Gap in Lymphedema Awareness

TON - September/October 2014 Vol 7 No 5

A small study indicates that many patients with breast cancer are not informed about lymphedema as a possible treatment-related side effect and do not know how to recognize its symptoms. Although this is a small study, the findings come from an academically affiliated cancer center and suggest that oncologists and nurses should be more proactive about educating patients about the possibility of lymphedema and how to manage it. The study was presented as a poster at the 2014 American Association of Nurse Practitioners National Conference in Nashville, Tennessee.

“Most of my patients don’t recognize the symptoms of lymphedema. Either surgeons are not telling them about it, or the patient is not listening,” said Dorothy Pierce, RN, MSN, a nurse practitioner in radiation oncology at the Rutgers Cancer Institute of New Jersey/Robert Wood Johnson University Hospital in New Brunswick.

The cross-sectional survey was conducted in 24 patients slated for radiation post surgery and lymph node dissection. Data were collected from April to June 2013. More than 50% of the participants were between the ages of 40 and 49 years. Most were white, and 75% had finished high school or had attended college. Of the patients, 63% had a lumpectomy and 50% had 1 or more involved lymph nodes removed; 71% underwent adjuvant chemotherapy.

Notably, of all 24 participants surveyed, 79% experienced lymphedema symptoms and 71% incorrectly assumed that the symptoms they had of heaviness, firmness, and tightness in the affected arm were “normal,” Pierce explained.

Sixteen of the women said they had received no information about lymphedema from their doctors or nurses and they did not know what it was. Of the 8 women who were informed about lymphedema, 5 said their radiation oncologist told them about it, 1 received information from a nurse, 1 heard about it from a medical oncologist, and 1 was told by a physical therapist.

Nine women had a mastectomy with 2 to 14 lymph nodes removed, and all of them developed symptoms of lymphedema. Among the 15 women who had a lumpectomy with 1 to 7 lymph nodes removed, 10 reported at least 1 symptom associated with lymphedema.

Ten women reported arm tenderness, 9 reported swelling of the arm, 6 reported arm numbness, and 5 reported impaired movement in the shoulders and fingers of the affected arm.
More than half of the patients with lymphedema symptoms did nothing for it. The other women used a variety of approaches: discussed it with their healthcare providers, had massage therapy, or slept with the elbow of the affected limb raised.

Reference

Pierce DN. Lymphedema knowledge and symptoms in breast cancer patients receiving radiation therapy. Poster presented at: 2014 American Association of Nurse Practitioners National Conference; June 17-22, 2014; Nashville, TN.

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