Transcript Preventing Lymphedema: Maintaining Quality of Life for

Preventing Lymphedema:
Maintaining Quality of Life for
Individuals Diagnosed with
Cancer
Presented by Christine Flaherty
The Lymphatic System and Lymphedema
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The lymphatic system includes: lymph fluid, lymphatic vessels
and lymph nodes.
Two primary functions of the lymphatic system: protect the
body from infection (immune response) and facilitate fluid
movement from tissues to bloodstream
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Lymphedema may occur when an individual’s lymphatic
system is impaired.
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When impairment occurs fluid may back up in an area, often
in the arms and legs, and cause swelling.
The Lymphatic System and Lymphedema


The lymphatic system includes: lymph fluid, lymphatic vessels
and lymph nodes.
Two primary functions of the lymphatic system: protect the
body from infection (immune response) and facilitate fluid
movement from tissues to bloodstream

Lymphedema may occur when an individual’s lymphatic
system is impaired.

When impairment occurs fluid may back up in an area, often
in the arms and legs, and cause swelling.
The Lymphatic System and Lymphedema
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Lymphedema is currently classified into two categories;
primary and secondary
Primary lymphedema: lymph vessel or lymph node
development has been impaired
Secondary lymphedema: the lymphatic system is damaged
Once the integrity of an individuals lymphatic system is
compromised, he/she is always vulnerable to developing
lymphedema
There is no cure for lymphedema, but treatment and
therapy do exist.
Possible Symptoms:
Possible Symptoms:
Swelling
 Pain/discomfort
 Numbness, tingling, sensation of
pressure or tightness
 Heaviness of limb
 Increased susceptibility to infection
 Skin breakdown
 Loss of mobility
 Inhibited Range of Motion
 Impaired wound healing

Why some cancer patients are vulnerable:
Surgery
Lymph nodes and vessels can be dissected or disrupted.
Radiation Therapy
Can result in fibrosis of involved tissue which can decrease
circulation of lymph fluid. Radiation can also shrink lymph
nodes.
Secondary lymphedema can develop as a result of surgery or
radiation because these procedures damage the lymphatic
system.
“Lymphedema should not be considered an inevitable
side effect of cancer treatment.”
- Some individuals’ bodies are able to compensate, for
instance; some individuals have adequate, existing
collateral circulation to manage the extra lymph load
- Education regarding risk factors
Evidence
QOL following cancer treatment is greater among
individuals who have not developed lymphedema
when compared to individuals who have.
Year of
Publication
QOL instrument
Sample
Size
Authors
2003
European Organization for
Research and Treatment of Cancer
QOL questionnaire
990
Engel, J. et
al.
2002
Functional Assessment of Cancer
Therapy-Breast QOL instrument
151
Beaulac, S. et
al.
2002
EORTC QLQ
744
Kwan, W. et al.
1999
SF-36
101
Velanovich, V.
et al.
1995
Psychosocial Adjustment to Illness
Scale
100
Woods, M. et
al.
1993
Interviews, Psychological
Symptom Index
205
Maunsell, E.
et al.
Quality of Life Domains Explored:
 Physical
 Psychological
 Social
 Sexual
 Functional
Evidence
The following risk factors were identified:
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High Body Mass Index
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Weight gain in post-treatment years
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Infections or injury in the associated
limb
Flying in airplanes
Application to Occupational Therapy:
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Health, function and quality of life
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Education regarding risk factors
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OTs are involved in the treatment of lymphedema:
Federal laws regulate who can perform complete decongestive
therapy (CDT) for treatment of lymphedema. Occupational
therapists are among the small group of healthcare professionals
who are able to treat lymphedema after receiving training.
Research reporting a lack of knowledge regarding the
condition of lymphedema and/or a lack of knowledge
regarding preventative measures among individuals
diagnosed with cancer:
Bosompra, K., Takamaru, A., O’Brien, P., Nelson, L., Skelly, J., & Beatty, D.
(2002). Knowledge about preventing and managing lymphedema: a
survey of recently diagnosed and treated breast cancer patients.
Patient Education and Counseling, 47, 155-163.
Clark, R., Wasilewska, T., & Carter, J. (1997). Lymphedema: a study of
Otago women treated for breast cancer. Nursing Praxis in New
Zealand, 12, 4-14.
Coward, D. (1999) Lymphedema prevention and management knowledge in
women treated for breast cancer. ONF, 26, 1047-1053.
Hawes, C., Neill, J., Borbasi, S., Groenkjaer, M., Piller, N., & Chapman, Y.
(2004). Ignorance is not bliss: information provided to Australian
women at risk of developing lymphoedema following treatment for
breast cancer. Australian Journal of Cancer Nursing, 5, 3-15.
Paskett, E., & Stark, N. (2000). Lymphedema: knowledge, treatment, and
Impact among breast cancer survivors. The Breast Journal, 6,
373-378.
Conclusion and Recommendations :
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That every individual considering surgery or
radiation therapy, for treatment of cancer, be
informed of the possibility of developing
lymphedema as a result of these procedures before
such measures are taken.
That every individual who receives a procedure
affecting lymph node integrity in conjunction with
cancer treatment be informed regarding risk factors
associated with lymphedema incidence by a
healthcare professional trained in this area.
That information regarding risk factors be presented
in both verbal and written form to every individual.
References
Beaulac, S., McNair, L., Scott, T., LaMorte, W., Kavanah, M. (2002). Lymphedema and quality of life in
survivors of early-stage breast cancer. Arch Surg, 137, 1253-1257.
Burt, Jeannie & White, Gwen. (1999). Lymphedema. Salt Lake City: Hunter House Publishers.
Casley-Smith, J., & Casley-Smith, J. (1996) Lymphedema initiated by aircraft flights. Aviation, Space,
and Environmental Medicine, 67, 52-56.
Engel, J., Kerr, J., Schlesinger-Raab, A., Sauer, H., & Holzel, D. (2003). Axilla surgery severely affects
quality of life: results of a 5-year prospective study in breast cancer patients. Breast Cancer
Research and Treatment, 79, 47-57.
Kelly, Deborah G. (2002). A Primer on Lymphedema. Upper Saddle River, New Jersey: Prentice Hall.
Kwan, w., Jackson, J., Weir, L., Dingee, C., McGregor, G., & Olivotto, I. (2002). Chronic arm morbidity
after curative breast cancer treatment: prevelance and impact on quality of life. Journal of Clinical
Oncology, 20, 4242-4248.
Johansson, K., Ohlsson, K., Ingvar, C., Albertsson, M., & Ekdahl, C. (2002). Factors associated with the
development of arm lymphedema following breast cancer treatment: a match pair case-control
study. Lymphology, 35, 59-71.
Maunsell, E., Brisson, J., & Deschenes, L. (1993). Arm problems and psychological distress after surgery
for breast cancer. Canadian Journal of Surgery, 36, 315-320.
Petrek, J., Senie, R., Peters, M., & Rosen, P. (2001). Lymphedema in a cohort of breast carcinoma
survivors 20 years after diagnosis. Cancer, 92, 1368-1377.
Velanovich, V., & Szymanski, W. (1999) Quality of life of breast cancer patients with lymphedema.
American Journal of Surgery, 177, 184-188.
Werner, R., McCormick, B., Petrek, J., Cox, L., Cirrincione, C., Gray, J., & Yahalom, J. (1991). Arm
edema in conservatively managed breast cancer: obesity is a major predictive factor.
Radiology, 180, 177-184.
Woods, M., Tobin, M., & Mortimer, P. (1995) The psychosocial morbidity of breast cancer patients with
lymphoedema. Cancer Nursing, 18, 467-471.