Patient-centered educational and behavioral program reduces risk of lymphedema

Promoting lymph flow and optimizing body mass index (BMI) after breast cancer surgery had a 97% success rate for patients in the program 1 year after surgery, according to a new study.

Viewed as one of the most unfortunate outcomes of breast cancer treatment, lymphedema is characterized by an accumulation of lymph fluid in the interstitial spaces of the affected limb. This leads to chronic ipsilateral limb swelling and causes psychosocial distress and physical challenges for patients.

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 1 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 lifestyle strategies in reducing these risk factors.

Now, a team of researchers led by Mei R. Fu, PhD, RN, ACNS-BC, FAAN, associate professor of Chronic Disease Management at the New York University College of Nursing (NYUCN) in New York City conducted a pilot study to evaluate a patient-centered educational and behavioral self-care program called The Optimal Lymph Flow.

The program aimed to promote lymph flow and optimize BMI over a 12-month period after breast cancer surgery. Findings were published in the Annals of Surgical Oncology (2014; doi:10.1245/s10434-014-3761-z). They offer initial evidence in support of a shift in the focus of lymphedema care away from treatment and toward proactive risk reduction.

“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,” said Fu. 

Fu's team 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 undergone 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, such as 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 nutrition instructions and encouraged to follow a balanced, portion-appropriate diet.

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. No patients reported injury or discomfort associated with The Optimal Lymph Flow program at any follow-up visit.

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