Self-management in lymphoedema
Although the prevalence of lymphoedema following breast cancer is well known, the authors noted that the prevention of lymphoedema following breast cancer treatment is not well-documented. While existing literature looks at the clinical interventions for lymphoedema management, the authors of this study aimed to assess the self-management programme, in the form of a home exercise programme as well as a self-lymphatic drainage (SLD) routine.
52 participants were included in the study. The participants had been referred by a specialist for radical breast mastectomy, or breast protective surgery.
The participants were divided into 2 groups: a randomised control group who were only given information on lymphedema, physical activity, and simple lymphatic drainage by the investigators. No home programme or self-lymphatic drainage was taught. Additionally, they were followed-up every fortnight for the estimation of outcome measures, but were asked to complete outcome measures such as the DASH and VAS at 2, 4, and 6 weeks post-operation.
The treatment group was given the following intervention: simple lymphatic drainage was started after the removal of the axillary drains and applied for 6 weeks. It was conducted before the physical activity session for 40 min, twice a week. Patients were also taught to perform SLD, during the procedure, and were asked to perform it on the evening of the day of implementation. Physical activity was stared the day before the surgery, and continued for 6 weeks following surgery.
Lymphoedema measurements were noted circumferentially, and it was noted by the authors that a change in 2 cm difference at any one anatomical point were significant for the diagnosis of lymphoedema when compared to the unaffected side.
With regards to circumferential measurements, specifically around the MCP of the affected arm, the authors noted that at the 6-week follow-up no significant change in the circumference measurements between arms was noted in the intervention group, but a statistically significant increase was present in all the measurement points of the arm in the control group, compared to the intervention group
For the daily living activities (DLA) scores, reporting of pain and heaviness of the affected limb decreased in the intervention group as compared to the control group. With DASH scores, there was a decrease in both groups over time, as expected following recovery from surgery. However, the intervention group was significantly lower overall.
This article makes a strong case for the need for intervention even before lymphoedema develops. The researches have done well to outline a simple and safe programme for all breast cancer related patients to adhere to, with or without the start of symptoms.
One limitation of this article is that the researchers did not note the extent or detail of the simple lymphatic drainage performed on the participants. Nevertheless, the difference between the groups was the exercise and self-lymphatic drainage – highlighting the impact a self-management programme can have.
While it is known that rates of painful and debilitating lymphoedema is high following mastectomy, a programme for self-management can be given early, before severe cases of lymphoedema develop. Starting interventions earlier may give the patient the best chance at managing lymphoedema before it becomes severe, and maintaining good upper extremity function.
> From: Donmez et al., Eur J Oncol Nurs 31 (2018-01-30 19:57:09) 12-21. All rights reserved to Elsevier Ltd. Click here for the online summary.
