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Assessing Breast Cancer-Related Lymphedema Screening and Treatment Gaps in a Safety-Net Hospital
Sara Young*1, Alaina Geary1, Xuewei Zhao1, Kelly Kenzik1, Michael Cassidy1, Robin Newman2, Andrea Merrill1
1Surgery, Boston Medical Center, Boston, MA; 2Occupational Therapy, Boston University, Boston, MA

Objective: This study assessed the BCRL screening and treatment needs at New England"ôs largest safety-net hospital by examining BCRL prevalence, BCRL risk factors, PT/OT referral and completion patterns in breast cancer patients.

Design: retrospective cohort study

Setting: Boston Medical Center (BMC), New England"ôs largest safety-net hospital & tertiary academic institution.

Patients (or Other Participants): We included patients who had undergone breast cancer operation with sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) from September 2016 to September 2021 (n=639). Of 639 patients, 41% patients were Black and 25% were White.

Interventions (if any): N/A

Main Outcome Measure (s): We assessed the prevalence of BCRL; BCRL diagnosis was defined as ICD 10 code 190.0 and 197.2 or referral to PT/OT for lymphedema. We then assessed PT/OT referral frequency, completion, and associated risk factors for BCRL.

Results: Of 639 patients, 83% underwent SLNB and the rest underwent ALND. There were no racial (p=0.08), orinsurance type (p=0.08) associations, or BMI (p=0.33) differences between types of nodal surgery. 17% of patients had documented BCRL. Patients undergoing ALND were significantly more likely to have documented BCRL than their SLNB counterparts (p<0.0001). There were no significant racial (p=0.61), insurance type (p=0.39), or radiation status (p=0.80) associations, or BMI (p=0.59) differences between patients with and without a BCRL diagnosis. Of those with BCRL, 58% received a PT/OT referral, and only 56% went to a single PT/OT visit. There were no racial (p=0.11), or insurance type (p=0.15) associations, or BMI (p=0.08) differences between those who received a PT/OT referral and those who did not.

Conclusions: In our high-risk population, there was a high rate of BCRL diagnosis, despite most patients undergoing SLNB. This is likely an underdiagnosis as this was retrospective and based on CPT coding. There were low PT/OT referral rates and a low subsequent PT/OT referral completion rate, concerning for an unmet BCRL education and treatment needs. No institutional disparities in care delivery were found, highlighting the equitable care provided at our safety-net hospital. As new treatment options decrease breast cancer mortality, minimizing treatment morbidity is imperative, especially for underserved, under-resourced patients. A program that addresses treatment gaps, ensures accessible and patient-centered care, and increases uptake of BCRL treatment is urgently needed.

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