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Patient anecdote outweighs data in AP’s look at lymph node transfer surgery

Rating

3 Star

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Replacing lymph nodes to ease painful legacy of cancer care

Our Review Summary

This article describes lymph node transfer surgery, which replaces lymph nodes that were removed or damaged during breast cancer surgery and radiation treatment with nodes from elsewhere on a patient’s body.

The article briefly cautions readers near the end of the story about the limited data and the need for patients to be evaluated by a “comprehensive lymphedema program.” But it doesn’t address costs, potential harms, and the actual number of women who might benefit from this invasive procedure. It also relies on a single anecdote of a Wisconsin woman whose condition rendered her unable to shovel snow or cross-country ski–a degree of severity that doesn’t appear to reflect the experience of most patients.

 

Why This Matters

It’s good to see media coverage of lymphedema, a little-discussed consequence of some breast cancer treatment in which lymph nodes can no longer carry out their function of draining fluid, leading to swelling of a patient’s arm and other areas of the upper body. More awareness could be helpful because, according to Breastcancer.org, detecting early symptoms can catch the condition before it damages soft tissue, increasing the likelihood of successful treatment with compression and other low-risk interventions. Surgery is a relatively risky and untested treatment option, and news coverage needs to stress that.

 

 

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

There’s no discussion of costs, although the story does mention that insurance coverage varies.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

After featuring one woman’s positive outcome, the only discussion in the story about the scope of the benefits was this statement:

About a third of lymph node transfer patients see some positive effect, Song said.

It’s not clear where that information comes from–a clinical trial? More should have been said about what we know (or don’t know) about the potential benefits.

The story does make it clear that this surgery works for “some but not all” women” and is “not a cure.”

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

There’s no discussion of medical risks and hardships of surgery. Along with the usual risks posed by surgery, there’s a risk that lymph node transfer could cause lymphedema to develop in the part of the body where healthy nodes were extracted, according to Breastcancer.org. For many women those drawbacks may outweigh the potential for an uncertain benefit.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

Near the end of the story, there is a paragraph that conveys the tenuous nature of the evidence to support this surgery, saying a surgeon “noted that over about the past decade, the microsurgeries have been studied only in small research trials, and results vary with surgeon experience.” That helps readers know there isn’t much research, but we think more specifics were needed. How many patients have been studied? How do we know results vary by surgeon? What kind of research trials were these? Did they compare microsurgery to other approaches?

Does the story commit disease-mongering?

Not Satisfactory

Not all people with lymphedema have symptoms as severe as the patient featured in this story, whose arm was “painfully swollen to lift anything heavy or even fit into her usual clothing.” That should have been conveyed more clearly.

The story also quotes a surgeon saying that typical patients have “had that swelling for a while” and “treatment is an uphill battle.” Of course, surgeons tend to see only a segment of cases that haven’t responded well to other treatments.

Breastcancer.org calls surgery “an option of last resort for severe lymphedema that does not respond to treatment. Most people with lymphedema would not be considered candidates for surgery.”

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The two doctors quoted are both surgeons. The article would have benefited from an expert familiar with a range of treatments for breast cancer-related lymphedema; for example, a lymphedema-certified physical therapist.

Does the story compare the new approach with existing alternatives?

Satisfactory

There are a range of treatment options for lymphedema. The article mentions a few:

The main treatment consists of wearing compression bandages and massage to bring down swelling. A lymphedema specialist initially prescribed a large pump that massaged (patient) Wolfe-Tank’s arm for an hour a night, temporarily relieving some of the pain.

It also says lymph node transfer is “not the only option. A technique called lymphovenous bypass reroutes lymph-carrying channels, going around damaged or missing nodes to drain into veins instead.”

The story laudably conveys a recommendation that patients be “evaluated in a comprehensive lymphedema program to determine their best options.” Information on what a “comprehensive lymphedema program” is and how to find one would have been useful.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story says “a small but growing number of hospitals offer microsurgical attempts at relief from lymphedema.” It also mentions that it’s sometimes covered by insurance.

Does the story establish the true novelty of the approach?

Satisfactory

The story mentions a “small but growing” number of hospitals that offer this microsurgery along with a backdrop of concern that women aren’t being adequately monitored for lymphedema following breast cancer treatment:

Yet too often women aren’t warned about symptoms or checked for early signs, when lymphedema is more easily treated, said Dr. Sheldon Feldman of New York’s Montefiore Einstein Center for Cancer Care. He co-authored physician guidelines issued this fall by the American Society of Breast Surgeons on prevention and treatment of breast cancer-related lymphedema.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story does not appear to rely on a news release.

Total Score: 5 of 10 Satisfactory

Comments (1)

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Rob Oliver

November 28, 2017 at 12:21 pm

Kind of a harsh grade there I think. This group of operations for lymphedema has been bouncing around for a decade or so. While direct lympatic-venous bypass microsurgery doesn’t seem to work, there are some stunning results being shown with node transfer. Even a fair response is life changing in these patients. The issue of donor site issues is real, but the availability of mesenteric nodes for this may eliminate that (albeit at the cost of a mini laparotomy to harvest them)

Severe lymphedema is just a heart breaking condition for patients, an the enthusiasm for adding axillary radiation by radiation oncologists for negligible benefits ensure we will see a steady stream of these patients.