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Intermittierende pneumatische Kompression und Kostensenkung/ Stanford University School of Medicine

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Lymphedema home treatment improves outcomes, reduces costs, researchers find

DEC 3rd 2014

Home therapy helps control symptoms and save on the costs of treating lymphedema, a painful, often debilitating side effect of life-saving cancer treatments, a new study has found.

Patients with swelling caused by cancer-associated lymphedema can both reduce the severity of the disease and the overall cost of medical care by taking therapeutic steps at home, according to a study by researchers at the Stanford University School of Medicine.

The study looked at the prevalence of lymphedema, a common side effect of cancer treatments, and found that the average annual cost of care for a patient with the condition decreased from $62,190 to $50,000 a year when the patient used pneumatic compression devices to treat the swelling.

“Total health-care costs for these patients are very high, but can be profoundly reduced with treatment intervention, in this case a compression device,” said Stanley Rockson, MD, professor of cardiovascular medicine at Stanford and senior author of the study, published online Dec. 3 in PLOS ONE. “This is clearly a compelling argument for increased coverage of similar home-care devices to reduce costs.”

The first author of the study is Kimberly Brayton, MD, JD, a former cardiovascular fellow at Stanford.

Painful, debilitating fluid buildup

Lymphedema is most commonly caused by the removal of or damage to lymph nodes as a part of cancer treatment. It results from a blockage in the lymphatic system, which is part of the immune system. The blockage prevents lymph fluid from draining well, and the fluid buildup leads to swelling, which can be painful and debilitating. These symptoms can be controlled with various treatments, including treatments done at home and outpatient physical therapy. Home treatments for lymphedema include manual lymphatic massage, multilayer bandaging techniques and application of various compressive garments to reduce tissue fluid.

Researchers chose to examine the use of pneumatic compression devices as an example, primarily because it was an easy therapy method to track through health-insurance coding. “We chose one specific intervention, not because it should supersede the others, but just as a representative, readily identified treatment intervention,” Rockson said.

Pneumatic compression devices are inflatable garments that, when applied to the swollen area, inflate and deflate in cycles to help drain lymph-fluid buildup.

Lymphedema, which is incurable, is common among cancer survivors, although it’s unclear exactly how many people suffer from it. The disorder is often ignored and undertreated, said Rockson, who holds the Allan and Tina Neill Professorship in Lymphatic Research and Medicine.

For the study, researchers set out to determine both the prevalence of the disorder and the possible benefits of these home treatments by examining information collected from the health claims database of United Health Care Group/Optum, a private health insurer that operates in 24 states. Those figures were then used to extrapolate nationwide statistics. (The insurance company stripped patients’ personal information from the data used by the researchers.)

The researchers evaluated health care claims and other data collected by the insurer from 2007 to 2013. Results showed that in 2007, 9,025 of the 950,333 cancer patients in the insurance database were diagnosed with lymphedema — a prevalence of 0.95 percent. By 2013, 14,775 of the 1.19 million cancer patients were diagnosed with lymphedema — a prevalence of 1.2 percent.

Increasing rates of lymphedema

Researchers estimated the current number of cancer patients nationwide at 10 million. At a prevalence of 1.2 percent, that would mean about 121,000 lymphedema diagnoses nationwide.

“Cancer rates are expected to continue increasing at significant rates for the next 20 years,” Rockson said. “We can expect to see corresponding increasing rates of lymphedema.”

Researchers also examined health claims in the year prior to and the year following the initiation of  pneumatic compression therapy for lymphedema patients in the insurance company’s database. Results showed that annual costs of medical care decreased from $62,190 in the year prior to the use of the device to $50,000 in the year after they started using the device. During the year following the use of the devices, there was a reduction in the extent to which the patients used all categories of health care, including the frequency of treatment of soft tissue infection, the study said.

“The potential public health implications of these findings are substantial,” Rockson said. “As the American population ages and lymphedema rates increase, effective home therapies are likely to become increasingly important.”

Information about Stanford’s Department of Medicine, which supported the work, is available athttp://medicine.stanford.edu/.

Tracie White is a science writer for the medical school’s Office of Communication & Public Affairs. Email her at tracie.white@stanford.edu.
Stanley Rockson

Stanley Rockson found that home therapy could help reduce the severity of lymphedema, a common side effect of cancer treatment.
Norbert von der Groeben

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Autor: monica boersch

Vor ein paar Jahre bin ich an Krebs erkrankt, bedingt durch meine Wertheim OP, Bestrahlung und Afterloading habe ich Lymphödeme bekommen, für mich sehr überraschend da ein paar Jahre dazwischen lagen, ich wusste das etwas nicht stimmt aber leider konnten unzählige Ärzte nicht helfen. Hier ist es auch so, wie in viele viele andere Länder auch, dass Lymphatische Erkrankungen erstens nicht wirklich ernst genommen werden und zweitens das kaum ein Arzt darüber Bescheid weiß, wie den auch, wenn in den Lehrbüchern so gut wie NICHTS steht. Mein Bestreben ist alles zu tun was in meiner Macht steht um dafür zu sorgen das jeder der betroffen ist weiß was er/ sie tun kann um sein Leben wieder so gestalten zu können wie er/sie das möchte. . Ich suche und suche immer weiter nach alternativ Möglichkeiten um meinen Leben so normal wie möglich zu gestalten. Die Empfehlungen die ich gebe sind bei mir durchaus wirksam und ich erziele gute Erfolge und behalte meine Lebensqualität. Mein Blog ist kein Ersatz für eine Ärztliche Betreuung und ich empfehle jeden mit seinem Arzt über Therapie Möglichkeiten etc. zu sprechen. Ich kann nur anregen und durch meine eigene, persönliche Erfahrung eventuell einen weg aufzeigen. Seit 2009 beschäftige ich mich weit über das übliche hinaus mit Lymphödeme. Nicht nur die „Diagnose“ interessiert mich, sondern ebenso was für einen Effekt es hat auf unser Sozialleben und unser Selbstwertgefühl. Ich habe viel Zeit und Geld investiert in andere Länder zu reisen um alternativen kennenzulernen, ich war bei Internationale Firmen als Gast um zu sehen welche Lösungen geboten werden, habe fast jeden Lymphologischen Kongress besucht um mich weiter zu bilden und einige Projekte als Freelancer machen können. Wie ihr sieht ist das weitaus mehr als nur ein Blog, es müssen sich grundliegende Dinge verändern um uns alle das zu geben was wir verdienen, Respekt, Empathie und das Bewusstsein das wir nichts Vorübergehendes haben, sondern das dieses ein Teil unseres Lebens ist und auch bleibt. After being diagnosed with Cancer and going through treatments, Wertheim operation, radiation therapy and afterloading I was suddenly hit by Lymphedema. Totally surprising since nobody even gave me a hint that this could happen. Running from one doctor to the other trying to find out what is wrong with me and why my body was changing so quickly, once again being in the situation of not having control of anything. This made me so angry that I started studying like crazy, I wanted to find out why we are left alone, why doctors don’t have a clue (sorry, most doctors) about Lymphedema and the consequences in all aspects of our lives. Sadly, I had to realize that hardly anyone knows anything about it. I started my quest to find alternatives in treatments, I traveled around the world investing my time and money, fortunate enough to spend time in companies specialized in Lymphedema treatment to learn all that I could and can. I hardly miss any Lymphatic congress, listening to the internationally known doctors, discussing what is important for us as patients. I have done some freelance work for the companies that I believe in and had the chance to work with a wonderful company in New Jersey. I have tested alternatives and I am still searching and studying because it is my quest to change things for all affected by this, not only our physical wellbeing but most importantly the impact that it has on our daily life. It’s not something that’s going to go away, it’s with us until the end and the minimum that we can expect is being taken seriously, respect and empathy for our situation and the importance for all of us that have the possibilities to change things for the better. There is so much work to do, and I am not going to give up. As you can see this is more than a blog. If you find something interesting on Lymphfantastic but you are having problems with the German, then just send me a message and I will be happy to translate that for you, my native language is English so that is no problem. Have a great day and looking forward to hearing from you soon. Bless you all, Monica

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