Proactive Approach to Lymphedema Risk Reduction

A Prospective Study

Mei R. Fu, Deborah Axelrod, Amber A. Guth, Francis Cartwright, Zeyuan Qiu, Judith D. Goldberg, June Kim, Joan Scagliola, Robin Kleinman, Judith Haber

Research output: Contribution to journalArticle

Abstract

Background: Advances in cancer treatments continue to reduce the incidence of lymphedema. Yet, many breast cancer survivors still face long-term postoperative challenges as a result of developing lymphedema. The purpose of this study was to preliminarily evaluate The Optimal Lymph Flow program, a patient-centered education and behavioral program focusing on self-care strategies to enhance lymphedema risk reduction by promoting lymph flow and optimize body mass index (BMI). Methods: A prospective, longitudinal, quasi-experimental design with repeated-measures was used. The study outcomes included lymph volume changes by infrared perometer, and BMI by a bioimpedance device at pre-surgery baseline, 2–4 weeks after surgery, 6-month and 12-month follow-up. A total of 140 patients were recruited and participated in The Optimal Lymph Flow program; 134 patients completed the study with 4 % attrition rate. Results: Fifty-eight percent of patients had axillary node dissection and 42 % had sentinel lymph node biopsy (SLNB). The majority (97 %) of patients maintained and improved their preoperative limb volume (LV) and BMI at the study endpoint of 12 months following cancer surgery. Cumulatively, two patients with SLNB and two patients with axillary lymph node dissection had measurable lymphedema (>10 % LV change). At the 12-month follow-up, among the four patients with measurable lymphedema, two patients’ LV returned to preoperative level without compression therapy but by maintaining The Optimal Lymph Flow exercises to promote daily lymph flow. Conclusions: This educational and behavioral program is effective in enhancing lymphedema risk reduction. The study provided initial evidence for emerging change in lymphedema care from treatment-focus to proactive risk reduction.

Original languageEnglish (US)
Pages (from-to)3481-3489
Number of pages9
JournalAnnals of Surgical Oncology
Volume21
Issue number11
DOIs
StatePublished - Oct 1 2014

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Lymphedema
Risk Reduction Behavior
Lymph
Prospective Studies
Sentinel Lymph Node Biopsy
Body Mass Index
Extremities
Patient Education
Self Care
Lymph Node Excision
Survivors
Dissection
Neoplasms
Research Design
Therapeutics
Outcome Assessment (Health Care)
Exercise
Breast Neoplasms
Equipment and Supplies
Incidence

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Proactive Approach to Lymphedema Risk Reduction : A Prospective Study. / Fu, Mei R.; Axelrod, Deborah; Guth, Amber A.; Cartwright, Francis; Qiu, Zeyuan; Goldberg, Judith D.; Kim, June; Scagliola, Joan; Kleinman, Robin; Haber, Judith.

In: Annals of Surgical Oncology, Vol. 21, No. 11, 01.10.2014, p. 3481-3489.

Research output: Contribution to journalArticle

Fu, MR, Axelrod, D, Guth, AA, Cartwright, F, Qiu, Z, Goldberg, JD, Kim, J, Scagliola, J, Kleinman, R & Haber, J 2014, 'Proactive Approach to Lymphedema Risk Reduction: A Prospective Study', Annals of Surgical Oncology, vol. 21, no. 11, pp. 3481-3489. https://doi.org/10.1245/s10434-014-3761-z
Fu MR, Axelrod D, Guth AA, Cartwright F, Qiu Z, Goldberg JD et al. Proactive Approach to Lymphedema Risk Reduction: A Prospective Study. Annals of Surgical Oncology. 2014 Oct 1;21(11):3481-3489. https://doi.org/10.1245/s10434-014-3761-z
Fu, Mei R. ; Axelrod, Deborah ; Guth, Amber A. ; Cartwright, Francis ; Qiu, Zeyuan ; Goldberg, Judith D. ; Kim, June ; Scagliola, Joan ; Kleinman, Robin ; Haber, Judith. / Proactive Approach to Lymphedema Risk Reduction : A Prospective Study. In: Annals of Surgical Oncology. 2014 ; Vol. 21, No. 11. pp. 3481-3489.
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abstract = "Background: Advances in cancer treatments continue to reduce the incidence of lymphedema. Yet, many breast cancer survivors still face long-term postoperative challenges as a result of developing lymphedema. The purpose of this study was to preliminarily evaluate The Optimal Lymph Flow program, a patient-centered education and behavioral program focusing on self-care strategies to enhance lymphedema risk reduction by promoting lymph flow and optimize body mass index (BMI). Methods: A prospective, longitudinal, quasi-experimental design with repeated-measures was used. The study outcomes included lymph volume changes by infrared perometer, and BMI by a bioimpedance device at pre-surgery baseline, 2–4 weeks after surgery, 6-month and 12-month follow-up. A total of 140 patients were recruited and participated in The Optimal Lymph Flow program; 134 patients completed the study with 4 {\%} attrition rate. Results: Fifty-eight percent of patients had axillary node dissection and 42 {\%} had sentinel lymph node biopsy (SLNB). The majority (97 {\%}) of patients maintained and improved their preoperative limb volume (LV) and BMI at the study endpoint of 12 months following cancer surgery. Cumulatively, two patients with SLNB and two patients with axillary lymph node dissection had measurable lymphedema (>10 {\%} LV change). At the 12-month follow-up, among the four patients with measurable lymphedema, two patients’ LV returned to preoperative level without compression therapy but by maintaining The Optimal Lymph Flow exercises to promote daily lymph flow. Conclusions: This educational and behavioral program is effective in enhancing lymphedema risk reduction. The study provided initial evidence for emerging change in lymphedema care from treatment-focus to proactive risk reduction.",
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