[Lymphedema in patients with breast cancer--a consensus regarding diagnostics and therapy in patients with postoperative lymphedema after primary breast cancer].
Secondary lymphedema is one of the most frequent long-term side effects affecting up to 30% of all breast cancer patients after local surgical and radiation treatment. Destruction of the lymphatic system causes a progressive and chronic condition with functional impairments and disabilities limiting patients in their daily activities and involving nearly all aspects of their quality of life. Also, problems in the occupational area may be caused by lymphedema. The need for improving oncological management for early diagnosis and referral for effective treatment of lymphedema is a major goal of breast cancer heath care while survival improves.


METHODS
A systematic consensus process was performed involving all relevant partners and providers of lymphedema health care to develop a practical documentation concept and make recommendations according to the evidence of clinical studies and currently available guidelines.


RESULTS
A practical concept of documentation with defined assessment points was developed for evaluation and monitoring of lymphedema, which included the assessment of quality of life parameters with recognised instruments by the patient themselves. Consensus recommendations for the postoperative management, prevention, treatment and follow-up of breast cancer patients along a clinical algorithm for in- and outpatient care were finalized.


CONCLUSIONS
With improved survival, long-term side effects with major impact on quality of life become a most important end point criteria of oncological treatment. The clearly defined documentation concept and the comprehensive recommendations for lymphedema management may assist clinicians and patients to make timely decisions about in- and outpatient health care practice to optimize the interface between acute medicine and rehabilitation. Patients' compliance with treatment and prevention routines will be as important as ensuring the continuity of care. A longitudinal prospective study evaluating the effectiveness and efficacy of the consensus recommendation is currently being implemented.
Seifart
U
U
Hamm-Kliniken, Bad Soden-Salmünster. dr.seifart@hamm-kliniken.de
Albert
U-S
US
Heim
M-E
ME
Hübner
J
J
Jungkunz
W
W
Prokein
R
R
Rick
O
O
Hoffmann
M
M
Engenhart-Cabillic
R
R
Kopp
I
I
Wagner
U
U
Kalder
M
M
D000465:Algorithms; D000553:Ambulatory Care; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D019468:Disease Management; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008197:Lymph Node Excision; D008209:Lymphedema / Q000175:diagnosis / Q000534:rehabilitation*; D010343:Patient Admission; D011183:Postoperative Complications / Q000175:diagnosis / Q000534:rehabilitation*; D011788:Quality of Life; D012050:Rehabilitation, Vocational