A SYSTEMATIC REVIEW OF CARE DELIVERY MODELS AND ECONOMIC ANALYSES IN LYMPHEDEMA: HEALTH POLICY IMPACT (2004-2011)

Abstract

A project of the American LymphedemaFramework Project (ALFP), this review seeksto examine the policy and economic impactof caring for patients with lymphedema, acommon side effect of cancer treatment. Thisreview is the first of its kind undertaken toinvestigate, coordinate, and streamlinelymphedema policy initiatives in the UnitedStates with potential applicability worldwide.As part of a large scale literature reviewaiming to systematically evaluate the level ofevidence of contemporary peer-reviewedlymphedema literature (2004 to 2011),publications on care delivery models, healthpolicy, and economic impact were retrieved,summarized, and evaluated by a team ofinvestigators and clinical experts. The reviewsubstantiates lymphedema education modelsand clinical models implemented at thecommunity, health care provider, and individuallevel that improve delivery of care. Thereview exposes the lack of economic analysisrelated to lymphedema. Despite a dearth ofevidence, efforts towards policy initiatives atthe federal and state level are underway.These initiatives and the evidence to supportthem are examined and recommendations fortranslating these findings into clinical practiceare made. Medical and community-based disease management interventions, taking ona public approach, are effective deliverymodels for lymphedema care and demonstrategreat potential to improve cancer survivorshipcare. Efforts to create policy at the federal,state, and local level should target implementationof these models. More research isneeded to identify costs associated with thetreatment of lymphedema and to model thecost outlays and potential cost savingsassociated with comprehensive managementof chronic lymphedema.