Preventing Lymphedema: Maintaining Quality of Life for Individuals Diagnosed with Cancer

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Preventing LymphedemaMaintaining Quality of
Life for Individuals Diagnosed with Cancer

• Presented by Christine Flaherty

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• 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 individuals
  lymphatic system is impaired.
• When impairment occurs fluid may back up in an
  area, often in the arms and legs, and cause
  swelling.

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• 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 individuals
  lymphatic system is impaired.
• When impairment occurs fluid may back up in an
  area, often in the arms and legs, and cause
  swelling.

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The Lymphatic System and Lymphedema

• 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.

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Possible Symptoms
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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

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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

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Evidence
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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.
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Quality of Life Domains Explored

• Physical
• Psychological
• Social
• Sexual
• Functional

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Evidence
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The following risk factors were identified

• High Body Mass Index
• Weight gain in post-treatment years
• Infections or injury in the associated limb
• Flying in airplanes

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Application to Occupational Therapy

• Health, function and quality of life
• Education regarding risk factors
• 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.
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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., OBrien, 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.
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Conclusion and Recommendations

• 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.

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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.

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• 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.