1. The prospective surveillance of breast cancer related lymphoedema
Kerry Sant
Advanced Lymphoedema Nurse Practitioner

2. The rationale for monitoring and early intervention
The sooner lymphoedema is diagnosed then the sooner it can be treated, limiting morbidity, minimising further swelling and preventing infection. (Stanton et al 2006)
Enables a more cost effective service and conservative intervention.
(Stout Gergich et al 2008).
Impairments in function are interrelated to lymphoedema and limit activity and vocational participation.
(Karki et al 2005, Hayes et al 2012, Hidding et al 2014)

3. Assessment of : Limb volume Shoulder range of movement Weight
Pre-operative
Assessment of :
Limb volume
Shoulder range of movement
Weight
FACT-B4 arm symptoms
DASH tool
Assess pre- morbid level of activity and function
Educate for post op shoulder ROM exercises
Briefly explain lymphoedema
6/52 Post op
Repeat pre-operative measures
plus assess for:
axillary web syndrome
scar adhesions
Education for prevention of lymphoedema
Review of exercise program
Educate for management of scars
Invite to therapy led ‘prehab’ event
Ongoing surveillance at keypoints of cancer treatment and beyond.
Repeat pre and post operative measures and assess for change
neuropathy
arthralgia
activity limitations and performance restrictions
3 monthly for 12 months with less frequency to 24 months. at key stages of treatment.
Consider referral to exercise programs during / after active treatment and link with wellbeing events.
Adapted from Stout et al (2012) and Campbell et al (2012) Cancer Apr 15; 118(8 supple):
If impairment is detected refer for specialist lymphoedema / physiotherapy intervention