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The risk factors for lymphedema nursing essay

The publisher's final edited version of this article is available at Ann Surg Oncol See other articles in PMC that cite the published article.

  1. But the authors have full control of all primary data, and they agree to allow the journal to review their data if requested. It was shown that the odds of edema in illiterates and low levels of education was 1.
  2. Breast Cancer Res Treat.
  3. Methods This is a prospective sub-analysis of the PAL trial, a randomized controlled trial of 295 breast cancer survivors.

Abstract Background Breast cancer-related lymphedema BCRL is a feared complication for breast cancer patients who have undergone axillary surgery.

Although clinical risk factors for BCRL are defined; data are sparse regarding common exposures that might induce incident arm swelling. The goal of this study was to quantify the association between common exposures thought to be potential risk factors, and the occurrence of incident arm swelling, among breast cancer survivors with or at-risk for BCRL. Methods This is a prospective sub-analysis of the PAL trial, a randomized controlled trial of 295 breast cancer survivors.

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Participants reported their exposure to 30 different potential risk-factors at three month intervals for one year. Conclusions In our patient cohort, many common exposures that have been reported to be risk factors did not prove to have a significant predictive relationship for incident arm swelling. This study supports the recommendation that breast cancer patients who have had axillary surgery should avoid sauna use. The results do not confirm the need for other restrictions that may interfere with the quality of life in women with breast cancer.


Lymphedema is characterized by progressive swelling that has an adverse effect on quality of life and increases utilization of healthcare resources [ 1 ]. Numerous studies have been published in an attempt to determine both risk factors for developing BCRL [ 4 - 8 ] and preventive strategies [ 9 - 11 ] to minimize the development of BCRL. Clinically-related risk factors, such as the type of surgery and adjuvant treatment, are the most commonly studied causes of BCRL because they are easiest to ascertain and are not subject to patient interpretation.

Many of the studies that have tried to elucidate prevention strategies are small, retrospective, single-institution reports, making it difficult to draw definitive conclusions. No definitive associations have been established between potentially high-risk, modifiable behaviors and lymphedema onset or worsening. This deficit is problematic because, confronted with an information void, non-evidence based recommendations proliferate and patients may engage in needless and potentially harmful avoidance behaviors [ 11 ].

One such example is the recommendation to avoid weight lifting exercise. This recommendation has been challenged [ 12 ], now that weight lifting among breast cancer survivors has been demonstrated to be safe, and to reduce the severity of self-reported lymphedema symptoms among breast cancer survivors [ 10 ].

Lifestyle Risk Factors Associated with Arm Swelling among Women with Breast Cancer

The primary goal of the current study was to quantify the association between common exposures and the occurrence of incident arm swelling. The secondary goals were to estimate the frequency of common exposures hypothesized to be associated with incident arm swelling as well as the frequency of incident arm swelling in a one year period in our patient cohort. Participants with stable BCRL were 1—15 years post breast cancer diagnosis, and participants at-risk for BCRL were 1—5 years post breast cancer diagnosis.

In addition, participants with BCRL were ineligible if they had any of the following: The patient cohort was recruited between October 2005 and February 2007.

The University of Pennsylvania Institutional Review Board approved the study protocol, and informed consent was obtained from all participants.

Participants in the PAL trial were randomized to a progressive weight lifting intervention versus no exercise. The primary aim of the PAL trial was to assess change in BCRL outcomes resulting from twice-weekly weight lifting among breast cancer survivors [ 13 ]. The primary outcomes [ 910 ] and detailed methods of the PAL trial [ 13 ] have the risk factors for lymphedema nursing essay reported previously. Demographic characteristics, cancer treatment and medication history were obtained by self-report.

Cancer staging was taken from the state cancer registries, surgical pathology reports, or self-report. The number of lymph nodes removed was obtained from surgical pathology reports. This questionnaire was completed at baseline, 3- 6- and 12-months and averaged over one year. Incident arm swelling Questionnaire Participants were asked to report their exposure to 30 different potential risk-factors.

For People at Risk of Lymphedema

The list of exposures was compiled by a physical medicine and rehabilitation physician expert in lymphedema. The questionnaire was administered at the time of entry into the study, 3- 6- and 12-months.

Patients were queried about exposure to any of the risk-factors encountered in the time interval since the last study visit. Objective Measures of Arm Volume Participants completed water volume displacement measures [ 16 ] to assess arm volume at baseline, 3- 6- and 12-months by blinded study staff.

Breast cancer-related lymphedema: Symptoms, diagnosis, risk reduction, and management

This method of calculation differs from previous analyses in that we compared arm volume to the most recent previous arm volume rather than to baseline arm volume.

We used the modified calculation of arm volume to isolate the change in arm volume percentage over each time interval to align with the data captured in the exposure questionnaire. Therefore, the frequency of incident arm swelling reported in this paper is different from the primary outcome analysis papers [ 910 ]. Statistical Analysis Descriptive statistics reported for baseline variables include rates for categorical variables and means or medians and standard deviations for continuous variables.

Baseline characteristics of women who did and did not experience incident arm swelling were compared using nonparametric methods that included Fishers exact test for categorical variables and the Kruskal-Wallis test for continuous variables. Model fit was assessed using the Akaike and Bayesian information criterion methods.

  1. Cellulitis is an infection in the tissues just under your skin. Single frequency versus bioimpedance spectroscopy for the assessment of lymphedema.
  2. So it is recommended that lymphedema assessment should begin preoperatively with assessment of both arm, and it ought to be continued at regular intervals.
  3. This is an urgent medical problem that you need to tell your doctor about right away. Pharmacological management of lymphedema uses benzopyrones, flavonoids, diuretics, hyaluronidase, pantothenic acid, and selenium[ 35 ].
  4. Definitely higher awareness and better self-care practice in educated patients have an important role in this difference.
  5. There are also known risk factors that are not directly related to breast cancer treatment. As life expectancy improves for women with breast cancer, more women will be living with possible side effects of the treatment.

Sensitivity analysis was conducted using generalized estimating equations with exchangeable and autoregressive correlation matrices; the study findings and conclusions did not differ among methods. Additional subgroup analysis was conducted between breast cancer survivors with BCRL and those at risk, and the results did not differ between groups.

  • The number of lymph nodes removed was obtained from surgical pathology reports;
  • Inflammation-infection and higher body mass index BMI are the main predictors of limb volume change and lymphedema besides treatment-related risk[ 3 - 6 ];
  • Clothing and compression garments should be supportive and have smooth, even compression.

All statistical analyses were performed with Stata SE 12. Participants were aged 36-80 years at baseline mean 56 years.

International Journal of Breast Cancer

Table 2 summarizes baseline clinical characteristics of all 295 participants. The number of lymph nodes removed ranged from 1-38 mean 11. Time since breast cancer diagnosis ranged from 11-138 months mean 62 months. Baseline BMI ranged from 17. Participation in self-reported physical activity did not change between baseline and 12-months [ 910 ].