Remote Monitoring of Bioelectrical Impedance in Patients With Breast Cancer–Related Lymphedema: 1-Year Pilot Longitudinal Study

Background: Breast cancer-related lymphedema (BCRL) is a chronic complication that impairs quality of life through persistent fluid accumulation. While clinical guidelines recommend longitudinal surveillance, implementation is often limited by the logistical challenges of frequent in-clinic visits. Bioelectrical impedance analysis (BIA), specifically the segmental extracellular water-to-total body water (ECW/TBW) ratio, offers a noninvasive method for tracking fluid status. However, the technical agreement between in-clinic and patient-led home-based BIA systems, as well as the feasibility of long-term self-monitoring in real-world settings, remains to be fully established. Objective: Our primary objective was to evaluate the agreement between in-clinic and home-based BIA systems for key body composition and fluid-related parameters. Our secondary objective was to characterize longitudinal fluid patterns and diurnal variations in ECW/TBW ratios to assess the feasibility of home-based monitoring. Methods: This prospective, patient-driven, 12-month observational study enrolled breast cancer survivors at risk for lymphedema. Agreement between the in-clinic BIA system (InBody 770) and the home-based device (BWA ON) was assessed using Bland-Altman analysis, intraclass correlation coefficients (ICCs), and the Lin concordance correlation coefficient (CCC). Longitudinal home-based ECW/TBW measurements were analyzed using linear mixed-effects models to evaluate diurnal differences (before-noon vs after-noon) across groups defined by limb dominance and BCRL status (International Society of Lymphology [ISL] stage 0 vs stage 1). Results: Over 12 months, ECW/TBW ratios measured by the home-based device demonstrated strong agreement with in-clinic measurements, showing minimal bias and high ICC/CCC values. Longitudinal analysis revealed that ECW/TBW changes did not follow uniform patterns within ISL stage categories, showing substantial physiological heterogeneity even among clinically stable groups. Diurnal analysis identified a small but statistically significant decrease in ECW/TBW ratios in the afternoon (P<.001). The magnitude of this decrease differed by limb dominance and BCRL status, with the most pronounced reduction observed in participants whose dominant arm was affected and who had a history of stage 1 lymphedema. ECW/TBW variability was driven more by within-individual factors (eg, measurement timing) than by between-individual differences. Conclusions: Home-based segmental bioimpedance provides reliable longitudinal data and reveals granular fluid patterns not captured by conventional ISL staging alone. The significant impact of diurnal variation, particularly in relation to limb dominance, underscores the need for standardizing measurement protocols. Standardizing home-based measurements to a fixed monitoring time can minimize physiological noise and enhance the interpretability of long-term self-monitoring strategies for breast cancer survivors.