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Proactive Approach to Lymphedema Risk Reduction: A Prospective Study

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Advances in cancer treatments continue to reduce the incidence of lymphedema. Yet, many breast cancer survivors still face long-term postoperative challenges as a result of developing lymphedema. The purpose of this study was to preliminarily evaluate The Optimal Lymph Flow program, a patient-centered education and behavioral program focusing on self-care strategies to enhance lymphedema risk reduction by promoting lymph flow and optimize body mass index (BMI).

Methods

A prospective, longitudinal, quasi-experimental design with repeated-measures was used. The study outcomes included lymph volume changes by infrared perometer, and BMI by a bioimpedance device at pre-surgery baseline, 2–4 weeks after surgery, 6-month and 12-month follow-up. A total of 140 patients were recruited and participated in The Optimal Lymph Flow program; 134 patients completed the study with 4 % attrition rate.

Results

Fifty-eight percent of patients had axillary node dissection and 42 % had sentinel lymph node biopsy (SLNB). The majority (97 %) of patients maintained and improved their preoperative limb volume (LV) and BMI at the study endpoint of 12 months following cancer surgery. Cumulatively, two patients with SLNB and two patients with axillary lymph node dissection had measurable lymphedema (>10 % LV change). At the 12-month follow-up, among the four patients with measurable lymphedema, two patients’ LV returned to preoperative level without compression therapy but by maintaining The Optimal Lymph Flow exercises to promote daily lymph flow.

Conclusions

This educational and behavioral program is effective in enhancing lymphedema risk reduction. The study provided initial evidence for emerging change in lymphedema care from treatment-focus to proactive risk reduction.

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Acknowledgment

This study was supported by the Avon Foundation, National Institute of Health (National Institute on Minority Health and Health Disparities Project No. P60 MD000538-03), Judges and Lawyers for Breast Cancer Alert, and the Vital Fund. Dr. Judith D. Goldberg was partially supported by NYU School of Medicine Cancer Center Support Grants National Cancer Institute 5 P30 CA16087-32. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Partial findings were presented at the 2012 Breast Cancer Symposium, San Francisco, CA, USA (13–15 September 2012).

Statement of Financial Interest

Mei R. Fu, Deborah Axelrod, Amber A. Guth, Francis Cartwright, Zeyuan Qiu, Judith D. Goldberg, June Kim, Joan Scagliola, Robin Kleinman, and Judith Haber have no financial interest or commercial association with information submitted in manuscript.

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Authors and Affiliations

  1. College of Nursing, New York University, New York, NY, USA

    Mei R. Fu PhD, RN, ACNS-BC, FAAN & Judith Haber PhD, RN, APRN-BC, FAAN

  2. Department of Surgery, New York University School of Medicine, New York, NY, USA

    Deborah Axelrod MD, FACS & Amber A. Guth MD, FACS

  3. NYU Clinical Cancer Center, New York, NY, USA

    Deborah Axelrod MD, FACS, Amber A. Guth MD, FACS, Francis Cartwright PhD, RN-BC, Joan Scagliola MS, RN & Robin Kleinman MS, RN

  4. New Jersey Institute of Technology, Newark, NJ, USA

    Zeyuan Qiu PhD

  5. Division of Biostatistics, New York University School of Medicine, New York, NY, USA

    Judith D. Goldberg ScD & June Kim MPS

Authors
  1. Mei R. Fu PhD, RN, ACNS-BC, FAAN
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  2. Deborah Axelrod MD, FACS
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  3. Amber A. Guth MD, FACS
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  4. Francis Cartwright PhD, RN-BC
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  5. Zeyuan Qiu PhD
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  6. Judith D. Goldberg ScD
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  7. June Kim MPS
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  8. Joan Scagliola MS, RN
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  9. Robin Kleinman MS, RN
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  10. Judith Haber PhD, RN, APRN-BC, FAAN
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Corresponding author

Correspondence to Mei R. Fu PhD, RN, ACNS-BC, FAAN.

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Fu, M.R., Axelrod, D., Guth, A.A. et al. Proactive Approach to Lymphedema Risk Reduction: A Prospective Study. Ann Surg Oncol 21, 3481–3489 (2014). https://doi.org/10.1245/s10434-014-3761-z

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  • DOI: https://doi.org/10.1245/s10434-014-3761-z

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