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Prescription and adherence to lymphedema self-care modalities among women with breast cancer-related lymphedema

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Abstract

Purpose

To profile the prescription for and adherence to breast cancer-related lymphedema (BCRL) self-care modalities among breast cancer (BrCa) survivors with BCRL in a 12-month randomized weightlifting trial.

Methods

We developed a questionnaire that assessed prescription for and adherence to 10 BCRL self-care modalities that included physical therapy exercise, pneumatic compression pump, medication, lymphedema bandaging, arm elevation, self-administered lymphatic drainage, therapist-administered lymphatic drainage, compression garments, skin care, and taping. We measured prescription for and adherence to BCRL self-care modalities at baseline, 3, 6, and 12 months. Longitudinal logistic regression was used to estimate the odds ratio (OR) and 95 % confidence interval (95 % CI) associated with prescription for and adherence to BCRL modalities over time.

Results

This study included 141 BrCa survivors with BCRL. Women were prescribed an average of 3.6 ± 2.1 BCRL self-care modalities during the study. The prescription for therapist-administered lymphatic drainage (OR = 0.92, 95 % CI 0.88–0.96), pneumatic compression pump use (OR = 0.94, 95 % CI 0.89–0.98), and bandaging (OR = 0.96, 95 % CI 0.93–0.99) decreased over 12 months of follow-up. No other prescribed BCRL self-care modalities changed during the study. Over 12 months, the average adherence to all BCRL self-care modalities varied with 13, 24, 32, and 31 % of women reporting <25, 25–49, 50–74, and ≥75 % adherence, respectively. Over 12 months, there was a noticeable change from high to low adherence in self-administered lymphatic drainage, such that there was a 15 % increased likelihood of adherence <25 % compared to ≥75 % (OR = 1.15 (95 % CI 1.05–1.26); p = 0.002). The adherence patterns of all other modalities did not change over follow-up.

Conclusions

Our findings suggest the prescription for BCRL self-care modalities is variable. The average adherence to BCRL self-care was non-optimal. Future research is necessary to prepare BrCa survivors with the knowledge, skills, abilities, and resources necessary to care for this lifelong condition.

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Funding

This study was funded by a National Cancer Institute Grant (R01-CA106851) to KH Schmitz. BSN medical provided custom-fitted compression garments to all study participants. Neither the National Cancer Institute nor BSN medical had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Conflict of interest

All authors declare no conflicts of interest. The authors have full control of all the primary data and agree to allow the editors of this journal access if requested.

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Authors and Affiliations

  1. University of Pennsylvania School of Medicine, 423 Guardian Drive, 8th Floor, Blockley Hall, Philadelphia, PA, 19104, USA

    Justin C. Brown, Julia C. Tchou & Kathryn H. Schmitz

  2. Mayo Clinic, Rochester, MN, USA

    Andrea L. Cheville

  3. University of British Columbia, Vancouver, BC, Canada

    Susan R. Harris

Authors
  1. Justin C. Brown
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  2. Andrea L. Cheville
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  3. Julia C. Tchou
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  4. Susan R. Harris
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  5. Kathryn H. Schmitz
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Corresponding author

Correspondence to Kathryn H. Schmitz.

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Brown, J.C., Cheville, A.L., Tchou, J.C. et al. Prescription and adherence to lymphedema self-care modalities among women with breast cancer-related lymphedema. Support Care Cancer 22, 135–143 (2014). https://doi.org/10.1007/s00520-013-1962-9

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