Compression Device Benefits Lymphedema

Fran Lowry

October 08, 2015

New evidence of clinical benefit from compression devices in patients with lymphedema comes from a retrospective analysis in 718 privately insured patients.

Receipt of an advanced pneumatic compression device (APCD) was associated with significant improvements in key clinical end points, including reductions in the rate of cellulitis episodes, outpatient care visits, and related costs, for both cancer- and non-cancer-related lymphedema patients.

"This finding has important implications for the patients who suffer from the disease, especially those who have high rates of cellulitis," Pinar Karaca-Mandic, PhD, from the University of Minnesota School of Public Health, Minneapolis, told Medscape Medical News.

Her study was published online October 7 in JAMA Dermatology

Dr Pinar Karaca-Mandic

"These devices serve as a viable self-management option and can reduce the need for more intensive outpatient care in rehabilitative settings," Dr Karaca-Mandic said.

APCD consist of garments worn by the patient that sequentially inflate and deflate with air generated by a small pump, she explained. The inflation and deflation cycle of the garments applies dynamic, mild pressure to the affected or swollen areas of the body in a specific, timed sequence.

"This treatment directs excess lymphatic fluid from the swollen area to functioning regions of the body where it can be effectively managed by the circulatory system. Advanced devices offer a range of treatment programs and garment configurations to address individualized clinical needs that cannot be met with a more simple pneumatic device," she explained.

Data From Real-World Settings

"Lymphedema is a common disease affecting several million people in the US, in particular, cancer patients," Dr Karaca-Mandic said.

"The disease is associated with edema, recurrent cellulitis, loss of physical function, stress, and, of course, diminished quality of life. It is also associated with high healthcare costs," she said.

"While there is no cure for lymphedema currently, it can be managed well with proper care. Pneumatic compressioin devices offer a valuable lymphedema self-management option. However, there was limited information on the effectiveness of these devices using data from real-world settings. We wanted to change that," she said.

So her team set out to examine the impact of these devices. The researchers used administrative and claims-based data from a major national insurer from 2007 through 2013 to examine the effectiveness of the device. They compared outcomes for the 12 months before and after APCD purchase.

The study population consisted of 374 cancer-related lymphedema patients and 344 non-cancer-related lymphedema patients.

The most common cancer in the cancer cohort was breast cancer, which affected about 76% of the cancer patients. Other dominant cancer types included bone/connective tissue/skin and genitourinary organs, each affecting about 13% of patients.

The researchers found that use of the device was associated with large declines in cellulitis rates.

For example, among the cancer patients, cellulitis infection rates fell by 79%, going from 21% to 4.5%.

Similar reductions were observed in the noncancer patients, whose rates of cellulitis infection fell by 75%, going from 28.8% to 7.3% (P < .001 for both).

The researchers also observed large reductions in the use of manual therapy (from 35.6% to 24.9% in the cancer cohort and 32.3% to 21.2% in the noncancer cohort; P < .001 for both) and in outpatient visits (from 58.6% to 41.4% in the cancer cohort, and from 52.6% to 31.4% in the noncancer cohort; P < .001 for both).

Finally, lymphedema-related outpatient costs decreased substantially. Among the cancer cohort, total lymphedema-related costs per patient, excluding medical equipment costs, were reduced by 37%, going from $2597 to $1642 (P = .002).

In the noncancer cohort, the decline in costs was 36%, from $2937 to $1883 (P = .007).

APCDs are available through Medicare, Dr Karaca-Mandic said.

"Medicare provides coverage and payment for them, and coverage is available generally if a simple pneumatic device has been tried but significant clinical symptoms remain, or if the patient has unique clinical conditions that cannot be addressed with treatment by a simple pump," she said.

Writing in an accompanying editorial, Peter J. Franks, PhD, from the Centre for Research and Implementation of Clinical Practice, London, and the School of Medicine, University of Glasgow, United Kingdom, and Christine J. Moffatt, PhD, RN, from the University of Nottingham, Royal Derby Hospital, detail the research that has been done to date on the treatment of lymphedema and emphasize that more data are needed.

They note that the reductions in major clinical and health economic outcomes "are impressive in the cohort studies" but that further randomized, controlled trials are needed.

"We await further clinical trials on the effectiveness and cost-effectiveness of these devices to prove their value. There is also a paucity of peer-reviewed research that compares outcomes among different categories of devices in the treatment of lymphedema," Dr Franks and Dr Moffatt write.

"Moreover, the precise dosage of compression needs to be determined in terms of the pressure applied, the cycle used, and the frequency and duration of PCD [pneumatic compression device] use. Without these data, we are relying on less-than-optimal studies to inform clinical practice," the editorialists conclude.

The study was supported in part by Tactile Medical (Minneapolis, Minnesota). Dr Karaca-Mandic receives consultative reimbursement from Tactile Medical, a company that manufactures a product used to treat lymphedema. Dr. Franks and Dr Moffatt serve as consultants to Tactile Systems Technology Inc and 3M.

JAMA Dermatol. Published online October 7, 2015. Abstract, Editorial

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