Pneumatic Compression Device Combats Post-Cancer Lymphedema

Patients with cancer-associated lymphedema may benefit from home care with an advanced pneumatic compression device

medwireNews: Advanced pneumatic compression device (APCD) use can reduce cellulitis and healthcare requirements arising from secondary lymphedema associated with cancer, US research suggests.

Pinar Karaca-Mandic, from University of Minnesota School of Public Health in Minneapolis, and team reviewed private insurance claims information for 374 affected individuals before and after they began using a specific pneumatic compressor device with or without calibrated gradient pressure at home.

The majority (75.9%) of patients had breast cancer, with the next most common sites being bone, connective tissue or skin, and the genitourinary organs.

As reported in JAMA Dermatology, the rate of cellulitis decreased by a significant 79% from 21.1% in the 12 months before the APCD was used to 4.5% in the 12 months after its purchase.

This decrease in skin infections was accompanied by a significant 30% reduction in the rate of manual therapy for lymphedema, from 35.6% to 24.9% and a significant 29% decline in the rate of outpatient hospital visits, from 58.6% to 41.4%.

These improvements significantly lowered lymphedema-related insurance costs, the authors emphasize, highlighting a 54% reduction in outpatient hospital care expenditure. This included a 50% reduction in the costs of physical and occupational therapy and a 42% lowering of costs associated with office visits.

Pinar Karaca-Mandic and team add that a second cohort of 344 patients with secondary lymphedema not associated with cancer also experienced a significant reduction in cellulitis, and the need for manual therapy and outpatient hospital care.

“While our findings are based on the outcomes from a specific device, it is possible other such devices may also reduce patient burden. This warrants explorations in future studies”, they say.

The authors of an accompanying editorial note that the role of PCDs has previously focused on limb volume and circumference or tissue elasticity and “largely ignored patient-centered outcomes, such as health-related quality of life and ability to perform daily activities.”

Peter Franks, from the University of Glasgow, UK, and Christine Moffatt, from the University of Nottingham, UK, therefore comment: “The consequences of a reduction in the incidence of cellulitis should not be ignored because this has other consequences, although much larger studies and longer follow-up than most of those identified in this article may be required for this to be a suitable outcome.”

Nevertheless, they conclude that although the “major clinical and health economic outcomes are impressive in cohort studies there is still a need to undertake [randomised controlled trials] to exclude bias” and now await clinical trials designed to compare different devices and compression parameters to determine the optimal treatment of lymphedema.

Reference

Karaca-Mandic P, Hirsch AT, Rockson SG, Ridner SH. The cutaneous, net clinical and health economic benefits of advanced pneumatic compression devices in patients with lymphedema. JAMA Dermatol 2015; Advance online publication 7 October. doi:10.1001/jamadermatol.2015.1895

Franks PJ, Moffatt CJ. Inermittent pneumatic compression devices in the management of lymphedema. JAMA Dermatol 2015; Advance online publication 7 October. doi:10.1001/jamadermatol.2015.1974

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