Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA.
Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA.
J Surg Oncol. 2024 Aug;130(2):204-209. doi: 10.1002/jso.27735. Epub 2024 Jun 14.
We evaluated the unmet breast cancer-related lymphedema (BCRL) treatment and education needs at New England's largest safety-net hospital serving a diverse population by assessing prevalence, risk factors, and treatment.
This was a retrospective cohort study examining breast cancer surgery patients from September 2016 to September 2021. The primary outcome was BCRL diagnosis. Secondary outcomes included BCRL risk factors, and physical and occupational therapy (PT/OT) referral frequency and completion.
Of 639 patients, 17% of patients had documented BCRL, which was significantly associated with axillary lymph node dissection (ALND). There were no racial, insurance, breast radiation, or BMI category differences between patients with and without a BCRL diagnosis. Of those with BCRL, 58% received a PT/OT referral, and 56% completed their referral. There were no racial, insurance, or BMI category differences between those who received a PT/OT referral and those who did not.
In our high-risk population, rates of documented BCRL were higher than expected, approaching rates of ALND, despite the majority undergoing sentinel lymph node biopsy (SLNB). PT/OT referral and completion rates were low, concerning for an unmet BCRL treatment and education need. No disparities in care delivery were seen, but a program that addresses treatment gaps and ensures accessible and patient-centered BCRL care is urgently needed.
我们通过评估发病率、风险因素和治疗方法，评估了新英格兰最大的服务于多元化人群的保障网医院中未满足的乳腺癌相关淋巴水肿（BCRL）治疗和教育需求。
这是一项回顾性队列研究，研究对象为 2016 年 9 月至 2021 年 9 月期间接受乳腺癌手术的患者。主要结局是 BCRL 诊断。次要结局包括 BCRL 的风险因素、物理治疗和职业治疗（PT/OT）转介频率和完成情况。
在 639 名患者中，17%的患者有记录的 BCRL，这与腋窝淋巴结清扫术（ALND）显著相关。在有或没有 BCRL 诊断的患者之间，没有种族、保险、乳房放疗或 BMI 类别差异。在有 BCRL 的患者中，58%的患者接受了 PT/OT 转介，56%的患者完成了转介。在接受 PT/OT 转介和未接受转介的患者之间，没有种族、保险或 BMI 类别差异。
在我们的高危人群中，记录在案的 BCRL 发生率高于预期，接近 ALND 的发生率，尽管大多数患者接受了前哨淋巴结活检（SLNB）。PT/OT 转介和完成率较低，表明 BCRL 的治疗和教育需求未得到满足。在护理提供方面没有发现差异，但迫切需要一个方案来解决治疗差距，并确保可及和以患者为中心的 BCRL 护理。
