Cost
Comparison for Treatment Versus Complications:
TREATMENT:
1) Physical
Therapy/Rehab $3,200.00 to $5,000 intensive phase
2) Compression Bandaging
$75.00 to $175.00 each
(replaced every six months)
3) Foam Compression
Garments $550.00 to $2,500.00 each
(replaced every two years)
4)
Multi-Density Foam Garments $550.00 to $3,000.00 each
(replaced yearly to
every two years)
5) Compression Stockings $ 80.00 to $300.00 per
pair
(replaced every six months)
6) Miscellaneous Other Compression $
50.00 to $1,500.00 each
7) Gradient Compression Pumps $5,500.00
each
(replaced every five years)
Physical therapy/Rehab, compression
bandages, and compression stockings are required for each individual.
Other
items are various alternatives therfore each patient would not need all seven
items listed. Each person
would use one or two of the items listed
with rehab, stockings, and bandages. Both diseases can be
managed
with appropriate treatment. When not managed, these diseases become worse. When
these
diseases progress health complications occur and the cost are
significantly higher than treatment as follows:
COMPLICATIONS:
1)
Wounds/Re-ocurring wounds $900 to $500,000
2) Infection/Cellulitis $100 to
$250,000
3) Infection/ Osteomylitis $80,000 to $500,000
4) Limb
deformation cost unknown
5) Reduced Mobility cost unknown
6) Obesity due
to lack of mobility cost unknown
7) Amputation $25,000
8) Loss of ability
to maintain employment Unknown
These amounts are per incident. Since wounds
and infection reoccur, the cost of health care results in
millions
of dollars being spent yearly unnecessarily. The CDC estimates 50% of
amputation could be
prevented with effective disease
management.
The only items Medicare covers is $1,750 per year for rehab
and gradient compression pumps. No other
items listed are currently
covered under Medicare guidelines.
In addition, as stated above, rehab
was covered as needed as long as progress was documented. As of
January, 2006, rehab benefits are now capped at $1,790 per
year.
Coalition for Quality Healthcare Copyright
2006
Lymphedema is a devastating disease resulting from an
excess accumlation of lymph fluid in the interstitial
tissue. This
disease is caused by a deformation or interrupution of the lymph system. It can
be caused by a
congential deformality, disease, surgery, trauma,
injury, and as is most commonly seen, cancer treatment
such as
lymph node removal and/or radiation.
Vascular disease is a disease that
results in a dysfunction of the blood vessels. Chronic venous insufficiency
many times is a diabetes related complication, and affects approximately
2% of America's population.
Chronic venous insufficiency, peripheral vascular disease, and peripheral arterial disease many times result in
non-healing or reoccurring ulcers. Vascular diseases also
frequently result in amputation.
There are approximately 5.1 to 7.5
million American's affected with Lymphedema, and approximately 20 to
30
million American's affected with vascular disease.
Currently, Medicare
does not cover most of the very inexpensive therapies available for disease
management. Our nation is unnecessarily spending millions yearly on the
expensive complications, such as
chronic non-healing wounds,
re-ocurring infections, amputation, amputation related rehab, prothethes and
other complication related therapies. These complications can be
avoided with proper treatment and long-
term disease management
therapies.
COMPREHENSIVE TREATMENT GUIDELINES
Establishing Disease
Management Guidelines for
LYMPHEDEMA
Cyndi Ortiz
Contributing
Authors:
Phyliss Tubbs-Gingrich, RN, LANA-CLT
Wade Farrow, MD, CWS,
FCCWS
Cheryl L. Morgan, PhD
Lawrence L. Tretbar, MD, FACS
Benoit
Blondeau, MD
Disease Management Practice Guidelines
Lymphedema
Cyndi
Ortiz, with Phyliss Tubbs-Gingrich, RN, LANA-CLT, Wade Farrow, MD, CWS, FCCWS,
Cheryl
L. Morgan, PhD, Lawrence L. Tretbar,
MD, FACS, Benoit
Blondeau, MD
COPYRIGHT 2005 All Rights Reserved
Lymphedema:
Goals
and Objectives:
Goals and objectives in current medical practice for
lymphedema are concentrated on assisting affected
individuals with
successful treatment and long-term disease management of chronic intractable
lymphedema,
with a focus on patient independence. Lymphedema is a chronic
disease due to an obstruction, interruption,
or
malformation of
the lymph system. Currently, there is no cure for lymphedema. The physical
results are
chronic edema caused by excess fluid that accumulates in the
interstitial tissue. This fluid is high in protein
content, which distinguishes it from other types of swelling. This fluid also has not yet been filtered and has a
high content of bacteria and other waste products not
normally found in this tissue. Health risks include
progressively
degenerative edema, tissue fibrosis, fibrotic skin changes, blisters, wounds,
re-occurring
cutaneous
and sub-cutaneous infections
(cellulitis), osteomylitis, deformed limb(s), decreased mobility due to
inactivity,
repeated hospitalizations for infections, severe weeping of
lymphatic fluid from swollen wounds
(lymphorrhea),
and in severe
cases can even result in amputation, or death due to sepsis. The psychological
affects due to
appearance, pain, reduced function, can be devastating to the
quality of life of affected patients.
As with many chronic diseases,
untreated lymphedema tends to worsen over time, resulting in
increased
complications and morbidity over time without treatment. When this
chronic diseases are not effectively
managed, the disease process progresses
causing significant and expensive health complications. Collateral
affects resulting from physical limitations and complications can interrupt a patient’s normal lifestyle activity
including employment, family relationships, social
activities, and exercise activity. Patients report a lack of
desire
to socialize due to appearance, difficulty purchasing clothes
and shoes that fit properly, which in turn, causes
depression. The change in
physical abilities contribute to depression causing a feeling of being needy
or
worthless. Prior to experiencing lymphedema, many individuals report
being able to perform normal daily
functions as well as actively assisting
friends and family in meeting their needs. Once the disease progresses
to a
point of affecting function, they are no longer able to
participate in normal daily activities such as cleaning
their
home, shopping for groceries, caring for children or family,
or other menial but important activities healthy
individuals take for
granted.
Goals and objectives must include the education of medical
practitioners in properly diagnosing upon
early onset, education of medical
professionals in properly identifying risk of onset, early diagnosis,
appropriate
treatment,
and educating patients about the management of this life long disease.
Treatment and disease
management that are geared towards individual needs
will create an environment for successful long-term
management. This
environment should consider and provide treatment and tools that facilitate
effective
results,
compliance, independence, exacerbation
prevention, and complication prevention. Treatment and
management
that is individual needs based not only should include
effective treatment, but providing an individualized
treatment plan allows
patients to enjoy a psychological view that gives them control over their
disease. This
improves compliance by increasing their ability to maintain
normal lifestyle activities, while implementing
disease management into
their daily regime.
Because 20 to 45% of cancer survivors who are treated
with surgery, radiation, and/or lymph node
removal develop lymphedema at
some time in their lives, patient education and early intervention for “at
risk”
cancer patients is essential. Some develop lymphedema immediately
after treatment, and some years later.
Many
cancer survivors
never develop lymphedema; therefore, those who do may have an existing
obstruction or
minor
congenital defect of the lymph system prior
to treatment, which predisposes them to experiencing
lymphedema.
Education for at risk cancer survivors provides them with
the necessary information for early recognition, so
they
are
able to obtain treatment immediately upon symptom onset.
Early intervention
is essential in achieving treatment success. As with any chronic disease with
early
intervention, desired goals are achieved at an accelerated rate, thus
reducing the need for lengthy treatment,
preventing expensive and
debilitating health complications, and better enables patients to continue with
normal
lifestyle activities. Failure of medical practitioners in
properly diagnosing early on, ordering the proper
treatment,
and
long-term disease management can facilitate disease progression that can not
only lead to health
complications but facilitates employment loss, and other
devastating life changing events. In order to achieve
effective results and
better enable long-term success, several factors must work together in order to
ensure
longterm
disease management success: education, early
intervention, effective treatment, and effective needs based
home management
tools that will allow independent, successful, and long-term home disease
management.
Treatment and management should include a comprehensive
approach that addresses each individual’s
physical,
mental, and
social objectives. Considerations during the treatment and long-term management
planning
should
not only include the patient’s objectives, but
their level of motivation, physical abilities, system of support,
employment
and social activity schedules. A realistic approach to disease management
should include the
evaluation of each patient’s ability and motivation to
implement management into their daily regime, and
should
involve
the necessary tools that are realistic in independent
application.
Prevalence In the United States:
Lymphatic obstruction
resulting in lymphedema can be caused by a congenital malformation, a
surgical
procedure(s), trauma, a benign or malignant tumor, radiation, lymph
node removal, sentinel node biopsy, and
disease. Because those affected are
considered an underserved population, a lack of knowledge in the
medical
community has resulted in many individuals who experience
lymphedema to remain undiagnosed. Estimated
figures are available however,
they may be significantly lower than those who truly experience
lymphatic
disease.
Current Cases Estimated in the United States due to
reasons other than cancer or cancer treatment:
An estimated 2.5 Million
current cases of lymphedema that exist in the United States resulting
from
congenital malformation, trauma, surgical procedures, or disease.
Approximately 26% of cancer survivors
treated
with surgery
and/or radiation will develop lymphedema at some time in their lives. The
National Cancer
Institute
reports in a survey of 1151 women
treated with radiation for breast cancer, 23% reported lymphedema at
zero
to
two years after treatment and 45% of these women developed lymphedema at
fift
Printed with permission from Cyndi Ortiz, PT, Las Vegas,
NV. 3/08 who is also the source
of information.
Comparison for Treatment Versus Complications:
TREATMENT:
1) Physical
Therapy/Rehab $3,200.00 to $5,000 intensive phase
2) Compression Bandaging
$75.00 to $175.00 each
(replaced every six months)
3) Foam Compression
Garments $550.00 to $2,500.00 each
(replaced every two years)
4)
Multi-Density Foam Garments $550.00 to $3,000.00 each
(replaced yearly to
every two years)
5) Compression Stockings $ 80.00 to $300.00 per
pair
(replaced every six months)
6) Miscellaneous Other Compression $
50.00 to $1,500.00 each
7) Gradient Compression Pumps $5,500.00
each
(replaced every five years)
Physical therapy/Rehab, compression
bandages, and compression stockings are required for each individual.
Other
items are various alternatives therfore each patient would not need all seven
items listed. Each person
would use one or two of the items listed
with rehab, stockings, and bandages. Both diseases can be
managed
with appropriate treatment. When not managed, these diseases become worse. When
these
diseases progress health complications occur and the cost are
significantly higher than treatment as follows:
COMPLICATIONS:
1)
Wounds/Re-ocurring wounds $900 to $500,000
2) Infection/Cellulitis $100 to
$250,000
3) Infection/ Osteomylitis $80,000 to $500,000
4) Limb
deformation cost unknown
5) Reduced Mobility cost unknown
6) Obesity due
to lack of mobility cost unknown
7) Amputation $25,000
8) Loss of ability
to maintain employment Unknown
These amounts are per incident. Since wounds
and infection reoccur, the cost of health care results in
millions
of dollars being spent yearly unnecessarily. The CDC estimates 50% of
amputation could be
prevented with effective disease
management.
The only items Medicare covers is $1,750 per year for rehab
and gradient compression pumps. No other
items listed are currently
covered under Medicare guidelines.
In addition, as stated above, rehab
was covered as needed as long as progress was documented. As of
January, 2006, rehab benefits are now capped at $1,790 per
year.
Coalition for Quality Healthcare Copyright
2006
Lymphedema is a devastating disease resulting from an
excess accumlation of lymph fluid in the interstitial
tissue. This
disease is caused by a deformation or interrupution of the lymph system. It can
be caused by a
congential deformality, disease, surgery, trauma,
injury, and as is most commonly seen, cancer treatment
such as
lymph node removal and/or radiation.
Vascular disease is a disease that
results in a dysfunction of the blood vessels. Chronic venous insufficiency
many times is a diabetes related complication, and affects approximately
2% of America's population.
Chronic venous insufficiency, peripheral vascular disease, and peripheral arterial disease many times result in
non-healing or reoccurring ulcers. Vascular diseases also
frequently result in amputation.
There are approximately 5.1 to 7.5
million American's affected with Lymphedema, and approximately 20 to
30
million American's affected with vascular disease.
Currently, Medicare
does not cover most of the very inexpensive therapies available for disease
management. Our nation is unnecessarily spending millions yearly on the
expensive complications, such as
chronic non-healing wounds,
re-ocurring infections, amputation, amputation related rehab, prothethes and
other complication related therapies. These complications can be
avoided with proper treatment and long-
term disease management
therapies.
COMPREHENSIVE TREATMENT GUIDELINES
Establishing Disease
Management Guidelines for
LYMPHEDEMA
Cyndi Ortiz
Contributing
Authors:
Phyliss Tubbs-Gingrich, RN, LANA-CLT
Wade Farrow, MD, CWS,
FCCWS
Cheryl L. Morgan, PhD
Lawrence L. Tretbar, MD, FACS
Benoit
Blondeau, MD
Disease Management Practice Guidelines
Lymphedema
Cyndi
Ortiz, with Phyliss Tubbs-Gingrich, RN, LANA-CLT, Wade Farrow, MD, CWS, FCCWS,
Cheryl
L. Morgan, PhD, Lawrence L. Tretbar,
MD, FACS, Benoit
Blondeau, MD
COPYRIGHT 2005 All Rights Reserved
Lymphedema:
Goals
and Objectives:
Goals and objectives in current medical practice for
lymphedema are concentrated on assisting affected
individuals with
successful treatment and long-term disease management of chronic intractable
lymphedema,
with a focus on patient independence. Lymphedema is a chronic
disease due to an obstruction, interruption,
or
malformation of
the lymph system. Currently, there is no cure for lymphedema. The physical
results are
chronic edema caused by excess fluid that accumulates in the
interstitial tissue. This fluid is high in protein
content, which distinguishes it from other types of swelling. This fluid also has not yet been filtered and has a
high content of bacteria and other waste products not
normally found in this tissue. Health risks include
progressively
degenerative edema, tissue fibrosis, fibrotic skin changes, blisters, wounds,
re-occurring
cutaneous
and sub-cutaneous infections
(cellulitis), osteomylitis, deformed limb(s), decreased mobility due to
inactivity,
repeated hospitalizations for infections, severe weeping of
lymphatic fluid from swollen wounds
(lymphorrhea),
and in severe
cases can even result in amputation, or death due to sepsis. The psychological
affects due to
appearance, pain, reduced function, can be devastating to the
quality of life of affected patients.
As with many chronic diseases,
untreated lymphedema tends to worsen over time, resulting in
increased
complications and morbidity over time without treatment. When this
chronic diseases are not effectively
managed, the disease process progresses
causing significant and expensive health complications. Collateral
affects resulting from physical limitations and complications can interrupt a patient’s normal lifestyle activity
including employment, family relationships, social
activities, and exercise activity. Patients report a lack of
desire
to socialize due to appearance, difficulty purchasing clothes
and shoes that fit properly, which in turn, causes
depression. The change in
physical abilities contribute to depression causing a feeling of being needy
or
worthless. Prior to experiencing lymphedema, many individuals report
being able to perform normal daily
functions as well as actively assisting
friends and family in meeting their needs. Once the disease progresses
to a
point of affecting function, they are no longer able to
participate in normal daily activities such as cleaning
their
home, shopping for groceries, caring for children or family,
or other menial but important activities healthy
individuals take for
granted.
Goals and objectives must include the education of medical
practitioners in properly diagnosing upon
early onset, education of medical
professionals in properly identifying risk of onset, early diagnosis,
appropriate
treatment,
and educating patients about the management of this life long disease.
Treatment and disease
management that are geared towards individual needs
will create an environment for successful long-term
management. This
environment should consider and provide treatment and tools that facilitate
effective
results,
compliance, independence, exacerbation
prevention, and complication prevention. Treatment and
management
that is individual needs based not only should include
effective treatment, but providing an individualized
treatment plan allows
patients to enjoy a psychological view that gives them control over their
disease. This
improves compliance by increasing their ability to maintain
normal lifestyle activities, while implementing
disease management into
their daily regime.
Because 20 to 45% of cancer survivors who are treated
with surgery, radiation, and/or lymph node
removal develop lymphedema at
some time in their lives, patient education and early intervention for “at
risk”
cancer patients is essential. Some develop lymphedema immediately
after treatment, and some years later.
Many
cancer survivors
never develop lymphedema; therefore, those who do may have an existing
obstruction or
minor
congenital defect of the lymph system prior
to treatment, which predisposes them to experiencing
lymphedema.
Education for at risk cancer survivors provides them with
the necessary information for early recognition, so
they
are
able to obtain treatment immediately upon symptom onset.
Early intervention
is essential in achieving treatment success. As with any chronic disease with
early
intervention, desired goals are achieved at an accelerated rate, thus
reducing the need for lengthy treatment,
preventing expensive and
debilitating health complications, and better enables patients to continue with
normal
lifestyle activities. Failure of medical practitioners in
properly diagnosing early on, ordering the proper
treatment,
and
long-term disease management can facilitate disease progression that can not
only lead to health
complications but facilitates employment loss, and other
devastating life changing events. In order to achieve
effective results and
better enable long-term success, several factors must work together in order to
ensure
longterm
disease management success: education, early
intervention, effective treatment, and effective needs based
home management
tools that will allow independent, successful, and long-term home disease
management.
Treatment and management should include a comprehensive
approach that addresses each individual’s
physical,
mental, and
social objectives. Considerations during the treatment and long-term management
planning
should
not only include the patient’s objectives, but
their level of motivation, physical abilities, system of support,
employment
and social activity schedules. A realistic approach to disease management
should include the
evaluation of each patient’s ability and motivation to
implement management into their daily regime, and
should
involve
the necessary tools that are realistic in independent
application.
Prevalence In the United States:
Lymphatic obstruction
resulting in lymphedema can be caused by a congenital malformation, a
surgical
procedure(s), trauma, a benign or malignant tumor, radiation, lymph
node removal, sentinel node biopsy, and
disease. Because those affected are
considered an underserved population, a lack of knowledge in the
medical
community has resulted in many individuals who experience
lymphedema to remain undiagnosed. Estimated
figures are available however,
they may be significantly lower than those who truly experience
lymphatic
disease.
Current Cases Estimated in the United States due to
reasons other than cancer or cancer treatment:
An estimated 2.5 Million
current cases of lymphedema that exist in the United States resulting
from
congenital malformation, trauma, surgical procedures, or disease.
Approximately 26% of cancer survivors
treated
with surgery
and/or radiation will develop lymphedema at some time in their lives. The
National Cancer
Institute
reports in a survey of 1151 women
treated with radiation for breast cancer, 23% reported lymphedema at
zero
to
two years after treatment and 45% of these women developed lymphedema at
fift
Printed with permission from Cyndi Ortiz, PT, Las Vegas,
NV. 3/08 who is also the source
of information.