Proactive Patient-Centered Program May Reduce the Risk of Lymphedema in Survivors of Breast Cancer
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, according to the results of a prospective study by Fu et al at New York University. These findings, reported in the Annals of Surgical Oncology, offer initial evidence in support of a shift in the focus of lymphedema care away from treatment and toward proactive risk reduction.
Lymphedema negatively impacts overall quality of life for many survivors of breast cancer. 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 lymphedema a year after breast cancer surgery.
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 self-care strategies in reducing these risk factors. Thus, the investigators conducted a pilot study to evaluate the patient-centered 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.
Study Details: Assortment of Self-Care Strategies
The investigators of this prospective, longitudinal study 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 via 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.
Study Results: Benefits Seen in 97% of Patients
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.
Two patients in the sentinel lymph node biopsy group had a 10% increase in limb volume at the 2- to 4-week visit, and two patients in the axillary lymph node dissection group had a 10% increase in limb volume at the 6-month visit. However, at the 12-month visit, all four of these women had a decrease in their limb volume to < 5%. Over the 12-month period, body weight did not change significantly, nor was there a major change in BMI.
No patients reported injury or discomfort associated with The Optimal Lymph Flow program at any follow-up visit, according to the investigators.
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, stated Mei R. Fu, PhD, RN, ACNS-BC, FAAN, of the New York University College of Nursing, in a recent e-mail.
Positive Feedback From Study Participants
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 breast cancer. 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.
“The Optimal Lymph Flow Program promotes lymph flow and optimal [BMI] by empowering, rather than inhibiting, how survivors live their lives,” said Dr. Fu in a recent e-mail. “Its underlying premise is ‘what to do’ rather than ‘what to avoid.’”
Dr. Fu is the corresponding author of the article in the Annals of Surgical Oncology.
This study was supported by the Avon Foundation, the National Institute of Health, Judges and Lawyers for Breast Cancer Alert, and the Vital Fund. Dr. Judith D. Goldberg was partially supported by a grant from the New York University School of Medicine Cancer Center. The study authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
