Researchers pilot educational and behavioral program to reduce lymphedema risk

May 28, 2014, New York University
This image depicts limb volume change assessed by an infrared perometer. Credit: NYUCN: Dr. Mei Fu

Viewed as one of the most unfortunate outcomes of breast cancer treatment, lymphedema is characterized by an accumulation of lymph fluid in the interstitial spaces of the affected limb, leading to chronic ipsilateral limb swelling causing psychosocial distress and physical challenges for patients.

Even conservative estimates suggest that 3% of women who have had sentinel lymph node biopsy and 20% of those who have had axillary lymph node dissection may develop a year after . Two established risk factors for lymphedema are compromised lymphatic drainage and higher body mass index (BMI).

To date, there is little high-quality evidence to support the role of precautionary life-style strategies in reducing these risk factors.

Now, a team of researchers led by Mei R. Fu, PhD, RN, ACNS-BC, FAAN, associate professor of Chronic Disease Management at the New York University College of Nursing (NYUCN) conducted a pilot study to evaluate a patient-centered educational and behavioral self-care program called The Optimal Lymph Flow. The goals of the program were to promote lymph flow and optimize BMI over a 12-month period after breast cancer surgery. Findings of the study entitled "Proactive Approach to Lymphedema Risk Reduction: A Prospective Study" was published first on-line in the Annals of Surgical Oncology (May 2014). They offer initial evidence in support of a shift in the focus of lymphedema care away from treatment and toward proactive risk reduction.

"A patient-centered educational and behavioral program focusing on self-care strategies appears to be an effective way to reduce the risk of lymphedema in survivors of breast cancer," said Dr. Fu. "Based on these study findings, the New York University College of Nursing has established this patient-centered lymphedema risk reduction program as a web-based avatar technology intervention."

Dr. Fu's team enrolled 140 women and followed them for 12 months after surgery for breast cancer. Women who had metastatic breast cancer, a history of breast cancer and lymphedema, or bilateral breast cancer were excluded from the study.

Nearly 60% of patients had undergone axillary lymph node dissection, and approximately 40% had undergone sentinel lymph node biopsy. Although more women in the dissection group had had a mastectomy and chemotherapy than in the biopsy group, both groups were similar in terms of body weight and BMI.

The educational and behavioral program consisted of an assortment of self-care strategies. They included shoulder mobility exercises, muscle-tightening deep breathing, muscle-tightening pumping exercises, and large-muscle exercises to promote lymph flow and drainage (eg, walking, marching, dancing, swimming, yoga, tai chi). In addition, to maintain their preoperative BMI, the women were offered nutritional instructions and encouraged to follow a balanced, portion-appropriate diet.

Limb volume change assessed by an infrared perometer and BMI via a bioimpedance device were outcome measures. Assessments were performed before surgery (baseline) and after surgery (at 2-4 weeks, 6 months, and 12 months). Lymphedema was defined as ≥ 10% increase in limb volume from baseline in the ipsilateral arm compared with changes in the contralateral arm.

Of the 134 women who completed the study, 97% of patients maintained and improved their preoperative limb volume and BMI at 12 months after surgery. No patients exceeded a 10% increase in limb volume at 12-month follow-up. No patients reported injury or discomfort associated with The Optimal Lymph Flow program at any follow-up visit, according to the investigators.

"The Optimal Lymph Flow Program promotes lymph flow and optimal [BMI] by empowering, rather than inhibiting, how survivors live their lives," said Dr. Fu. "Its underlying premise is 'what to do' rather than 'what to avoid."

These preliminary findings suggest that self-care strategies such as The Optimal Lymph Flow program may prove to be an effective way to reduce the risk of lymphedema in survivors of . In fact, nearly 90% of the women studied reported that the program helped them to understand how to reduce their risk of lymphedema as well as dispel their fear and anxiety about developing this side effect. Future research requires a larger study with a randomized, controlled design to confirm the program's overall benefits.

Explore further: Researchers find a new solution in detecting breast-cancer related lymphedem

More information: Paper: http://www.annsurgoncol.org/journals/abstract.html?v=0&j=10434&i=0&a=3761_10.1245_s10434-014-3761-z&doi=

Related Stories

Researchers find a new solution in detecting breast-cancer related lymphedem

November 12, 2013
Viewed as one of the most feared outcomes of breast cancer treatment, doctors struggle detecting and diagnosing breast-cancer related Lymphedema—a condition affecting the lymphatic system and causing psychosocial distress ...

Breast cancer patients' fear of developing lymphedema far exceeds risk

February 25, 2013
Women who have had the lymph nodes under their arm surgically removed during breast cancer treatment are warned to avoid certain practices that can cause lymphedema—a condition that causes chronic, painless swelling in ...

Lymph node ultrasounds more accurate in obese breast cancer patients

April 30, 2014
Mayo Clinic research into whether ultrasounds to detect breast cancer in underarm lymph nodes are less effective in obese women has produced a surprising finding. Fat didn't obscure the images—and ultrasounds showing no ...

Less can be more when removing lymph nodes during breast cancer surgery

October 1, 2013
A conservative approach to removing lymph nodes is associated with less harm for breast cancer patients and often yields the same results as more radical procedures, researchers at UT Southwestern Medical Center have found.

New guidelines might limit need for lymph node removal for breast cancer

March 24, 2014
(HealthDay)—Biopsies of so-called "sentinel" lymph nodes under the arms should become more widespread among breast cancer patients, according to updated guidelines from the American Society of Clinical Oncology (ASCO).

Recommended for you

T-cells engineered to outsmart tumors induce clinical responses in relapsed Hodgkin lymphoma

January 16, 2018
WASHINGTON-(Jan. 16, 2018)-Tumors have come up with ingenious strategies that enable them to evade detection and destruction by the immune system. So, a research team that includes Children's National Health System clinician-researchers ...

Researchers identify new treatment target for melanoma

January 16, 2018
Researchers in the Perelman School of Medicine at the University of Pennsylvania have identified a new therapeutic target for the treatment of melanoma. For decades, research has associated female sex and a history of previous ...

More evidence of link between severe gum disease and cancer risk

January 16, 2018
Data collected during a long-term health study provides additional evidence for a link between increased risk of cancer in individuals with advanced gum disease, according to a new collaborative study led by epidemiologists ...

Researchers develop a remote-controlled cancer immunotherapy system

January 15, 2018
A team of researchers has developed an ultrasound-based system that can non-invasively and remotely control genetic processes in live immune T cells so that they recognize and kill cancer cells.

Dietary fat, changes in fat metabolism may promote prostate cancer metastasis

January 15, 2018
Prostate tumors tend to be what scientists call "indolent" - so slow-growing and self-contained that many affected men die with prostate cancer, not of it. But for the percentage of men whose prostate tumors metastasize, ...

Pancreatic tumors may require a one-two-three punch

January 15, 2018
One of the many difficult things about pancreatic cancer is that tumors are resistant to most treatments because of their unique density and cell composition. However, in a new Wilmot Cancer Institute study, scientists discovered ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.