Implementing an Early Intervention Lymphoedema Model of Care at Scale – a world first

Mr Andrew Davison1, Ms Stacey Bradshaw2

1NSW Health, St Leonards, Australia, 2NSW Health , St Leonards, Australia

Conservative estimates suggest that 20% of breast cancer survivors will develop upper limb lymphoedema. The scientific literature and national guidelines support surveillance and early intervention as best practice for reducing the prevalence of breast cancer related lymphoedema (BCRL). Translating this into usual practice across a resource-constrained public health system has previously been limited to a small number of facilities with established lymphoedema services.

Through the Commonwealth funded Lymphoedema Garment and Allied Health Therapies program a surveillance and early intervention model of care for breast surgery patients has been developed and piloted in thirteen (13) NSW Local Health Districts. The pilot aims to demonstrate that a surveillance and early intervention model can be implemented at scale and reduce the prevalence of BCRL to less than 10%. The pilot will run until 2024 with up to 2500 patients participating each year.

The surveillance phase of the model involves assessing patients before surgery using a SOZO/U400 body composition analyser to establish a baseline L-dex. Patients are then monitored for sub-clinical lymphoedema on a 3-monthly basis post-surgery for 12-24 months. If sub-clinical lymphoedema is detected patients are given early intervention involving ready-to-wear compression garments and education by a lymphoedema-trained OT or physiotherapist.

The pilot will fund 4.7 FTE physiotherapist/OT, ready-to-wear garments, 25 SOZO body composition analyses and training in lymphoedema therapy for 24 allied health clinicians. Pilot sites will match their funding with in-kind clinician support and implementation has involved engaging surgeons and breast care nurses, developing clinician guidelines and monitoring and evaluation processes.


Biography:

Andrew is the NSW Health, Chief Allied Health Officer.  He has 20 years of experience working in health care, as an allied health clinician, in health service management and in executive leadership roles. He has worked in inpatient, outpatient, community and primary care settings in metropolitan, rural and remote NSW, as well as in the UK. He also has experience working in the not-for profit sector as well as the private pharmaceutical and insurance industries.  Andrew holds a Bachelor of Health Science (Nutrition and Dietetics), a Master of Business Administration with Distinction and a Graduate Diploma of Health Management.  He is passionate about growing the value-based healthcare provided by the multidisciplinary teams, through advancing allied health clinical practice to improve patient outcomes and their experience of receiving care and treatment, through research and data analytics, as well as strengthening allied health clinical and professional governance.

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