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      • Record: found
      • Abstract: found
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      Is Open Access

      Building a Multidisciplinary Comprehensive Academic Lymphedema Program

      research-article
      Author(s): , MD, MBChB, MSc, MEd, FRCS(Plast) 1 , , , MD, FACS 1 , , MD, MPH, FACS 1 , , MD, FACS 1 , , MD, FACS 1 , , MD, FACS 1 , , MD, PhD, FACS 1 , , MD, FACS 1
      Publication date (Electronic):
      Journal: Plastic and Reconstructive Surgery Global Open
      Publisher: Wolters Kluwer Health

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Background:

          Lymphedema is a debilitating clinical condition predominantly affecting survivors of cancer. It adversely affects patients' quality of life and results in substantial cost burdens to both patients and the healthcare system. Specialist lymphedema care is optimally provided within integrated clinical programs that align the necessary specialties to provide patient-focused, multidisciplinary, structured, and coordinated care. This article examines our experience building a specialist lymphedema academic program.

          Methods:

          We describe the critical components necessary for constructing a multidisciplinary comprehensive academic lymphedema program. Furthermore, lessons learned from our experience building a successful lymphedema program are discussed.

          Results:

          Building a comprehensive academic lymphedema program requires institutional support and engagement of stakeholders to establish the necessary infrastructure for comprehensive patient care. This includes the infrastructure for outpatient clinical assessment, diagnostic investigations, radiological imaging, collection of outcomes metrics, non-surgical treatment delivered by lymphedema-specialist therapists, surgical procedures using specialized equipment, and integration of an outpatient framework for comprehensive patient evaluation during follow-up at standardized time intervals.

          Conclusions:

          This article examines our experience building a multidisciplinary comprehensive academic lymphedema program and provides a structured roadmap to benefit others that are embarking on this mission.

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          Most cited references50

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          A prospective analysis of 100 consecutive lymphovenous bypass cases for treatment of extremity lymphedema.

          David Chang, Hiroo Suami, Roman J Skoracki (2013)
          The authors prospectively evaluated the efficacy of lymphovenous bypass in patients with lymphedema secondary to cancer treatment.
          Article 0 comments Cited 115 times – based on 0 reviews     Review now
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            Estimating the population burden of lymphedema.

            Stanley Rockson, Brian K Rivera (2007)
            Lymphedema is a complex, regional edematous state that ensues when lymph transport is insufficient to maintain tissue homeostasis. The disorder is remarkably prevalent, but the population implications of lymphatic dysfunction are not well-studied. Prevalence estimates for lymphedema are relatively high, yet its prevalence is likely underestimated. The ability to estimate the burden of disease poses profound implications for current and future lymphedema patients, but the challenge to correctly surmise the incidence and prevalence of lymphedema is complex and the relevant medical literature is scanty. In the absence of the highly desired, prospectively designed and rigorously performed relevant epidemiologic studies, it is instructive to look at the existing studies of lymphedema disease burden. In the current review, the extant literature is examined in the context of the disease setting in which tissue edema is encountered. Incidence or prevalence estimates are provided or inferred, and, where feasible, the size of the subject population is also identified. It is extremely attractive to contemplate that future approaches will entail formal, prospectively designed studies to objectively quantitate incidence and prevalence statistics for individual categories, as well as for the global lymphedema population.
            Article 0 comments Cited 103 times – based on 0 reviews     Review now
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              Incidence, treatment costs, and complications of lymphedema after breast cancer among women of working age: a 2-year follow-up study.

              JANICE N. CORMIER, Sheila H Ridner, Ying Xu … (2009)
              This study estimated the economic burden of breast cancer-related lymphedema (BCRL) among working-age women, the incidence of lymphedema, and associated risk factors. We used claims data to study an incident cohort of breast cancer patients for the 2 years after the initiation of cancer treatment. A logistic regression model was used to ascertain factors associated with lymphedema. We compared the medical costs and rate of infections likely associated with lymphedema between a woman with BCRL and a matched control. We performed nonparametric bootstrapping to compare the unadjusted cost differences and estimated the adjusted cost differences in regression analysis. Approximately 10% of the 1,877 patients had claims indicating treatment of lymphedema. Predictors included treatment with full axillary node dissection (odds ratio [OR] = 6.3, P < .001) and chemotherapy (OR = 1.6, P = .01). A geographic variation was observed; women who resided in the West were more likely to have lymphedema claims than those in the Northeast (OR = 2.05, P = .01). The matched cohort analysis demonstrated that the BCRL group had significantly higher medical costs ($14,877 to $23,167) and was twice as likely to have lymphangitis or cellulitis (OR = 2.02, P = .009). Outpatient care, especially mental health services, diagnostic imaging, and visits with moderate or high complexity, accounted for the majority of the difference. Although the use of claims data may underestimate the true incidence of lymphedema, women with BCRL had a greater risk of infections and incurred higher medical costs. The substantial costs documented here suggest that further efforts should be made to elucidate reduction and prevention strategies for BCRL.
              Article 0 comments Cited 103 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Plast Reconstr Surg Glob Open
                Journal ID (iso-abbrev): Plast Reconstr Surg Glob Open
                Journal ID (publisher-id): GOX
                Title: Plastic and Reconstructive Surgery Global Open
                Publisher: Wolters Kluwer Health
                ISSN (Electronic): 2169-7574
                Publication date Collection: March 2020
                Publication date (Electronic): 20 March 2020
                Volume: 8
                Issue: 3
                Electronic Location Identifier: e2670
                Affiliations
                [1]Division of Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex.
                Author notes
                Mark V. Schaverien, MD, MBChB, MSc, MEd, FRCS(Plast), The University of Texas MD Anderson Cancer Center, Department of Plastic Surgery, Unit 1488, 1400 Pressler Street, Houston, TX 77030, E-mail: mvschaverien@ 123456mdanderson.org
                Article
                Accession ID: 00026
                DOI: 10.1097/GOX.0000000000002670
                PMC ID: 7253282
                SO-VID: aba348d5-539f-40b4-9735-82ce508b84c4
                Copyright © Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

                History
                Date received : 1 November 2019
                Date accepted : 6 January 2020
                Categories
                Subject: Special Topic
                Custom metadata
                OPEN-ACCESS TRUE

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