Evidence-Based Practices for Lymphedema Risk Reduction

Wednesday, 1 August 2012

Judy Phillips, FNP-BC, MSN, AOCN
Cancer Care of Western North Carolina, Mission Health, Asheville, NC
Anne E. Belcher, PhD, RN, FAAN, ANEF
Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD
Mary Terhaar, DNSc, RN
Department of Health Systems and Outcomes, Johns Hopkins University School of Nursing, Baltimore, MD

Learning Objective 1: Identify risk factors for lymph edema that can be attenuated by self-care strategies

Learning Objective 2: Evaluate the impact of evidence based strategies on behaviors of women following breast surgery

Patients with breast cancer are often cured, yet many face a lifelong threat of lymphedema. Lymphedema is swelling of the arm, hand, fingers, chest, or back on the affected side of the breast cancer. Research establishes the risk of this occurrence as being between 6.8% and 93.7% (Soren et al., 2011). Once mild lymphedema occurs there is a 79% risk of progression to severe lymphedema within the first year and 66% in three years; in five years the risk diminishes to 52% (Bar, 2010).

Although ten risk factors have been identified from review of high quality research on lymphedema, only four have the potential for mitigation; these are BMI, infection, injury, and repetitive hand/arm use.  Providing education about risks and prevention strategies empowers the patients to take actions to prevent the occurrence/severity of lymphedema. This cohort study investigated the benefits of professional and patient education about lymphedema risk and prevention.

The primary aim was to increase the knowledge of nurses and patients regarding evidence based lymphedema risk minimization and prevention strategies.  Content included risk identification and coaching patients about weight control, exercise, skin care, and avoiding affected hand/arm repetitive movements. A brochure was developed and pre-tested for use in the coaching of the patients.  Pre and posttest of nurses’ and patients’ knowledge and measurement of patient behavior changes via survey was completed.

Bar Ad, V., Cheville, A., Solin, L. J., Dutta, P., Both, S., & Harris, E. E. (2010). Time course of mild arm lymphedema after breast conservation treatment for early-stage breast cancer. International Journal of Radiation Oncology, Biology, Physics, 76(1), 85-90. doi:10.1016/j.ijrobp.2009.01.024

Soran, A., Wu, W. C., Dirican, A., Johnson, R., Andacoglu, O., & Wilson, J. (2011). Estimating the probability of lymphedema after breast cancer surgery. American Journal of Clinical Oncology, 34(5), 506-510. doi:10.1097/COC.0b013e3181f47955