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Lymphedema is a chronic, progressive condition caused by an imbalance of lymphatic flow. It primarily affects the dermal and subcutaneous tissues and if left untreated, the condition worsens until severe, irreversible changes occur. In a study done in Brazil titled ”Alteration of Blood Circulation in the Upper Limb Before and After Surgery for Breast Cancer Associated with Axillary Lymph Node Dissection or Sentinel Lymph Node Biopsy”, showed that, upper extremity lymphedema has been reported in 16–40% of breast cancer patients following axillary lymph node dissection (ALND).
Absolute prevention of lymphedema post mastectomy is not yet fully possible; however, advances in cancer diagnostic imaging and surgical techniques have reduced the risk of lymphedema and newer tools and techniques have enabled earlier detection of subclinical lymphedema. In addition, early implementation of risk-reduction strategies may improve outcomes by preventing progression of lymphedema post mastectomy.
The optimal lymph flow is a patient-centered educational and behavioral program focusing on self-care risk-reduction strategies to promote lymph flow and optimize BMI. Lymphedema risk reduction strategies include avoiding lifting weighted objects, needle punctures, blood draw, as well as use of compression garments for air travel, preventing infection and trauma in addition to daily skin care that maintain skin moisture and integrity and promote lymph fluid drainage.
Aim of the study:
The present study aimed to:
Determine the relation between practicing lymphedema risk reduction strategies by women post mastectomy and stages of lymphedema through:
1) Assessing of the women’s knowledge and practices regarding lymphedema risk-reduction strategies.
2) Assessing of the stages of lymphedema.
3) Determine the relation between practicing lymphedema risk reduction strategies by women post mastectomy and stages of lymphedema.
Is there a relation between practicing lymphedema risk reduction strategies by women post mastectomy and stages of lymphedema?
A cross-sectional descriptive design was used to achieve the aim of the current study.
Subjects and Methods:
The study was conducted at the oncology outpatient clinics and oncology department at radiation oncology & nuclear medicine center affiliated to Ain Shams University.
A purposive sample of 80 adult female patients with post mastectomy lymphedema was selected within the following inclusion criteria; adult female patients with post mastectomy lymphedema, free from debilitating diseases (e.g. active malignancy) and agree to participate in the study. The exclusion criteria included; lymphedema due to other systemic disorders and bilateral lymphedema in both arms.
Tools of data collection:
Data was collected using the following three tools:
1) Patients` knowledge assessment structured interview questionnaire:
It was include the following parts:
Part I: Demographic characteristics of patients as age, marital status, place of residence, educational level, and occupation.
Part II: It was used to assess patients’ clinical data.
Part III: It was used to assess patients’ knowledge regarding lymphedema post mastectomy. The questionnaire consisted of 24 statements. The patients’ responses were either ”I know” or ”I don’t know”.
2) Lymphedema risk reduction strategies checklist:
It was adapted from American Cancer Society, National Cancer Institute and National Lymphedema Network (2006) to assess lymphedema risk reduction practices among women with post mastectomy lymphedema including the following domains (infection prevention, skin care, avoidance of arm constriction, avoidance of extreme heat, exercises and home activities and improving lymphatic drainage strategies).
3) Lymphedema staging assessment scale:
This scale was developed by the researcher based on the International Society of Lymphology Staging System to assess patient’s stage of lymphedema. This scale is based on the observed criteria in every stage.
The results of this study have shown the following:
• Concerning patients’ level of knowledge regarding lymphedema post mastectomy the highest percentage was unsatisfactory (61%).
• Regarding percentage of the study subjects who had satisfactory level of practice for lymphedema risk reduction strategies, the highest percentage of the studied subjects (70%) had unsatisfactory level of practice for lymphedema risk reduction strategies
• Concerning the total percentage distribution according to their lymphedema stages, (47%) suffer from stage one, followed by (41%) suffer from stage zero, then (11%) suffer from stage two, lasted by (1%) suffer from stage three.
• Concerning the relation between practicing of lymphedema risk reduction strategies and stages of lymphedema, there was highly statistically significant relation between the total risk reduction strategies and stages of post mastectomy lymphedema, especially the strategies related to skin care and exercise and home activities (p=0.000), infection prevention and avoidance of extreme heat (p=0.001).while, there was significant relation between avoidance of arm constriction strategies and stages of post mastectomy lymphedema (p=0.012). But, there was no statistically significant relation between improving lymphatic drainage strategies and stages of post mastectomy lymphedema (p=0.078).
There was highly statistically significant relation between the practicing for total risk reduction strategies and stages of post mastectomy lymphedema, especially the strategies related to skin care and exercise and home activities, infection prevention and avoidance of extreme heat. While, there was significant relation between practicing for avoidance of arm constriction strategies and stages of post mastectomy lymphedema. But, there was no statistically significant relation between practicing for improving lymphatic drainage strategies and stages of post mastectomy lymphedema.
Based on the results of the study, the researcher recommends an educational program about lymphedema risk reduction strategies for patients undergoing mastectomy to decrease physical, psychological and social burden of lymphedema post mastectomy.