As the survival rate of breast cancer patients increases so does the incidence of BCRL. These conditions can become progressive if not diagnosed quickly and can have a significant impact on the patient's quality of life and the NHS.2
BCRL affects approximately 20% of patients treated for breast cancer, although the true impact may be greater as this does not take into account lymphoedema of the breast and torso.
BCRL results from a failure of the lymphatic system due to:
Patients treated for breast cancer often report:
Treatment considerations
A lifelong chronic condition
Lymphoedema results from a failure of the lymphatic system. Consequences are swelling, skin and tissue changes and a predisposition to infection. It most commonly affects the lower or upper limbs, but may also affect midline structures such as the head and neck, trunk, breasts or genitalia.3 Research shows that lymphoedema affects between 1.33 and 3.99 per 1,000 population.4
Due to the high maintenance nature of lymphoedema and the impact on the immune system the risk of developing cellulitis is the most common side effect of lymphoedema. Cellulitis is a costly condition often requiring hospital admission.
NHS Choices state: “In England in 2009, around 80,000 people were admitted to hospital as a result of cellulitis. The number of annual cases of cellulitis has increased three-fold over the past 15 years”.5
The cost of hospital admission in a one year period, for the treatment of cellulitis in three counties with a population of 2.5 million, was approximately £4.1 million.5 It has been shown that the average hospital stay for cellulitis associated with lymphoedema was approximately 12 days and incurred an estimated cost of £2,300 per patient.4
More than £178 million per year was spent on admissions in the UK, due to complications from lymphoedema, with a rise in costs of £7 million from 2013 to 2014, equating to more than 22,904 additional admissions.6
Recent research by McMillian Cancer Support has shown that for every £1 spent on the management of lymphoedema, the NHS will save approximately £100.6
Impact of lymphoedema
Lymphoedema can be one of the most dreaded and unfortunate outcomes of breast cancer treatment. Currently, there is no cure for this chronic condition. This creates a very distressing and upsetting situation, where patients having survived breast cancer are forced to live with a life-time risk of developing or living with lymphoedema.7
Research outlined in the ‘Commissioning Guidance for Lymphoedema Services for Adults Living with and Beyond Cancer’ and carried out by Christine Moffat outlines the impact of lymphoedema to both the patient and the NHS due to complications associated to lymphoedema.8
Improved awareness, diagnosis and prompt treatment of lymphoedema can minimise treatment costs and importantly improve outcomes and experience for people living with lymphoedema.
References