For decades, survivorship care has largely stopped once active treatment ends, relying on periodic scans and patients reporting symptoms. In this editorial, Maureen L. McBeth, PT, MPT, CLT-LANA, Senior Medical Affairs Liaison at ImpediMed, draws on more than 25 years of oncology rehabilitation practice to explain why that gap misses complications like lymphedema, sarcopenia, and cardiometabolic decline until they’ve already taken hold. She makes the case for bioimpedance spectroscopy (BIS) as a simple, routine measurement that can catch these changes while they are still reversible.
Key Takeaways
- Recurrence surveillance and recovery surveillance are not the same thing. Scans and labs are built to detect cancer coming back, not to reveal muscle loss, cardiometabolic shifts, or lymphedema developing in a survivor’s body.
- Subclinical lymphedema is treatable, but only if it’s caught. The PREVENT trial showed early compression can reverse subclinical lymphedema before it becomes chronic — but only for patients being monitored in the first place.
- The scale can hide serious risk. In a study of more than 3,200 women with nonmetastatic breast cancer, roughly a third had low muscle mass at diagnosis, undetectable by weight or BMI alone, and faced a 41 percent higher risk of death.
- Objective monitoring is gaining institutional backing. BIS is now recommended by NCCN, NAPBC, and an international MASCC panel, and is covered by U.S. insurers for 331 million lives — reflecting a shift toward starting monitoring at diagnosis rather than after treatment ends.
Rebuilding After Cancer
I’ve spent more than 25 years as a physical therapist working with cancer survivors, and I’ve watched the same situation play out more times than I can count. During active treatment, a patient is surrounded by measurement. Scans, labs, vitals, and frequent visits create a continuous picture of what is happening inside the body. Then treatment ends. Most of the measuring stops, and what’s left is a periodic scan and the expectation that the patient will speak up if something feels wrong.
During this time, some of the most consequential changes begin. Lymphedema, muscle loss, cardiometabolic shifts, and functional decline develop slowly and invisibly. By the time the patient or clinician notices, the window for the simplest intervention has potentially closed.
Scans and Lab Work Only Answer One Question
Survivorship visits are designed to answer the question of whether the cancer has come back. But imaging and labs are built to find recurrence, and they say little about how well a patient is recovering.
It’s not a failure of the clinician. An oncologist watching for recurrence is doing exactly what survivorship follow-up was meant to do.
The trouble is that the changes shaping a survivor’s long-term health sit outside what recurrence surveillance looks for. Lymphedema gets the most attention, but it is one of several concerns. Muscle loss, cardiometabolic decline, bone density changes, and persistent fatigue can all occur in the months after treatment. Imaging built to spot tumors was never designed to see them. A survivor can come in for a scan and hear good news, while these changes go undetected.
What the Scale Quietly Hides
Each of these complications has its own early signal, and most of them are invisible on the scale or a routine scan. Lymphedema is a good example. I still get referrals for lymphedema that arrive long after the cancer was treated and the swelling first appeared. By then, early compression and targeted exercise have a much smaller chance of keeping the condition from becoming chronic. In many cases, it is already chronic. Chronic lymphedema is more than swelling. It leaves patients prone to infections that can flare without warning and turn serious enough to require hospitalization, sometimes years or even decades after the cancer itself is gone. It also demands intensive daily management that is costly and wears on a patient’s quality of life.
The PREVENT trial, the largest randomized study of lymphedema assessment to date, showed that identifying subclinical lymphedema early and starting a short course of compression can reverse it before it becomes a chronic, lifelong condition. [1] But that early signal only exists for patients who are being monitored. Without a surveillance program, there is no reading to act on. The first sign is swelling that has already set in. Routine screening changes that. We catch prediabetes because we test for elevated blood sugar every year and treat it before symptoms appear. Lymphedema deserves the same standard.
Fluid balance and phase angle describe what is happening at the cellular level, and body composition shows whether a survivor’s weight loss is coming from fat or muscle. In these cases, the scale can be misleading. I have tested survivors who were pleased with falling weight and was stunned to learn how much of that loss was muscle. This muscle loss, known clinically as sarcopenia, can take a toll on recovery and survival. Muscle loss like that carries real consequences for recovery and survival. In a study of more than 3,200 women with nonmetastatic breast cancer, about a third had low muscle mass at diagnosis, and those women faced a 41 percent higher risk of death than women without it. Weight and body mass index alone did not identify them. Sarcopenia is exactly this kind of hidden risk: it can be present at a completely normal weight, which is precisely why the scale misses it.[2]
What This Looks Like in Clinic
The measurement, a painless 30-second reading called bioimpedance spectroscopy (BIS), can be run during routine intake, alongside vitals, without adding a visit or slowing the schedule. We take a baseline at diagnosis, before treatment begins, then repeat it at each follow-up, so every reading is measured against that patient’s own norm rather than a population average.
The numbers tell me where to intervene. When I see fluid accumulating, I can start conservative compression before there is any visible swelling. If lean muscle mass slips, a sign of emerging sarcopenia, I shift the focus toward rebuilding strength and adjust how hard I push a patient’s training. And because the whole care team sees the same numbers during the same visit, the oncologist, the therapist, and the patient work from one picture instead of three.
When the Whole Panel Gets the Same Early Warning
Early detection changes what the care team can do, and the evidence base is strongest where objective monitoring has been studied longest. The PREVENT trial found that BIS monitoring held progression to chronic lymphedema to 7.9 percent, compared with 19.2 percent under tape measurement, a 59 percent relative reduction.
Objective monitoring also catches the patients that symptom reporting tends to miss. Because it doesn’t depend on someone noticing and reporting a change, every survivor gets the same early warning, including the ones least likely to speak up. A vague “how are you feeling” becomes a number the survivor and the clinician can look at together and act on.
The NCCN and NAPBC now recommend BIS for early detection of lymphedema in at-risk patients, and an international MASCC panel reinforced that position for breast cancer-related lymphedema in 2024. [3][4][5] Payer coverage has followed, with U.S. insurers now covering BIS-based lymphedema monitoring for 331 million lives.
In my experience, a survivor can feel fine while something quietly goes wrong. Survivorship care should catch an issue early, not wait for it to surface.
Survivorship Care Is About to Get Quieter and Smarter
Over the next few years, I expect the line between active treatment and survivorship to blur. Survivorship does not begin when treatment ends. It begins at diagnosis, when the first BIS reading should be taken, giving every later reading a true baseline. As fields like exercise oncology reshape care, we will stop waiting for treatment to finish to build the survivorship plan. Monitoring will start at diagnosis and run on a regular cadence, keeping patients healthier during treatment, not only after.
The goal hasn’t changed. Survivorship has always been about recovery. What is changing is that we no longer wait for recovery to slip before we act, and that includes catching sarcopenia while it’s still reversible. When we catch a change early, we can keep a small decline from becoming a steep one, so a patient does not have to break down before we build them back up.
Reference
[1] Shah C, Boyages J, Koelmeyer L, Chen SL, Vicini F. Timing of Breast Cancer Related Lymphedema Development Over 3 Years: Observations from a Large, Prospective Randomized Screening Trial Comparing Bioimpedance Spectroscopy (BIS) Versus Tape Measure. Ann Surg Oncol. 2024 Oct;31(11):7487-7495. doi: 10.1245/s10434-024-15706-x. Epub 2024 Jul 4. PMID: 38965099.
[2] Caan BJ, Cespedes Feliciano EM, Prado CM, Alexeeff S, Kroenke CH, Bradshaw P, Quesenberry CP, Weltzien EK, Castillo AL, Olobatuyi TA, Chen WY. Association of Muscle and Adiposity Measured by Computed Tomography With Survival in Patients With Nonmetastatic Breast Cancer. JAMA Oncol. 2018 Jun 1;4(6):798-804. doi: 10.1001/jamaoncol.2018.0137. PMID: 29621380; PMCID: PMC6584322.
[3] NCCN Guidelines. Online. Last accessed on September 15, 2026.
[4] National Accreditation Program for Breast Centers / ACS. Online. Last accessed on September 15, 2026.
[5] Wong HCY, Wallen MP, Chan AW, Dick N, Bonomo P, Bareham M, Wolf JR, van den Hurk C, Fitch M, Chow E, Chan RJ; MASCC BCRAL Expert Panel and the Oncodermatology and Survivorship Study Groups. Multinational Association of Supportive Care in Cancer (MASCC) clinical practice guidance for the prevention of breast cancer-related arm lymphoedema (BCRAL): international Delphi consensus-based recommendations. EClinicalMedicine. 2024 Feb 2;68:102441. doi: 10.1016/j.eclinm.2024.102441. PMID: 38333542; PMCID: PMC10850412.
Featured image: © 2026 CHA/JCO ONC. Used with permission.
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