D. Balaji1, T. Hughes2, A. Chagpar1 1Yale University,Surgery,New Haven, CT, USA 2McPherson Hospital,Surgery,McPherson, KS, USA
Introduction: Recently, more data has emerged noting that avoidance of IVs, blood pressures and blood draws do not significantly increase lymphedema after breast cancer surgery, while resistance exercise is effective in reducing lymphedema. We sought to determine surgeons’ practices in preventing lymphedema after breast cancer surgery and factors associated with variation in this.
Methods: An anonymous survey was posted on the American College of Surgeons’ Communities online platform. From June 28, 2015 to August 9, 2015, 273 surgeons responded to the survey. In addition to their demographics and practice patterns, surgeons were asked about their perceptions regarding the prevalence of lymphedema after sentinel lymph node biopsy (SLNB) and axillary node dissection (ALND). Bivariate analyses using non-parametric statistics were performed using SPSS Ver. 21 software.
Results: 56.4% of respondents were 40-60 years of age; 52.3% had been in practice 11-30 years. 29.7% had solely breast practices; 14.7% were academic, 44.3% in private practice. 85% of respondents felt the risk of lymphedema after SLNB was < 5%; 52.1% felt that the risk of lymphedema after ALND was <10%. In terms of their routine practice, 49.1% said they advise avoiding ipsilateral blood pressures, 58.6% avoid ipsilateral blood draws/ivs. Only 3.7% routinely recommended a sleeve to avoid lymphedema, while 21.6% recommended a sleeve for air travel. 31.5% encouraged lifting weights, while 2.2% advised patients to avoid doing so. Surgeons who were in solely breast-related practices were more likely to routinely encourage lifting weights (53.1% vs. 22.5%, p<0.001) and advocate sleeves for air travel (44.4% vs. 12.0%, p<0.001). They were also more likely to quote a rate of >20% of lymphedema after ALND (20.5% vs. 7.2%, p<0.001). There was no significant variation in recommendations regarding avoidance of ivs, blood pressures, or routine sleeve use based on surgeon demographic or practice type or location.
Conclusion: Despite mounting data that lymphedema can be reduced with weight-bearing exercise, only a third of surgeons routinely recommend this. There seems to be variation in recommendations to avoid blood pressures and ivs among surgeons, with roughly half routinely recommending to avoid these after lymphadenectomy, but this variation is not mediated by surgeon demographic or practice type. Consensus guidelines may therefore be indicated regarding appropriate prevention of lymphedema in breast cancer patients.