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:

• Surgery
• Radiotherapy
• Infection
• Chemotherapy
• Obesity

Patients treated for breast cancer often report:

• Being unaware that lymphoedema was a possible outcome of cancer treatment
• Healthcare professionals were not well informed and / or not helpful in guiding them on how to reduce the risk of lymphoedema
• Being unaware that lymphoedema can also develop in the breast, chest wall or back as well as the arm
• Limited support on how to manage this debilitating chronic condition

Treatment considerations

• Seroma
• Fibrotic / hardened tissues
• Palliative care

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
 

• 80% of people with lymphoedema required time off work
• 50% of patients with lymphoedema experienced recurrent episodes of cellulitis
• 50% of patients reported uncontrolled pain
• 33% of people had not been told they had lymphoedema
• 36% of people had received no treatment for their condition
• 29% had cellulitis in the preceding year
• 27% of those with cellulitis required hospital admission for intravenous antibiotics and the mean hospital stay was 12 days

Improved awareness, diagnosis and prompt treatment of lymphoedema can minimise treatment costs and importantly improve outcomes and experience for people living with lymphoedema.

References

1. Cancer Research UK, breast cancer incidence. Available online at “http://www.cancerresearchuk.org/health-professional/cancer-statistics/ statistics-by-cancer-type/breast-cancer” www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/breast-cancer
2. M Göker et al. 2013. Systematic review of breast cancer related lymphoedema: making a balanced decision to perform an axillary clearance. Facts, Views & Vision in ObGyn, 5 (2): 106-115)
3. The British Lymphology Society, Available online at HYPERLINK “http://www.theBLS/education/what” www.theBLS/education/what is lymphoedema
4. Moffatt CJ, Franks PJ, Doherty D et al. (2003) Lymphoedema: an underestimated health problem. Q J Med 2003;92:731-38.
5. Parliament.uk, Written evidence from the Lymphoedema Support Network (LTC 10). Available online: Https://publications.parliament.uk/pa/cm201415/cmselect/cmhealth/401/401vw09.htm (accessed 10 May 2018)
6. Macmillan Cancer Support (2011) Specialist lymphoedema services: an evidence review. http://tinyurl.com/mfwf785 (accessed 12 December 2015)  and Lymphoedema Services in England: A case for change. NCAT, 2013
7. Breast cancer-related lymphedema: Symptoms, diagnosis, risk reduction, and management. Mei R Fu, World J Clin Oncol 2014 August 10; 5(3): 241-247, ISSN 2218-4333 (online)
8. Commissioning Guidance for Lymphoedema Services for Adults Living with and Beyond Cancer available online https://www.healthylondon.org/wp-content/uploads/2017/10/Commissioning-guidance-lymphoedema-August-2016.pdf (accesses 10 May 2018)
9. Baroness Finlay of Llandaff. Health: Lymphoedema — Question for Short Debate  Available online: https://www.theyworkforyou.com/lords/?id=2015-09-09a.1457.3&p=13471, Citation: HL Deb, 9 September 2015, c1466 (accessed 10 May 2018)