The Cardiovascular Center, Tufts Medical Center, Tufts University School of Medicine, Boston, Mass.
Health Advances LLC, Weston, Mass.
J Vasc Surg Venous Lymphat Disord. 2021 Mar;9(2):461-470. doi: 10.1016/j.jvsv.2020.04.030. Epub 2020 May 26.
The objective of this study was to define the current forms of treatment in a contemporary population of lymphedema (LED) patients for LED related to breast cancer, the most prevalently diagnosed LED comorbidity in Western countries, and phlebolymphedema with venous leg ulcer (PLEDU), a sequela of chronic venous disease. The goals of LED therapy are to reduce edema, thereby improving function and related symptoms, and to improve skin integrity to prevent development of infection. Treatment is generally nonsurgical: conservative care, including complex physical therapy, manual lymphatic drainage, and compression bandaging; or pneumatic compression device (PCD) therapy by a simple nonprogrammable device or an advanced programmable device.
To determine the frequency of individual types of treatment for LED and their relationship to breast cancer-related lymphedema (BCRL) and PLEDU, we queried claims from a deidentified Health Insurance Portability and Accountability Act-compliant commercial administrative insurance database with >165 million members. A total of 26,902 patients identified with LED who had been enrolled with continuous medical benefits for 12 months before and after the index date for the complete years 2012 through 2016 were separated into four treatment categories: no treatment, conservative care, simple PCD (SPCD), and advanced PCD. LED treatment was related to the BCRL and PLEDU comorbidities.
BCRL patients, who represented 32.1% of all study patients, made up 41% of all patients receiving conservative care and 24% of patients receiving PCD therapy. By contrast, PLEDU patients (9.6% of study patients) were proportionally under-represented in the conservative care group (7.8%) but composed a disproportionately high share of the PCD therapy group (17.7%). PLEDU patients represented 23.5% of all LED patients prescribed SPCD therapy, whereas BCRL patients composed 10.3% of total LED patient SPCD prescriptions (P < .001).
Our analysis of a large health care administrative database showed clear differences between the way BCRL and PLEDU patients are treated. Compared with BCRL patients, PLEDU patients were less likely to receive conservative care and more likely to be prescribed SPCDs for pneumatic compression therapy. These differences suggest that lymphatic therapy may be undervalued for treatment of chronic venous swelling and prevention and treatment of PLEDU.
本研究旨在确定当代淋巴水肿（LED）患者的治疗方式，这些患者的 LED 与西方国家最常见的乳腺癌相关，以及静脉淋巴水肿伴静脉性腿部溃疡（PLEDU），这是慢性静脉疾病的后遗症。LED 治疗的目标是减少水肿，从而改善功能和相关症状，并改善皮肤完整性以预防感染。治疗通常是非手术的：保守治疗，包括复杂的物理治疗、手动淋巴引流和压缩绷带包扎；或使用简单的非程控设备或先进的程控设备进行气动压缩设备（PCD）治疗。
为了确定 LED 的各种治疗方法的频率及其与乳腺癌相关的淋巴水肿（BCRL）和 PLEDU 的关系，我们从一个符合健康保险流通与责任法案（HIPAA）规定的匿名商业管理保险数据库中查询了索赔信息，该数据库拥有超过 1.65 亿名成员。我们将在 2012 年至 2016 年的完整年份中，索引日期前和后 12 个月内连续享受医疗福利的 26902 名 LED 患者分为四个治疗类别：无治疗、保守治疗、简单 PCD（SPCD）和高级 PCD。LED 治疗与 BCRL 和 PLEDU 合并症有关。
BCRL 患者占所有研究患者的 32.1%，占所有接受保守治疗患者的 41%和接受 PCD 治疗患者的 24%。相比之下，PLEDU 患者（占研究患者的 9.6%）在保守治疗组中比例偏低（7.8%），但在 PCD 治疗组中所占比例过高（17.7%）。PLEDU 患者占所有接受 SPCD 治疗的 LED 患者的 23.5%，而 BCRL 患者占接受总 LED 患者 SPCD 处方的 10.3%（P<.001）。
我们对大型医疗保健管理数据库的分析显示，BCRL 和 PLEDU 患者的治疗方式存在明显差异。与 BCRL 患者相比，PLEDU 患者更有可能接受保守治疗，而更有可能接受 SPCD 进行气动压缩治疗。这些差异表明，淋巴治疗可能被低估了，用于治疗慢性静脉肿胀和预防和治疗 PLEDU。
