Jane M. Armer

Predicting Breast cancer-related Lymphedema using self-reported symptoms

ObjectivesThis study aimed to determine the accuracy of using self-reported signs and symptoms to identify the presence of lymphedema as well as the usefulness of identifying clinically measurable lymphedema on the basis of certain symptoms elicited by the Lymphedema Breast Cancer Questionnaire (LBCQ). MethodsThis analysis used logistic regression to identify symptoms predictive of differences between symptom experiences of participants belonging to two distinct groups (study A): those with known post-breast cancer lymphedema (n = 40) and those in a control group of women with no history of breast cancer or lymphedema (n = 40). Symptoms in this model of best fit were used to examine their relation to limb circumferences of breast cancer survivors in a second independent data set (study B; n = 103) in which a diagnosis of known lymphedema was not previously determined using symptom experiences. ResultsThe presence of lymphedema was predicted by three symptoms comprising a model of best fit for study A (c = .952): “heaviness in past year,” “swelling now,” and “numbness in past year.” Using this model, prediction of absolute maximal circumferential limb difference (i.e., ≥2 cm) in study B showed that “heaviness in the past year” (p = .0279) and “swelling now” (p = .0007) were predictive. “Numbness in the past year” was not predictive. However, those with lesser limb differences reported this symptom more often. ConclusionsThe findings suggest that changes in sensations may be indicators of early lymphedema or other treatment-related sequelae that must be assessed carefully at each follow-up visit and over time. A combination of symptom assessment and limb volume measurement may provide the best clinical assessment data for identifying changes associated with post-breast cancer lymphedema.

Lymphedema beyond breast cancer

Secondary lymphedema is a debilitating, chronic, progressive condition that commonly occurs after the treatment of breast cancer. The purpose of the current study was to perform a systematic review and meta‐analysis of the oncology‐related literature excluding breast cancer to derive estimates of lymphedema incidence and to identify potential risk factors among various malignancies.

The problem of post-breast cancer lymphedema: impact and measurement issues.

Breast cancer treatment is recognized as the most common cause of secondary lymphedema (LE) in the developed countries of the world. LE occurs as both an acute and chronic health condition in which significant and persistent swelling is associated with an abnormal accumulation of protein-rich fluid. The impact of LE is significant on a wide range of daily activities and survivorship quality of life. Measurement and quantification of LE has been problematic despite the fact that various methods have been used to measure limb volume (LV). Perhaps in part because of difficulties in measurement and diagnosis, the reported incidence of LE varies greatly among persons treated with surgery and radiation for breast cancer. Through increased measurement accuracy, LE incidence and prevalence following current therapeutic approaches for breast cancer treatment cancer will be better understood, and more informed decisions about risk factors, treatment interventions, and recovery will be made. Further identification of epidemiological and clinical factors associated with risk and incidence will provide the necessary foundation for preventive intervention. Bilateral measurements at pre-op and over time are necessary to assess LV changes during follow-up, as it is important as part of the differential diagnosis to note whether volume change has occurred in the affected limb alone or in both limbs. Application of rigorous measurement protocols, assessment of symptom experience, and establishment of a data base on bilateral LV at pre-op for later comparison are essential components of a solid foundation for intervention studies. Through multidisciplinary collaboration with rigorous scientific approaches feasible to be carried out in the clinical setting, we have the opportunity to better target risk factors for development of LE, design data-based interventions, and improve post-treatment quality of life.

Upper-Body Morbidity After Breast Cancer* Incidence and Evidence for Evaluation, Prevention, and Management Within a Prospective Surveillance Model of Care

The purpose of this paper is to review the incidence of upper‐body morbidity (arm and breast symptoms, impairments, and lymphedema), methods for diagnosis, and prevention and treatment strategies. It was also the purpose to highlight the evidence base for integration of prospective surveillance for upper‐body morbidity within standard clinical care of women with breast cancer. Between 10% and 64% of women report upper‐body symptoms between 6 months and 3 years after breast cancer, and approximately 20% develop lymphedema. Symptoms remain common into longer‐term survivorship, and although lymphedema may be transient for some, those who present with mild lymphedema are at increased risk of developing moderate to severe lymphedema. The etiology of morbidity seems to be multifactorial, with the most consistent risk factors being those associated with extent of treatment. However, known risk factors cannot reliably distinguish between those who will and will not develop upper‐body morbidity. Upper‐body morbidity may be treatable with physical therapy. There is also evidence in support of integrating regular surveillance for upper‐body morbidity into the routine care provided to women with breast cancer, with early diagnosis potentially contributing to more effective management and prevention of progression of these conditions. Cancer 2012;118(8 suppl).

Complementary and Alternative Medicine Use Among Women With Breast Cancer: A Systematic Review

Patients with breast cancer use complementary and alternative medicine (CAM) despite the fact that no studies have shown altered disease progression attributable to CAM use. The purpose of this systematic review is to summarize research as it relates to CAM use among women with breast cancer. Among the many findings of the review, biologically based practices were noted as the types of CAM most used by women with breast cancer, followed by mind-body medicine, whole medical systems, and energy medicine. Sources of information about CAM use for women with breast cancer vary widely, including family, friends, mass media, healthcare providers, CAM providers, and self-help groups. Sociodemographic factors that appear to be related to CAM use were younger age, higher education, higher income, married status, involvement in a support group, and health insurance. The reasons for CAM use reported by women with breast cancer were to help healing, to promote emotional health, and to cure cancer. Oncology nurses should learn more about CAM use among women with breast cancer. Open communication about CAM use helps ensure that safe and holistic care is provided. Additional research in this particular area is needed.

Psychosocial impact of lymphedema: a systematic review of literature from 2004 to 2011

This systematic review aimed to evaluate the level of evidence of contemporary peer‐reviewed literature published from 2004 to 2011 on the psychosocial impact of lymphedema.

A Systematic Review of the Evidence for Complete Decongestive Therapy in the Treatment of Lymphedema From 2004 to 2011

To critically analyze the contemporary published research that pertains to the individual components of complete decongestive therapy (CDT), as well as CDT as a bundled intervention in the treatment of lymphedema.

Exercise in patients with lymphedema: a systematic review of the contemporary literature.

BackgroundControversy exists regarding the role of exercise in cancer patients with or at risk for lymphedema, particularly breast. We conducted a systematic review of the contemporary literature to distill the weight of the evidence and provide recommendations for exercise and lymphedema care in breast cancer survivors.MethodsPublications were retrieved from 11 major medical indices for articles published from 2004 to 2010 using search terms for exercise and lymphedema; 1,303 potential articles were selected, of which 659 articles were reviewed by clinical lymphedema experts for inclusion, yielding 35 articles. After applying exclusion criteria, 19 articles were selected for final review. Information on study design/objectives, participants, outcomes, intervention, results, and study strengths and weaknesses was extracted. Study evidence was also rated according to the Oncology Nursing Society Putting Evidence Into Practice® Weight-of-Evidence Classification.ResultsSeven studies were identified addressing resistance exercise, seven studies on aerobic and resistance exercise, and five studies on other exercise modalities. Studies concluded that slowly progressive exercise of varying modalities is not associated with the development or exacerbation of breast cancer-related lymphedema and can be safely pursued with proper supervision. Combined aerobic and resistance exercise appear safe, but confirmation requires larger and more rigorous studies.ConclusionsStrong evidence is now available on the safety of resistance exercise without an increase in risk of lymphedema for breast cancer patients. Comparable studies are needed for other cancer patients at risk for lymphedema.Implications for cancer survivorsWith reasonable precautions, it is safe for breast cancer survivors to exercise throughout the trajectory of their cancer experience, including during treatment.

Measuring the psychological impact of mindfulness meditation on health among patients with cancer: A literature review.

PURPOSE/OBJECTIVES To describe the construct of mindfulness meditation and systematically review instruments measuring the psychological impact of mindfulness-based stress reduction (MBSR) on health among patients with cancer. DATA SOURCES PubMed, CINAHL, PsycINFO, ISI Web of Knowledge, EBSCO, and published literature (1987-2006). DATA SYNTHESIS 13 psychological instruments used in seven studies (2000-2005) to measure effects of MBSR on health in patients with cancer were reviewed. Most studies used a one-group pre- and post-test design. The post-MBSR outcomes for each instrument varied, suggesting different yet promising relationships. For some instruments, data were insufficient to conclude sufficiently whether any were strong or appropriate to use in future intervention studies. CONCLUSIONS To enhance knowledge of MBSR, more intervention research studies of MBSR in patients with cancer and reexamination of specific instruments are needed. IMPLICATIONS FOR NURSING Based on the review, instruments can measure MBSR effects and found MBSR to be a potentially beneficial oncology nursing intervention.

Mindfulness-Based Stress Reduction Among Breast Cancer Survivors: A Literature Review and Discussion

PURPOSE/OBJECTIVES To evaluate and discuss existing studies of mindfulness-based stress reduction (MBSR) among breast cancer survivors. DATA SOURCES Articles published from 1987-2009 were retrieved using MEDLINE®, CINAHL®, Ovid, and Scopus. Key words, including mindfulness-based stress reduction and mindfulness meditation, were combined with breast cancer. DATA SYNTHESIS The search resulted in 26 articles that were narrowed down to 16 by selecting only quantitative studies of MBSR conducted with breast cancer (n = 7) or heterogeneous types of cancer in which the predominant cancer was breast cancer (n = 9). Most studies were one-group pre- and post-test design and examined the effect of MBSR on psychological outcomes. Overall, the studies had large effect sizes on perceived stress and state anxiety and medium effect sizes on symptoms of stress and mood disturbance. Four studies measured biologic outcomes and had small effect sizes, except cytokine production, which showed a large effect size at 6- and 12-month follow-ups. CONCLUSIONS Future studies using randomized, control trials and longitudinal, repeated-measures designs are needed. Studies conducted with heterogeneous types of cancer and gender should be analyzed and the results reported separately. IMPLICATIONS FOR NURSING The comprehensive summary and critical discussion of existing studies of MBSR usage among breast cancer survivors provide essential information that can be used by nurses and others working in the healthcare setting.