Korean J Women Health Nurs.  2011 Dec;17(5):474-483. 10.4069/kjwhn.2011.17.5.474.

Details of Lymphedema, Upper Limb Morbidity, and Self Management in Women after Breast Cancer Treatment

• Chung CW
• Hwang EK
• Hwang SW

• KMID: 2308238
• DOI: http://doi.org/10.4069/kjwhn.2011.17.5.474

Abstract

PURPOSE
To examine the details of lymphedema, upper limb morbidity, and its self management in women after breast cancer treatment.
METHODS
Using a cross-sectional survey design, 81 women were recruited from a university hospital. Lymphedema was detected by a nurse as a 2-cm difference between arm circumferences at 6 different points on the arm. Degrees of pain, stiffness, and numbness were scored using a drawing of upper limb on a 0~10 point scale. Aggravating conditions and self-management for lymphedema were also recorded.
RESULTS
The mean age of the participants was 52.5 years; the average time since breast surgery was 29.7 months. Histories of modified radical mastectomy (55%) and lymph node dissection (81%) were noted. Lymphedema was found in 59% of women, then pain and stiffness were prevalent most at upper arm while numbness was apparentat fingers, and the symptom distress scores ranged 3.9~6.7. Women experienced aggravated arm swelling after routine housework with greatly varied duration. Self-management was conservative with a wide range of times for the relief of symptoms.
CONCLUSION
Lymphedema education for women with breast cancer should be incorporated into the oncologic nursing care system to prevent its occurrence and arm morbidity. Risk reduction guidelines, individually tailored self-care strategies, and self-awareness for early detection need to be refined in clinical nursing practices.

Keyword

Breast cancer; Lymphedema; Self-management; Morbidity

MeSH Terms

Arm
Breast
Breast Neoplasms
Cross-Sectional Studies
Female
Fingers
Housekeeping
Humans
Hypesthesia
Lymph Node Excision
Lymphedema
Mastectomy, Modified Radical
Oncologic Nursing
Risk Reduction Behavior
Self Care
Upper Extremity

Reference

1. Ahmed R.L., Prizment A., Lazovich D., Schmitz K.H., Folsom A.R. Lymphedema and quality of life in breast cancer survivors: The Iowa women's health study. Journal of Clinical Oncology. 2008. 26:5689–5696.

2. Armer J. Research on risk assessment for secondary lymphedema following breast cancer treatment. Cancer Epidemiology, Biomarkers and Prevention. 2010. 19:2715–2717.

3. Armer J., Fu M.R. Age differences in post-breast cancer lymphedema signs and symptoms. Cancer Nursing. 2005. 28:200–207.

4. Bani H.A., Fasching P.A., Lux M.M., Rauh C., Willner M., Eder I., et al. Lymphedema in breast cancer survivors: Assessment and information provision in a specialized breast unit. Patient Education and Counseling. 2007. 66:311–318.

5. Bennett J.A., Winters-Stone K., Nail L. Conceptualizing and measuring physical functioning in cancer survivorship studies. Oncology Nursing Forum. 2006. 33:41–49.

6. Chun M.S., Moon S.M., Lee H.J., Lee E.H., Song Y.S., Chung Y.S., et al. Arm morbidity after breast cancer treatments and analysis of related factors. The Journal of the Korean Society for Therapeutic Radiology and Oncology. 2005. 23:32–42.

7. Clark B., Sitzia J., Harlow W. Incidence and risk of arm oedema following treatment for breast cancer: A threeyear follow-up study. Monthly Journal of the Association of Physicians. 2005. 98:343–348.

8. Erickson V.S., Pearson M.L., Ganz P.A., Adams J., Kahn K.L. Arm edema in breast cancer patients. Journal of the National Cancer Institute. 2001. 93:96–111.

9. Fu M.R., Axelrod D., Haber J. Breast-cancer-related lymphedema: Information, symptoms, and risk-reduction behaviors. Journal of Nursing Scholarship. 2008. 40:341–348.

10. Fu M.R., Chen C.M., Haber J., Guth A.A., Axelrod D. The effect of providing information about lymphedema on the cognitive and symptom outcomes of breast cancer survivors. Annals of Surgical Oncology. 2010. 17:1847–1853.

11. Jeffs E. Treating breast cancer-related lymphoedema at the London Haven: Clinical audit results. European Journal of Oncology Nursing. 2006. 10:71–79.

12. Lee K.H. Post-operative morbidity, menopause symptoms and quality of life in patients with breast cancer. 2006. Seoul: Yonsei University;Unpublished master's thesis.

13. Lee K.W., Kim S.B., Yoon K.S., Kwak H., Cho S.H., Park J.M., et al. The risk factors associated with lymphedema after axillary dissection for breast cancer. Journal of the Korean Surgical Society. 2006. 71:85–90.

14. McNeely M.L., Campbell K., Ospina M., Rowe B.H., Dabbs K., Klassen T.P., et al. Exercise interventions for upper-limb dysfunction due to breast cancer treatment. Cochrane Database of Systematic Reviews (Online). 2010. 16(6):CD005211.

15. Meneses K.D., McNees M.P. Upper extremity lymphedema after treatment for breast cancer: A review of the literature. Ostomy/Wound Management. 2007. 53:16–29.

16. Moffatt C.J., Franks P.J., Doherty D.C., Williams A.F., Badger C., Jeffs E., et al. Lymphoedema: An underestimated health problem. Monthly Journal of the Association of Physicians. 2003. 96:731–738.

17. National Cancer Information Center. The occurrence of cancer incidence trends 1999-2007. 2010. Retrieved December 5, 2010. from http://www.cancer.go.kr/cms/statics/incidence/index.html.

18. Position statement of the National Lymphedema Network. Topic: Lymphedema risk reduction practices. National Lymphedema Network. 2008. Retrieved April 30, 2009. from http://www.lymphnet.org.

19. Norman S.A., Localio A.R., Potashnik S.L., Simoes Torpey H.A., Kallan M.J., Weber A.L, et al. Lymphedema in breast cancer survivors: Incidence, degree, time course, treatment, and symptoms. Journal of Clinical Oncology. 2009. 27:390–397.

20. Paskett E.D., Naughton M.J., McCoy T.P., Case L.D., Abbott J.M. The epidemiology of arm and hand swelling in premenopausal breast cancer survivors. Cancer Epidemiology, Biomarkers and Prevention. 2007. 16:775–782.

21. Park J.H. Predictors of breast cancer lymphedema. 2005. Seoul: Yonsei University;Unpublished master's thesis.

22. Poage E., Singer M., Armer J., Poundall M., Shellabarger J. Demystifying lymphedema: Developing of the lymphedema Putting Evidence Into Practice®Card. Clinical Journal of Oncology Nursing. 2008. 12:951–964.

23. Ridner S.H. Breast cancer lymphedema: Pathophysiology and risk reduction guidelines. Oncology Nursing Forum. 2002. 29:1285–1293.

24. Thomas-MacLean R., Miedema B., Tatemichi S.R. Breast cancer-related lymphedema: Women's experiences with an underestimated condition. Canadian Family Physician Médecin de Famille Canadien. 2005. 51:206–208.