Early Screening for Breast-Cancer-Related Lymphedema Using Bioimpedance Spectroscopy

Lazarte, Melford
Pagan, Joan
Norris-Taylor, Joyce
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Breast cancer is a common cancer diagnosis in women. Management generally includes chemotherapy, radiation, and or surgery. The surgical option involves the removal of a suspicious or cancerous lump, based on diagnostic imaging or a needle core biopsy, respectively. The decision for surgery then takes place. Surgery could mean lumpectomy or mastectomy, with sentinel node biopsy or full axillary dissection. Although the option for bilateral mastectomies is not required, it is discussed openly in addition to clinical history, personal risks, and recurrences. After any combination of recommended management is accomplished, the risk for breast-cancer-related lymphedema (BCRL) is increased. The use of bioimpedance spectroscopy (BIS), a non-invasive tool similar to standing on a weighing scale, is approved by the U.S. Food and Drug Administration (FDA) as a safe screening method for BCRL. Like other available screening measures, BIS should be adopted into clinical practice. Adoption carries the possibility to improve the quality of routine breast cancer care. Purpose: To bring awareness of early BCRL screening with the use of BIS and encourage its adoption. Conceptual Framework: Population, Intervention, Comparison, and Outcome (PICO) format. Theoretical Framework: The Diffusion of Innovation (DOI) theory. Method and Instrument: Anonymous survey via Survey Monkey or Word document based on participant preference. The survey contained 22 simple questionnaires in the form of categorical, nominal, dichotomous, ordinal, or rank-order data. After one month of data collection, data from all 22 questionnaires were extrapolated into Excel spreadsheets. Participants: n = 12 clinics/providers through non-probability or convenience sampling of practice settings located in widespread areas of Maui. Research Design: Non-experimental, descriptive, cross-sectional research at a single point in time. Statistical Analyses: Chi-square (x2) test – which included a null (H0) hypothesis, alternative (HA) hypothesis, degree of freedom (df), probability value (p-value) or alpha () value set at 0.05 – and 95% confidence interval (CI) in select data of 22 questionnaires. Results and Discussions: Specific characteristics of participants were identified and paralleled current literature. This Practice Inquiry Project (PIP) needed to delineate the type of clinic, define the term “future,” and ask the type of adopter explicitly. The x2 test determined possible associations, but could not anticipate or quantify variability. Statistically, participants were not ready or not likely to adopt BIS in the future, yet BIS was recommended. There was n = 1 participant that had the BIS device. Also supported by statistics, barriers existed. The two common barriers were organizational/institutional and insurance/financial. Implications: Clinical diagnosis became apparent as the most commonly utilized method to screen or diagnose BCRL. BIS was statistically recommended. The adoption of BIS was associated with variability, again, which was not anticipated and could not be quantified. Such variability was recognized later as relative advantage, compatibility, complexity, triability, and observability – all of which was an essential part of the DOI theory. Due to the small sample size (n = 12), there was inherent sharing or overlap of patients within each practice that was also not foreseen. The specific characteristics and barriers that were determined could be pivotal not only in coming up with strategies for adoption but also for primary prevention. Recommendations: The n = 1 participant could become a leading innovator and be a part of an extensive future study – to establish clinical information surrounding BCRL from screening, to diagnosis, management, costs, insurance coverage, and challenges, even patient experiences. Instead of an online survey, attending or presenting in a staff meeting would be considered. The timeframe and research design could be modified respectively, for a few months and be retrospective or prospective. Such n = 1 participant would be the target population and identify a sample population within it based upon specific characteristics found in this PIP. By extension, the inherent sharing or overlap of patients could be circumvented. The PICO and DOI frameworks may be kept. The type of clinic, type of adopter, and range of time for adoption must be investigated explicitly. Variability should also be addressed. More rank-order data might be warranted to apply not only the x2 test but also the 95% CI in select data. Conclusion: Statistically, participants were not likely to adopt but recommend the use of BIS in early BCRL screening. Barriers go hand in hand with any changes in clinical practice; thus, they need to be addressed with practical or individualized strategies ahead of time. Perhaps then, the momentum for adoption and method of primary prevention would be gained. Even more, the quality of routine breast cancer care could be elevated not just in one clinic or Maui but throughout the Hawai’i state at large.
Breast--Cancer, Lymphedema, Medical screening, bioimpedance, Spectrum analysis, Clinics, providers
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