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Proactive Approach to Lymphedema Risk Reduction: A Prospective Study

Annals of Surgical Oncology volume 21, pages 3481–3489 (2014)Cite this article

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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References

  1. Fu MR, Ridner SH, Hu SH, et al. Psychosocial impact of lymphedema: a systematic review of literature from 2004 to 2011. Psychooncol. 2013;22(7):1466-84.

    Article  Google Scholar 

  2. Chachaj A, Malyszczak K, Pyszel K, et al. Physical and psychological impairments of women with upper lymphedema following breast cancer treatment. Psychooncol. 2009;19:299–305.

    Article  Google Scholar 

  3. Petrek JA, Senie RT, Peters M, Rosen PP. Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis. Cancer. 2001;92(6):1368–77.

    Article  PubMed  CAS  Google Scholar 

  4. Armer JM, Stewart BR, Shook RP. 30-month post-breast cancer treatment lymphoedema. J Lymphoedema. 2009;4(1):14–18.

    PubMed  PubMed Central  Google Scholar 

  5. International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema. Consensus document of the International Society of Lymphology. Lymphology. 2003;36:84–91.

    Google Scholar 

  6. Stanton AW, Modi S, Mellor RH, et al. Recent advances in breast cancer-related lymphedema of the arm: lymphatic pump failure and predisposing factors. Lymphat Res Biol. 2009;7(1):29–45.

    Article  PubMed  Google Scholar 

  7. Brorson H, Aberg M, Svensson H. Chronic lymphedema and adipocyte proliferation: clinical therapeutic implications. The Lymphatic Continuum. National Institutes of Health, Bethesda, USA, 2002. Lymphat Res Biol. 2003;1:88.

    Google Scholar 

  8. Mak SS, Yeo W, Lee YM, et al. Predictors of lymphedema in patients with breast cancer undergoing axillary lymph node dissection in Hong Kong. Nurs Res. 2008;57:416-25.

    Article  PubMed  Google Scholar 

  9. Kwan ML, Darbinian J, Schmitz KH, et al. Risk factors for lymphedema in a prospective breast cancer survivorship study: the Pathways Study. Arch Surg. 2010;145:1055–63.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ahmed RL, Schmitz KH, Prizment AE, et al. Risk factors for lymphedema in breast cancer survivors, the Iowa Women’s Health Study. Breast Cancer Res Treat. 2001;130:981–91.

    Article  Google Scholar 

  11. Paskett ED, Naughton MJ, McCoy TP, et al. The epidemiology of arm and hand swelling in premenopausal breast cancer survivors. Cancer Epidemiol Biomarkers Prev. 2007;16:775–82.

    Article  PubMed  Google Scholar 

  12. Ruocco V, Schwartz RA, Ruocco E. Lymphedema: an immunologically vulnerable site for development of neoplasms. J Am Acad Dermat. 2002;47:124–7.

    Article  Google Scholar 

  13. Fu MR, Chen C, Haber J, et al. The effect of providing information about lymphedema on the cognitive and symptom outcomes of breast cancer survivors. Ann Surg Oncol. 2010;17(7):1847–53.

    Article  PubMed  Google Scholar 

  14. Cemal Y, Pusic A, Mehrara BJ. Preventative measures for lymphedema: separating fact from fiction. J Am Coll Surg. 2011;213(4):543–51.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Nielsen I, Gordon S, Selby A. Breast cancer-related lymphoedema risk reduction advice: a challenge for health professionals. Cancer Treat Rev. 2008;34(7):621–8.

    Article  PubMed  Google Scholar 

  16. Stout NL, Binkley JM, Schmitz KH, Andrews K, Hayes SC, Campbell KL, et al. A prospective surveillance model for rehabilitation for women with breast cancer. Cancer. 2012;118(8 Suppl):2191–200.

    Article  PubMed  Google Scholar 

  17. Armer JM, Stewart BR. A comparison of four diagnostic criteria for lymphedema in a post-breast cancer population. Lymphat Res Biol. 2005;3:208–17.

    Article  PubMed  Google Scholar 

  18. McLaughlin SA, Bagaria S, Gibson T, et al. Trends in risk reduction practices for the prevention of lymphedema in the first 12 months after breast cancer surgery. J Am Coll Surg. 2013:216:380–9.

    Article  PubMed  Google Scholar 

  19. Lasinski BB, Thrift KM, Squire D, et al. A systematic review of the evidence for complete decongestive therapy in the treatment of lymphedema from 2004 to 2011. PM R. 2012;4(8):580–601.

    Article  PubMed  Google Scholar 

  20. American Cancer Society. Breast Cancer Facts & Figures 2013-2014. Atlanta: American Cancer Society, Inc.; 2013.

    Google Scholar 

  21. Shih YC, Xu Y, Cormier JN, et al. Incidence, treatment costs, and complications of lymphedema after breast cancer among women of working age: a 2-year follow-up study. J Clin Oncol. 2009;27(12):2007–14.

    Article  PubMed  Google Scholar 

  22. McLaughlin SA, Wright MJ, Morris KT, et al. Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements. J Clin Oncol. 2008;26(32):5213–19.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Fitzmaurice G, Laird N, Ware J. Applied longitudinal data analysis. New Jersey: John Wiley & Sons; 2004.

    Google Scholar 

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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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