Patterns of Practice for Prophylactic Lymphedema Sleeve Prescription at a Tertiary Care Center

Studies have shown that prophylactic compression sleeve use following axillary lymph node dissection (ALND) for breast cancer (BC) can reduce the incidence of arm swelling in women at high risk for lymphedema. As of January 2024, Medicare Part B has expanded to include coverage of lymphedema compression treatment items, but currently, only 38% of US private insurance policies include a statement of coverage for lymphedema treatment. To understand prophylactic sleeve prescription patterns prior to this expansion, we identified potential factors associated with prophylactic sleeve prescription at our institution.

Using the electronic medical record, we identified patients who had a lymphedema therapy (LT) referral within three months of ALND between May 2022-August 2023. Patients were excluded if they did not undergo a true ALND (<10 nodes removed), if they did not have a BC diagnosis, or if they did not have complete LT records. Chi-squared and ANOVA tests were executed to assess relationships between sleeve prescription and patient factors.

Eighty-two patients had a diagnosis of BC and an LT referral following ALND. Median age at diagnosis was 53 years and a median of 20 nodes were removed at ALND. Most (70%) patients underwent mastectomy, while the remainder underwent lumpectomy, chest wall wide local excision, or ALND alone. Nearly all (88%) patients had private insurance, while 8.5% had exclusively Medicaid and 3.7% had only Medicare or Tricare. About a quarter (21/80; 26.3%) of patients received prophylactic lymphedema sleeve prescriptions, and prescriptions were not associated with type of breast surgery, dominant side ALND, number of nodes removed, percentage of positive nodes, body mass index, smoking status, prior cellulitis, cup size, or type of insurance. Younger patients were more likely to receive a prophylactic compression sleeve prescription, but this did not meet statistical significance (p = 0.055).

None of the factors that we examined were associated with receiving prophylactic compression sleeve prescription. However, specific private insurance policies may be a barrier for patients wishing to receive prophylactic compression treatment. Given the recent lymphedema sleeve coverage expansion by Medicare, we hope to use our data to compare sleeve use before and after this change in the future. Additionally, education about the benefit of prophylactic compression sleeve use may also increase the rate of prescriptions.