Great strides have been made over the last few decades that see more women and men surviving breast cancer, but the journey leaves survivors with physical, mental and emotional impacts that can take years to recover from or to learn to cope with the often disabling new realities.
For Dr. Nandini N. Kulkarni, medical director of surgical oncology at New Jersey-based Inspira Health Network, technologies that provide early detection to prevent chronic conditions, increase accuracy for biopsies and lumpectomies and elevate surgical outcomes improve survivorship.
Preventing lymphedema with early intervention
Kulkarni called bioimpedance spectroscopy a game changer andwas eager to share the progress that’s been made in ongoing surgical care.
Finding subclinical lymphedema much sooner than clinical manifestations “allows me to refer the patients in a much more timely and aggressive fashion to physical therapy than I would have in the past,” she said.
Lymphedema can quickly develop to chronic stages, and it’s functionally debilitating and potentially deadly with a risk of lymphangitis infection and the development of sarcomas over time.
Some women have higher risk factors to develop lymphedema, but even those who have had sentinel node biopsy and no further lymph node dissection as part of their cancer treatment run a 6-12% risk, she said.
“The risk doesn’t nullify five, seven, ten years down the line. There can be delayed lymphedema,” Kulkarni said.
And only in the early stages can lymphatic dysfunction be reversed.
Catching lymphedema early to improve the quality of life and reduce down-the-line diseases is where this patient data collection tool is so attractive for preventive care for breast cancer programs.
“This is going to become a fairly vital tool in every surgeon’s repository,” she said.
Before the L-Dex
Beginning ideally with diagnosis, breast cancer patients are scanned as part of their regularly scheduled appointments at their surgeon’s office, said Kulkarni.
Of the 261 Inspira Health breast cancer patients scanned post-treatment between January 2021 and October 12 across two cancer centers, nearly 15% met the threshold and were referred for physical therapy.
“The alternative to bioimpedance spectroscopy was the tape measure. You know, kind of actual physical limb circumference measurements, which as you can imagine is a fairly cumbersome process because it has to be standardized,” Kulkarni explained.
There was a lot of variability in the measure depending on the technician. However, Impedimed’s SOZO platform calibrates itself, making sure the patient is positioned correctly to get the most accurate Lymphedema Index (L-Dex) score.
“That has been extremely helpful, I don’t have to worry that these measurements are not accurate,” she said.
While patients must avoid exercise and liquids prior to their L-Dex scans and remove jewelry, socks and shoes, results from the 30-second test are available immediately. Patients simply stand on the device, and low-level electrical signals pass through the body providing a precise picture of fluid status and tissue composition.
As part of the New Jersey-based non-profit health system’s “prehab to rehab” program, patients are measured and monitored up to five years after surgery.
Studied and in use in Australia since the early 2000s, there are more that 700 SOZO devices in use. Practitioners there advocate for widespread L-Dex monitoring of all breast cancer patients for early detection of disease progression.
While it is too soon for Kulkarni to report statistically significant results, it’s clear that the surveillance and early intervention program is reducing the incidence of chronic lymphedema in clinical practice at Inspira Health.
“Anecdotally, it’s definitely made a difference. I have seen patients where a greater than six rise in their fluid index score has triggered a physical therapy appointment, and I can see that number go back down,” she said.
Patients that had their L-Dex numbers rise up to almost the point of clinical lymphedema are able to start treatment with manual compression devices and reverse their scores, said Kulkarni.
“I’ve seen that number go back into the green and stay in the green,” she said.
Going wireless with localizing
Kulkarni also uses SAVI SCOUT – wireless localization tags from Merit Medical that increase patient comfort, decrease the number of steps before breast cancer surgery and improve the accuracy of lumpectomies and lymph node dissections.
The size of a grain of rice, the tags are also used to locate biopsied lymph nodes for greater accuracy in dissection.
“The localization is far superior than you know, kind of estimating where that wire went based on mammography images. Now I have a probe telling me exactly what the distance from the probe to the clip is. There’s no guesses here. And it allows me to put my incision in a much more cosmetic fashion,” she explained.
The tags can safely be placed prior to the day of surgery. According to the manufacturer’s website, they can even be placed during the initial biopsy after detection.
Oncoplastic device sharpens radiation field
A bioabsorbable spiral scaffolding product embedded with radiation clips serves a dual purpose is also one of her favorite tools, said Kulkarni.
The scaffolding provides a more precise 3-D view of where the tumor was for targeted radiation treatment.
“It really hones down the area they have to boost during radiation,” she said.
The second advantage the Hologic Biozorb provides is filling the loss of volume that a lumpectomy creates, allowing Kulkarni to connect the adjacent breast tissue and improve the overall cosmetic result of the surgery.
The bioabsorbable device dissolves over a period of two years, just leaving the clips behind, having bridged the cavity so it doesn’t sink in.
Andrea Fox is senior editor of Healthcare IT News.
Email: [email protected]
Healthcare IT News is a HIMSS publication.
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