May 19 2008
A poster session presented by The University of Texas M. D. Anderson Cancer Center at the Oncology Nurses Society 33rd Annual Congress, found that early nursing intervention and implementation of effective strategies can lead to a decrease in the incidence of lymphedema, better management of chronic lymphedema and improved quality of life in breast cancer patients.
The literature review, led by Mattie J. Sennett McDowell, RN, BSN, a research nurse in the Department of Breast Medical Oncology at M. D. Anderson, examined 20 years of data about the prevention, management and care of upper extremity lymphedema (ULE), or lymphedema that occurs in the arms, in breast cancer patients. The goal of the review was to identify a comprehensive list of current evidenced-based strategies that nurses and hospitals can use in caring for their patients.
"Women are living longer as breast cancer treatments get better, but at the same time, they face more devastating side effects like lymphedema," McDowell said. "So many women present with the symptoms, yet it is understudied and not well understood. More can to be done to proactively recognize and address lymphedema in breast cancer patients."
ULE is an often a distressing and debilitating side effect of breast cancer treatment in which protein-rich fluid in the tissue of the arms accumulates and obstructs the lymph vessels. According to the National Lymphedema Network, approximately 15 to 20 percent of all breast cancer patients are affected by ULE. Its development can be triggered by breast cancer diagnostic procedures, radiation, surgery or environmental factors. It also can can occur immediately after treatment or many years down the road. ULE, which can make simple tasks such as picking up children, getting dressed or exercising painful, has a detrimental impact on the patient's quality of life.
According to the literature, effective strategies to address lymphedema included early identification of at-risk patients through enhanced assessment techniques, monitoring, standardizing at-risk assessment tools and increased awareness of lymphedema through educational efforts of the health care team. The studies noted that increased awareness through educational forums, patient-nurse learning modules, and increasing the number of research studies focusing on ULE are vital in addressing this problem.
McDowell, who is dedicated to the study, prevention and management of ULE after a breast cancer patient died from significant disease progression, complicated by advanced, unmanageable lymphedema, said, "This research is centered on what is important to the patient and their quality of life after treatment. Nurses are on the frontline and may hold the key in proactively preventing lymphedema in many patients by educating them about triggers and symptoms, continual and specific lymphedema assessments during each visit and pursuing research in this area."
At M. D. Anderson, nurses and patient care teams have implemented several strategies to educate breast cancer patients about lymphedema and treat it aggressively. One such strategy is having a nurse and physician present information via discussion and prepared handouts before women undergo surgery. Additionally, all women are assessed for lymphedema during treatment and at follow-up visits. M. D. Anderson's multidisciplinary care team also offers comprehensive support and collaboration from prevention of the sequelae to advanced physical therapy for those with lymphedema.
McDowell plans to develop further research studies examining the evidenced-based practices for ULE identified in this study, with the end-goal of developing a standard set of recommendations. More information on the causes and symptoms of lymphedema, risk reduction strategies and recommended treatment are provided online at M. D. Anderson's Rehabilitation Services Lymphedema homepage or by logging onto the National Lymphedema Network Web site.
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