CLINICAL PRACTICE GUIDELINES
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Survivorship

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Survivorship

The NCCN Guidelines® are consistent about the importance of early detection of lymphedema and use of an objective tool, such as bioimpedance spectroscopy.

National Comprehensive Cancer Network® (NCCN®)

Principles of Lymphedema SLYMPH-21

Early detection/diagnosis and early referral are key for optimal lymphedema management because stages 0 and 1 are reversible, whereas stages 2 and 3 are less responsive to treatment. Therefore, survivors at risk for lymphedema should be regularly screened for lymphedema by symptom assessment, clinical exam, and, if available, bioimpedance spectroscopy. Patients should be educated about early symptoms and signs of lymphedema including fullness, tightness, heaviness, and pain.

Lymphedema Screening Workflow (SLYMPH-3)2

Understanding Bioimpedance Spectroscopy

Bioimpedance spectroscopy (BIS) is a non-invasive technology that can instantly and accurately evaluate extracellular fluid levels to help detect early signs of breast cancer-related lymphedema.

Learn More About BIS

SOZO® Digital Health Platform

With the SOZO Digital Health Platform and L-Dex, ImpediMed is the only company to offer FDA-cleared technology that uses bioimpedance spectroscopy for the clinical assessment of lymphedema.

Discover SOZO

 

SOZO® Digital Health Platform with nurse and patient

Lymphedema Prevention Program

ImpediMed’s Lymphedema Prevention Program (LPP) uses SOZO with L-Dex to help detect lymphedema in breast cancer patients at the early stage, so that it can be treated and stopped from progressing to a lifelong condition.

Implementing LPP with the SOZO Digital Health Platform can greatly improve the quality of life for cancer patients and survivors5.

  • Limb lymphedema is a devastating side effect that currently impacts 20% of breast cancer patients3. However, with a program of early detection and intervention using BIS, this rate can be reduced to 3%4.
  • SOZO’s L-Dex score is specifically designed to detect lymphedema at its earliest, subclinical stage – when it is still reversible.
  • In the largest randomized trial to assess lymphedema prevention in breast cancer patients, 92% of patients with early detection using L-Dex and intervention did not progress to chronic lymphedema5.

Learn More About LPP

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References

  1. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Survivorship V.1.2023. © National Comprehensive Cancer Network, Inc. 2023. All rights reserved. Accessed March 24, 2023. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.
  2. Adapted with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Survivorship V.1.2023. © 2023 National Comprehensive Cancer Network, Inc. All rights reserved. The NCCN Guidelines® and illustrations herein may not be reproduced in any form for any purpose without the express written permission of NCCN. To view the most recent and complete version of the NCCN Guidelines, go online to NCCN.org. The NCCN Guidelines are a work in progress that may be refined as often as new significant data becomes available.
  3. Gillespie TC, Sayegh HE, Brunelle CL, Daniell KM, Taghian AG. Breast cancer-related lymphedema: risk factors, precautionary measures, and treatments. Gland Surg. 2018 Aug;7(4):379-403. doi: 10.21037/gs.2017.11.04. PMID: 30175055; PMCID: PMC6107585.
  4. Whitworth PW, et al. Preventing breast cancer-related lymphedema in high-risk patients: The impact of a structured surveillance protocol using bioimpedance spectroscopy. Front Oncol (2018) 8:197. doi: 10.3389/fonc.2018.00197.
  5. Ridner SH, et al. A Comparison of Bioimpedance Spectroscopy or Tape Measure Triggered Compression Intervention in Chronic Breast Cancer Lymphedema Prevention. Lymphatic Research and Biology 2022
FOOTNOTES FOR LYMPHEDEMA TREATMENT (SLYMPH-3):
  1. Certified lymphedema therapists can be located using the following resource: https://www.clt-lana.org/therapists. National Comprehensive Cancer Network® (NCCN®) recommends attention to evidence-based practice and specialized training for lymphedema management.
  2. If baseline measurement is not available, measure unaffected contralateral limb as a reference.
  3. Lymphedema Management: The Comprehensive Guide for Practitioners. Joachim Ernst Zuther, Steve Norton (Autoren) Buch | Hardcover 592 Seiten; 2017 | 4th New l edition; Thieme Medical Publishers Inc (Verlag); 978-1-62623-433-8 (ISBN); Chapter 5.
  4. Compression garments should be prescribed. Optimally, they should be fitted and measured by a certified lymphedema therapist.
  5. If a certified therapist is not available, survivors with lymphedema can perform resistance training with a professional trainer who has knowledge of cancer-related n physical activity principles. Weights should be slowly progressed as tolerated, and lymphedema should be evaluated periodically.
  6. Aerobic exercise or other forms of physical activity as tolerated. See Principles of Physical Activity for Survivors with or At Risk for Lymphedema (SLYMPH-B).
  7. If a certified lymphedema therapist is not available, consider referral to appropriate provider for treatment.
  8. Trained personnel can include physical and occupational therapists, certified exercise professionals, and rehabilitation specialists. Specialized training in working with survivors is available for both physical therapists and exercise professionals: ACSM [http://www.acsm.org/get-stay-certified] and APTA Oncology section [http://oncologypt.org].