Enhancing the prospective surveillance and early intervention model of care for women at high risk of developing breast cancer-related lymphoedema
Breast cancer is a major cause of illness burden in Australia, and breast cancer related lymphoedema is known as a significant survivorship issue for an individual following treatment for breast cancer which may impact them physically, psychologically, and financially. Detection of sub-clinical lymphoedema through surveillance and early intervention has been found to reduce progression to clinical lymphoedema. The primary aim of the work presented in this thesis was to explore the prospective surveillance model of care in the early detection and management of breast cancer related lymphoedema and explore ways to enhance this model of care. This primary aim was achieved through the conduct of four clinical research studies with different methodologies over a six-year period.
A retrospective analysis of breast cancer clinical data collected in a private lymphoedema clinic was conducted comparing the traditional model of care to those involved in a prospective surveillance model of care (Study I). This study found that women undergoing early surveillance received lymphoedema care almost two years earlier than women in the traditional referral group. The early surveillance group had significantly lower incidence of clinical lymphoedema than the traditional referral group and those that were diagnosed had significantly less severe lymphoedema.
A qualitative focus group approach (Study II) was carried out to gain an in-depth understanding of attitudes towards lymphoedema home monitoring using bioimpedance spectroscopy (BIS) technology among those at-risk of, or living with, lymphoedema following breast cancer. Five overarching themes were identified regarding perspectives towards home monitoring to improve self-management. These included: Lymphoedema knowledge; Facilitators of self-care; Barriers to self-care; Perceived control; and Overall perceptions of home monitoring. This study supported the concept of home monitoring using BIS as an adjunct to clinic monitoring and self-management in lymphoedema.
Since women were supportive and encouraged by the concept of home monitoring using BIS technology, a cross-sectional study (Study III) was performed, aimed to assess whether there was a validated device that could reliably take BIS measurements in the home setting. The findings of this study supported impedance measurements being made reliably using a new stand-on device which has the potential to be used within a home setting as an adjunct to in-clinic monitoring for those at high risk for developing lymphoedema.
A feasibility study, (Study IV) was then conducted to determine whether the validated stand-on device could be successfully used as a home monitoring device for women at high risk of developing lymphoedema. This study suggests that a prospective surveillance model of care delivered in the home consisting of BIS monitoring, education and support to promote selfmanagement and physical activity for women at high risk of developing lymphoedema is feasible and has the potential to be beneficial.
The work presented in this thesis has demonstrated that home monitoring in addition to in-clinic monitoring is feasible and may assist in detecting sub-clinical lymphoedema earlier. The findings have highlighted the benefits of adopting a prospective surveillance and early intervention model of care in breast cancer in reducing the incidence of clinical lymphoedema and how the concept of home monitoring using BIS technology may further educate, support and empower individuals in their own self-management following breast cancer.
