The objective of the medi lymphedema program is for our patients to live an independent lifestyle and to assist with the self-management of their lymphatic disease. The medi solution center encompasses a complete line of products for every phase of treatment, that enables our patients and clinicians to have specific choices to meet their lifestyle and therapy requirements.
This way, medi offers the patient more flexibility and freedom in their day-to-day life.
The incidence of lymphedema post breast cancer treatment varies from patient to patient depending on the severity of the procedure with the number of lymph nodes removed being the leading factor. Other factors are body mass indices, lifestyle, and family history. The development of lymphedema can occur years after the procedure and can easily be mistaken as “weight gain” since proven diagnostic tools are not available …. until now.
How to prevent lymphedema with early detection and compression?
A recent study published in May of 2019 in the Annals of Surgical Oncology demonstrates clear clinical evidence that the early use of the Bioimpedance screening surveillance and utilization of compression garments is an effective tool in lymphedema prevention. Use of mediven harmony arm sleeves and gauntlets assisted in preventing the progression of subclinical lymphedema in the largest randomized controlled trial focused on lymphedema prevention.
A Randomized Trial Evaluating Bioimpedance Spectroscopy Versus Tape Measurement for the Prevention of Lymphedema Following Treatment for Breast Cancer: Interim Analysis
Journal: Annals of Surgical Oncology
Publication Date: May 2019
Authors: Ridner et al.
Breast cancer-related lymphedema (BCRL) represents a major source of morbidity among breast cancer survivors. Increasing data support early detection of subclinical BCRL followed by early intervention. A randomized control trial is being conducted comparing lymphedema progression rates using volume measurements calculated from the circumference using a tape measure (TM) or bioimpedance spectroscopy (BIS).
Patients were enrolled and randomized into either TM or BIS surveillance. Patients requiring early intervention were prescribed a mediven harmony compression sleeve and gauntlet for 4 weeks and then re-evaluated. The primary endpoint of the trial was the rate of progression to clinical lymphedema requiring complex decongestive physiotherapy (CDP). CDP was deemed necessary once the patient’s at-risk arm showed a 10% or greater increase in volume vs. the baseline measurement taken prior to surgery. This prespecified interim analysis was performed when at least 500 trial participants had ≥ 12 months of follow-up.
Out of 508 patients, 109 triggered pre-threshold interventions; 68 TM and 41 BIS. Of the 68 TM, 10 (14.7%) progressed to CDP and of the 41 in the BIS group, 2 (4.9%) progressed to CDP. Patients in the TM group triggered when they had a volume change in the at-risk arm that was between ~ 5 and ~ 10% above presurgical baselines (without a similar change in the non-at-risk arm). The prevention intervention trigger point for patients in the BIS group were when patients had a BIS change of ~ 6.5 BIS L-Dex units to detect sub- clinical lymphedema. Once triggered, patients underwent 4 weeks of wearing a class 2 (23–32 mmHg) compression sleeve and gauntlet therapy for 12 h per day (medi).
A total of 508 patients were included in this analysis, with 109 (21.9%) patients triggering pre-threshold interventions pre-threshold being a change in at risk arm volume of less than 10%. Compared with TM, BIS had a lower rate of trigger (15.8% vs. 28.5%, p < 0.001) and longer times to trigger (9.5 vs. 2.8 months, p = 0.002). Using mediven harmony 20-30 mmHg, twelve triggering patients progressed to CDP (10 in the TM group [14.7%] and 2 in the BIS group [4.9%]), representing a 67% relative reduction and a 9.8% absolute reduction (p = 0.130).
Interim results demonstrated that post-treatment surveillance with BIS reduced the absolute rates of progression of BCRL requiring CDP by approximately 10%, a clinically meaningful improvement. These results support the concept of post-treatment surveillance with BIS to detect subclinical BCRL and initiate early intervention. For full article, visit https://doi.org/10.1245/s10434-019-07344-5
Lymphedema prevention solutions with mediven harmony arm and hand products
Harmony products have been called the perfect balance between effective containment (strong) and wearing comfort (soft) for upper limb compression. mediven harmony is a unique fabric that is soft to touch, clinically effective and easy to apply. The precision fit and unique elbow ellipses (one in the crease and one on the point of the elbow) provide accurate compression therapy with freedom of movement, encouraging compliance and ultimately allowing patients to “feel better”.
Harmony arm sleeves – This effective round-knitted arm sleeve for primary and secondary stage 1 lymphedema has a double ellipses for freedom of movement, a comfortable top band with napped silicone coating, high containment with an innovative supple knit, and a soft fabric structure with Lanolin that stimulates the tissue for a massaging effect.
Harmony glove – Matched to the mediven arm sleeve, the mediven harmony compression glove offers maximum wearing comfort with a breathable, latex-free material and a new seamless version with seamless technology in the finger borders and between the digits (fingers and base of thumb) for maximum mobility and flexibility.
Harmony gauntlet/hand piece – Matched to the mediven arm sleeve, the mediven harmony compression gauntlet/hand piece without fingers with thumb base offers maximum wearing comfort with a breathable, latex-free material with seamless technology for maximum mobility and flexibility.
Lymphedema Therapy Concept
The first phase of complex physical decongestion therapy lasts about three to six weeks. The individual duration depends on how successful decongestion is. Once the circumference of the affected regions of the body are no longer reduced any further, we then move to the maintenance phase.
The circaid juxtafit can be worn in the transition phase to optimize the result of reduction. Following intensive therapy, some patients may benefit from a transition phase, where results achieved during the decongestion phase can be optimized before moving on to the maintenance phase. The transition period may be helpful to:
- maximize the effects of intensive therapy and stabilize fluctuations in swelling to an individually acceptable level
- prevent rebound swelling on transfer to compression hosiery
- evaluate long-term maintenance strategies
- support and facilitate self-management
- reduce practitioner input
During the maintenance phase, patients with lymphedema normally wear flat-knitted compression stockings or an inelastic circaid compression wrap, such as a the circaid juxtafit or the circaid graduate. The circaid graduate is a custom-made, padded device to be worn at night, which maintains the outcome of decongestion even when the patient sleeps. So, patients with lymphedema can be cared for around the clock with medi products.
medi’s lymph therapy concept offers the necessary flexibility and variety of products for this and all three phases.