QIM22-207: Physical Therapy Assessment for Management of Breast Cancer Related Lymphedema After Axillary Lymph Node Dissection

Authors: Kevin Zhang BA1, Ladan Navari BS1, Amy Li Undergraduate2, Sandy Lee BA3, Yevgeniya Gokun MS3, Min-Jeong Cho MD3, Roman Skoracki MD3, and Ko Un Park MD3
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  • 1 College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
  • | 2 The Ohio State University, Columbus, OH
  • | 3 The Ohio State University Wexner Medical Center, Columbus, OH

INTRODUCTION: Up to 40% of patients after axillary lymph node dissection (ALND) develop breast cancer related lymphedema (BCRL), which has significant medical, financial, and psychosocial implications. NCCN guideline recommends referral to lymphedema specialist for baseline limb measurements of both sides prior to surgery and early detection of lymphedema for optimal management. The goal of this study is to evaluate the rate of physical therapy (PT) assessment after ALND. Methods: Under IRB approval, we retrospectively reviewed those who underwent ALND at a NCCN member institution between 9/2017 and 12/2020. Patient demographics, treatment, and surgical characteristics, including prophylactic lymphovenous bypass (PLVB) were evaluated. Starting 2017, we began to perform PLVB at time of ALND using microsurgical technique. Data on PT attendance were collected for the pre-operative timepoint and for six post-operative timepoints up to two years. P-values were calculated with the chi-square, Fisher’s exact, Wilcoxon rank sum, and Kruskal-Wallis tests. Results: 503 patients underwent ALND; among them 223 (44.3%) had pre-op PT and 340 (67.6%) had at least one post-op PT appointment. The rate of post-op PT decreased over time: 231 (45.9%) patients attended at 3-month, 162 (32.2%) at 6-month, 103 (20.4%) at 9-month, 107 (21.3%) at 12-month, 92 (18.3%) at 18-month, and 49 (9.7%) at 24-month. Patients who underwent PLVB were significantly more likely to complete a pre-op PT appointment (84.2% PLVB vs 31.9% without PLVB) but completed fewer post-op PT appointments (p<0.0001) (Table1). Patients who received neoadjuvant chemotherapy or adjuvant radiation were more likely to have a pre-op PT appointment, while those who received either adjuvant chemotherapy (p=0.0038) or adjuvant radiation (p<0.0001) went to significantly more post-op PT visits. Breast reconstruction at the time of ALND had no effect on PT attendance. Patients attended more pre-op (p<0.0001) and post-op (p=0.0062) PT appointments in the latter years investigated by this study. Conclusion: There is a high rate of attrition over time among patients completing their post-ALND PT appointments. Although there has been improvement over time with PT rates, future research will need to focus on strategies to increase PT follow-ups for early detection and treatment of BCRL.

QIM22-207 Table 1. Clinical Characteristics of Patients who Completed PT Appointments for BCRL Assessment

T1

Corresponding author: Ko Un Park, MD
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