Pen Bay utilizes the latest lymphedema detection technology called L-Dex. L-Dex is a measurement of fluid buildup in an at- risk limb compared to a healthy limb. It is measured on the SOZO® device, which uses a sophisticated technology called bioimpedance spectroscopy (BIS). The SOZO test is non-invasive, takes less than 30 seconds to complete, and provides results immediately after the test. At-risk patients receive a baseline measurement and then are measured regularly after cancer treatment (i.e. every three months for two years). An L-Dex increase of 6.5 or more from baseline is an indication that lymphedema is developing and intervention is needed. Recently published data from the largest randomized trial to assess lymphedema prevention, the PREVENT trial, showed that early detection using L-Dex combined with intervention can stop 92% of patients from progressing to chronic lymphedema through three years. Other methods of measurement, such as use of a tape measure by a trained clinician, have also been found to be effective if used regularly and consistently. The key is good communication with oncology providers, and routine monitoring for symptoms for early detection and treatment.