Lymphedema after breast cancer:: Regional consensus recommendations for postoperative management, prevention, treatment and follow-up care

Purpose: 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. The distruction of the lymphatic system results in 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. The need to improve oncological management to achieve early diagnosis and referral for effective treatment of lymphedema is a major goal of breast cancer health care while survival improves. Method: A systematic consensus process was carried out involving all relevant partners and providers of lymphedema health care to develop a practical documentation concept and make recommendations based on the evidence of clinical studies and current available guidelines. Results: A practical concept for documentation with defined assessment points including the assessment of quality of life parameters with recognised instruments by the patient herself for evaluation and monitoring of lymphedema was developed. Consensus recommendations for the postoperative management, prevention, treatment and follow-up of breast cancer patients together with a clinical algorithm for in- and outpatient care were finalized. Conclusion: With improved survival long-term side effects with a major impact on quality of life become an 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. 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.