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Annals of Surgical Oncology

, Volume 21, Issue 11, pp 3481–3489 | Cite as

Proactive Approach to Lymphedema Risk Reduction: A Prospective Study

  • Mei R. Fu
  • Deborah Axelrod
  • Amber A. Guth
  • Francis Cartwright
  • Zeyuan Qiu
  • Judith D. Goldberg
  • June Kim
  • Joan Scagliola
  • Robin Kleinman
  • Judith Haber
Breast Oncology

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.

Keywords

Sentinel Lymph Node Biopsy Lymphedema Compression Garment Limb Volume Sentinel Lymph Node Biopsy Group 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

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.

List of Products Used

No products, devices, or drugs were used or identified in the manuscript.

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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Mei R. Fu
    • 1
  • Deborah Axelrod
    • 2
    • 3
  • Amber A. Guth
    • 2
    • 3
  • Francis Cartwright
    • 3
  • Zeyuan Qiu
    • 4
  • Judith D. Goldberg
    • 5
  • June Kim
    • 5
  • Joan Scagliola
    • 3
  • Robin Kleinman
    • 3
  • Judith Haber
    • 1
  1. 1.College of NursingNew York UniversityNew YorkUSA
  2. 2.Department of SurgeryNew York University School of MedicineNew YorkUSA
  3. 3.NYU Clinical Cancer CenterNew YorkUSA
  4. 4.New Jersey Institute of TechnologyNewarkUSA
  5. 5.Division of BiostatisticsNew York University School of MedicineNew YorkUSA

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