Integrating Lymphedema Prevention Into Oncology Pathways: Insights From Oncology Nursing

Sabrina Korentager, MSN, BS, RN

Veteran oncology nurse Sabrina Korentager shares her passionate journey into lymphedema prevention, emphasizing the transformative impact of early detection, patient education, and nurse-led care coordination in elevating survivorship outcomes across cancer care.

Please introduce yourself by stating your name, title, and any relevant experience you’d like to share.

Sabrina Korentager, MSN, BS, RN: Good morning. I'm Sabrina Korentager. I am a master's level registered nurse in my 29th year of nursing. I am currently working as an advisor for lymphedema prevention.

I've worked in the realm of lymphedema prevention for over 10 years. I started the program in combination with one of our breast surgeons at the University of Kansas Cancer Center. Before that, I was a cardiac nurse and an operating room nurse. So, a little bit of a wide background. In my last decade of nursing, I've decided to focus extensively on lymphedema prevention. I believe that's where the future is for cancer care.

Oncology nurses are playing a pivotal role in survivorship care. How do you see this role evolving in the coming years, particularly in the management of chronic conditions like lymphedema?

Korentager: I thought about that question, and what has happened is that as we became very sophisticated with early detection, the needs have evolved and dramatically changed. It used to be that when somebody was diagnosed with cancer, it was much later in the stage of cancer. Now, we're catching cancers in almost their infancy stage, which opens up the door to a lot being needed by the entire treatment team.

You've got fertility, you've got sexuality, you've got exercise, you've got diet, you've got other cancers as a result of your treatment for your initial cancer. The possibilities are endless when you look at how cancer care is evolving.

The nurse component of this is pretty easy. When I first say this, I always have to explain it. The nurse is the hub of the entire treatment team. That doesn't mean that they're more important than any one aspect, what it means is they appreciate the role that everyone else does: the surgeon, the oncologist, the plastic surgeon, the dietician, the therapist, whoever else. But they are the best to say, holistically, "This is what's needed for this patient—for their recovery and their survivorship."

Survivorship, again, wasn't something we talked about even 10 years ago because people weren't being diagnosed as early. Now, survivorship is going to encompass all of those things. People are being followed for 10 to 20 years after they've had surgery, and as they are being followed, those needs change. The nurse is in a wonderful position to be that hub in the middle of the treatment team—to be able to coordinate, reach out, and ensure they're advocating for the patient to get all of those services they need so that not only do they survive their cancer, but they also return back to a quality of life that they can enjoy and come completely through that cancer journey.

What role does patient education play in the success of lymphedema prevention, and how do you engage patients in understanding the importance of early detection?

Korentager: When I first started working in lymphedema prevention, I had a blended practice because many patients had never even heard the word lymphedema. Unfortunately, the first time they heard it was when they were diagnosed. We know now from extensive research that early detection is what plays a role in better outcomes. I believe conversations are necessary from day one.

One of the workflows I designed was when a patient is having their initial cancer meeting—whether that be with an oncologist or a surgeon—the topic of lymphedema should come up. It doesn't need to be an extensive discussion at that moment, but the patient needs to have it on their radar for 2 reasons. One, it should never be a surprise. In the year 2025, the word lymphedema and cancer should never, ever be a surprise to patients.

Two, when you have a [conversation and say,] "Hey, this is always a possibility, but we have a plan for you. We're going to worry about this. We're going to work with you, and we're going to educate you at these key steps along your journey," patients have trust, a level of comfort, and the anxiety about developing lymphedema becomes greatly reduced.

I worked with patients—this is one of the reasons I got into lymphedema and I always tell this story—who were not angry about their cancer. They were angry about lymphedema because lymphedema doesn't allow them to get past the cancer journey. People stare, and oftentimes it interferes with their ability to work and care for their children.

Again, we're having younger and younger patients diagnosed. Many of these patients have toddlers. Many of these people are at the heart of their careers. These patients are angry that they weren't told about this, and they weren't given the option to have a prevention plan in place.

By doing this early and having education, you're not scaring a patient. You're not giving them unnecessary information. It's quite the opposite; you're engaging them and giving them a chance to be a participant in their own care and prevent something that could be a possibility.

With the endorsement of bioimpedance spectroscopy (BIS) by the National Accreditation Program for Breast Centers (NAPBC) and its inclusion in survivorship care guidelines, what do you see as the next steps in integrating this tool into standard oncology practices?

Korentager: Everybody who has worked with me knows how I feel about BIS and SOZO. I think it's a game changer. Again, my own research studies have shown that it can completely eradicate lymphedema in early detection. Not only can it do that, but in patients that actually do develop it, it develops it at a much lower level.

Think about it this way, the standard of care adopts it. It becomes part of the clinical pathway, so all patients have access to this care. You have a patient who maybe would have developed it at a much more advanced degree. Now, they develop it at either a degree that's completely reversible or a degree that doesn't interfere with their quality of life. The whole chain reaction of that is enormous. The patient feels good about themselves. They're not angry. The patient is able to continue to work, and health care dollars are saved.

It's such a crescendo effect that when they endorsed it and indicated that it was a standard of care, I think I was jumping up and down because it should be a standard of care for all cancer patients, not just [those with] breast cancer, but all patients who could get lymphedema. Lower body, breast—obviously it's not indicated in head and neck—but there are so many cancers, like ovarian and prostate, where lymphedema affects health care dollars, quality of life, and treatment outcomes. By them saying this is a standard of care, I think you're going to see it being adopted.

The facility I came from is National Cancer Institute (NCI)-designated, and you're seeing more and more that these NCI designations are requiring that they have a clinical pathway for lymphedema prevention. I would be surprised if any institution could be NCI certified without a clinical pathway for early detection of lymphedema.

Obviously, SOZO makes it easy. It's integrable into the pathways, takes only a few seconds, and is noninvasive. There are so many great things about this technology and what it can do for early detection that I'm surprised that it wasn't introduced as a standard of care a little bit earlier, but I am certainly completely happy that they are introducing it now. I think you're going to see that continue to be enforced and pushed in all areas of cancer care.

What message would you give to other oncology nurses who may want to start similar initiatives at their institutions but may feel uncertain about where to begin?

Korentager: Prevention is tough. It is not a glorious spotlight kind of thing. Prevention is hard. It's hard to convince not only providers, but patients that this might happen and we're going to start it before it even happens. I always use this example: what happens when you are super busy in life and you know you need to go to the dentist for your routine checkup? You're like, "I can maybe stretch it a few more months. I can put it off. I need to go to work. I need this." This is slightly different. You have to have the ability to engage not only with patients, but also with the health care team—showing why this is important.

So, you have to love this. This can't just be something you say, "I think I'd like this as a job." No, you have to love it, and you have to understand it. I had to learn a lot about lymphedema and prevention in order to do this role. It became my passion because I realized that when it's done properly, it really is a game changer for these patients. Imagine having a reduction from 40% of patients developing lymphedema to 6% or 8%. When you're able to use those kinds of numbers, patients believe in you and listen to you.

My advice would be, first of all, to take the time to understand it. I went back to school and became a lymphedema therapist, and I didn't do that because it was absolutely necessary for me to do the job, I did it because I wanted to understand it. I wanted to understand how to care for these patients, to understand where they're at and what motivates them.

A lot of times people say, "This pathway is what works for my organization." I will work with them and say, "But what works for the patient?" Getting the patient back at the right time that fits with their schedule will ensure that you have compliance, which, in turn, ensures that you have good outcomes.

My advice is to look at your patient's needs. Where are they accessing their care? How are they coming back for care? What are their barriers to success? Whether it’s “I can't take time off from work,” “I can't have 2 copays,” or “I don't have money for this,” find out what motivates your set of patients, because it's different according to the region you practice in. Find out what motivates them. Then find out how the treatment team sees your role fitting in.

I got really lucky in that I had a breast surgeon for whom this was her love too—and it still is her love—so I had a champion for me. But a nurse is going to need a champion, because even though they may drive the boat, they need a physician as their champion. In historic Western medicine, that still is what will drive patients into your facility. That's just the honest truth.

So, find a champion who partners with you. Figure out where your patients are accessing, what gives them pause about coming back, what motivates them to come back, and then find answers to the problems that patients are going to face. Be that resource for them.

Share with them education in a manner that is not frightening, but helpful and supportive. Share with them ways that you're going to help them overcome the barriers that they may face if they need treatment or if they're starting to have problems. Don't be afraid to have hard conversations about it. I never shied away from conversations about lymphedema—I was always honest, always upfront, and I always gave the facts as I knew them.

If I didn't know, I told the patient that I don't honestly know because that builds a level of trust. When you're doing prevention, it's so different from traditional medicine that you have to find ways to be part of that treatment team and engage the patient, while still waiting for that "what if" that may never come.

Is there anything else you hope audiences will take away from this?

Korentager: I always just say that I love prevention. Prevention has given me the greatest joy in life—not because I feel like somehow the world shifted, it gave me a change in life because there is a need for it. I can't even tell you how many patients I've worked where it changed their game.

Patients, if they get advanced lymphedema, can't work. If you can't work, you can't support your family. If you can't work, you certainly can't come back to your appointments. Prevention is such a great area of health care. I wish more people embraced it like I do. I wish more people took the time to understand it, because if we had better prevention upfront for things like this, the secondary parts of treating cancer, our overall health care would shift into a way that would allow for the focus to be on curing cancer and less about the side effects from cancer.

I don't think we're there yet, but I think we're getting there. It's an area I encourage everybody to learn more about, get involved with, adopt it into your facility—whether it be small or large—and look at what prevention can do.

It is not difficult to institute this into your workflow or your pathways. Even small organizations can introduce a prevention program with a device like SOZO. Anybody can do it—small, large, rural, suburban, any of those. I encourage everybody to learn more about lymphedema prevention, because as we continue to roll out more and more early detection of cancers, it's going to be more at the forefront of what patients need.