What is prospective surveillance?

Prospective surveillance is a protocol that is used to detect and prevent lymphedema. Patients are referred to a lymphedema clinic prior to a surgical procedure so the therapist can take circumferential measurements of the patient's arms or legs to determine a baseline for limb volume (how big the arms or legs are). Measurements are taken again after surgery and compared to the baseline measurements. This allows the therapist to assess changes in the limb volume that resulted from the surgery.

There are several methods for determining limb volume. At Therapy Achievements, arms are measured starting at the base of the fingers, then the wrist, then every 4 cm up the arm to the axilla. Legs are measured starting at the base of the toes, then the ankle, then every 4 cm up the leg. The measurements are entered into a spreadsheet using formulas to give a percentage comparison of the limbs (arms or legs). The average volume percentage difference between limbs (arms or legs) is 3%-5%. 

Why is prospective surveillance important? 

Prospective surveillance is important to identify patients that are at risk of having lymphedema before they have symptoms. Prospective surveillance allows therapists to establish a true baseline for treatment after surgery. It also allows for the opportunity to educate patients on risk factors and what they can do to reduce the risk of flare ups. 

Who should be considered for prospective surveillance? 

Anyone that has lymph nodes removed, especially 3 or more, needs to be watched for lymphedema signs and symptoms from the very beginning. The National Cancer Institute states that anywhere from 5%-17% of women who have sentinel lymph node biopsy will develop lymphedema. For those who have axillary lymph nodes removed, the percentage goes up to 20%-53%. The more lymph nodes removed the higher the risk of developing lymphedema. It is very important to ask your surgeon how many lymph nodes were removed and where they were removed from to determine proper treatment. Prospective surveillance is not just for those recovering from breast cancer. Anyone who has surgery that involves removal of lymph nodes is a candidate for prospective surveillance.

Who is involved and what is their role?

• Patient/Caregiver: Consult with your oncologist/surgeon for a referral to therapy with a Certified Lymphedema Therapist for measurements to be taken.  
• Physician: Their role is to refer patients to certified lymphedema therapists to ensure an appropriate plan of care is in place for post-surgery treatment. 
• Therapist: Their role is to take baseline measurements to aid in establishing an appropriate treatment plan after surgery and educate you on risk factors.

What steps should I take as a patient?

• Contact your physician and discuss prospective surveillance options.
• Ask your physician to refer you to a Certified Lymphedema Therapist to establish baseline measurements prior to surgery.
• After surgery, discuss further therapy treatment with your physician.
• After surgery and a referral to the Certified Lymphedema Therapist, begin treatment to manage lymphedema such as Complete Decongestive Therapy. This includes manual lymph drainage (a massage technique) and compression therapy to decrease swelling after lymph node removal.