Living with Leg Lymphedema: Developing a Novel Model of Quality Lymphedema Care for Cancer Survivors

Overview

Journal J Cancer Surviv

Specialty Oncology

Date 2020 Jul 27

PMID 32712757

Citations 3

Authors

Catharine Bowman

Devesh Oberoi

Lori Radke

George J Francis

Linda E Carlson

Affiliations

Soon will be listed here.

Abstract

Purpose: Lower-extremity lymphedema (LEL) is a lifelong consequence of cancer therapy and can lead to serious physical and psychosocial complications for many cancer survivors. However, clinical knowledge and treatment of LEL remain minimal. The purpose of this study was to integrate perspectives of lymphedema patients and healthcare providers (HCPs) on LEL to develop a novel model for quality lymphedema care.

Methods: A mixed-methods approach was implemented. Standardized questionnaires and semi-structured interviews were used to assess psychosocial well-being and experiences of LEL patients. Interviews were also used to evaluate the clinical experiences of HCPs working within tumour groups associated with cancer-related LEL. Thematic analysis was used to analyse qualitative data.

Results: Twenty-two patients and eleven HCPs participated in this study. Patient QOL, generalized anxiety and depressive symptom scores revealed a complex interplay between psychosocial well-being and supportive LEL care after cancer. Three themes emerged from interviews with patients (n = 19) and HCPs (n = 11): level of lymphedema knowledge, effectiveness of rehabilitation oncology services and barriers to care.

Implications For Cancer Survivors: We developed a novel model for quality lymphedema care that emphasizes the importance of continued physical and psychosocial support for LEL patients, while illustrating the importance of HCPs in facilitating a smooth transition for patients to LEL care after cancer treatment.

Citing Articles

The lymphedema patient experience within the healthcare system: a cross-sectional epidemiologic assessment.

Bowman C, Rockson S Sci Rep. 2024; 14(1):12600.

PMID: 38824156 PMC: 11144203. DOI: 10.1038/s41598-024-63145-1.

The Role of Inflammation in Lymphedema: A Narrative Review of Pathogenesis and Opportunities for Therapeutic Intervention.

Bowman C, Rockson S Int J Mol Sci. 2024; 25(7).

PMID: 38612716 PMC: 11011271. DOI: 10.3390/ijms25073907.

Depressive symptoms and their severity in a sample with lymphedema: a case-control investigation.

Monteiro A, de Labra C, Losa-Iglesias M, Dias A, Becerro-de-Bengoa-Vallejo R, Silva-Migueis H Front Psychiatry. 2023; 14:1202940.

PMID: 37476539 PMC: 10354281. DOI: 10.3389/fpsyt.2023.1202940.

References

Spitzer R, Kroenke K, Williams J, Lowe B . A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006; 166(10):1092-7. DOI: 10.1001/archinte.166.10.1092. View

Howard A, Smillie K, Turnbull K, Zirul C, Munroe D, Ward A . Access to medical and supportive care for rural and remote cancer survivors in northern British Columbia. J Rural Health. 2014; 30(3):311-21. DOI: 10.1111/jrh.12064. View

Butow P, Phillips F, Schweder J, White K, Underhill C, Goldstein D . Psychosocial well-being and supportive care needs of cancer patients living in urban and rural/regional areas: a systematic review. Support Care Cancer. 2011; 20(1):1-22. DOI: 10.1007/s00520-011-1270-1. View

Cornelissen A, Kool M, Keuter X, Heuts E, de Grzymala A, van der Hulst R . Quality of Life Questionnaires in Breast Cancer-Related Lymphedema Patients: Review of the Literature. Lymphat Res Biol. 2018; 16(2):134-139. DOI: 10.1089/lrb.2017.0046. View

Armer J, Heckathorn P . Post-breast cancer lymphedema in aging women: self-management and implications for nursing. J Gerontol Nurs. 2005; 31(5):29-39. DOI: 10.3928/0098-9134-20050501-07. View

Soran A, Ozmen T, McGuire K, Diego E, McAuliffe P, Bonaventura M . The importance of detection of subclinical lymphedema for the prevention of breast cancer-related clinical lymphedema after axillary lymph node dissection; a prospective observational study. Lymphat Res Biol. 2014; 12(4):289-94. DOI: 10.1089/lrb.2014.0035. View

Kenyon M, Mayer D, Owens A . Late and long-term effects of breast cancer treatment and surveillance management for the general practitioner. J Obstet Gynecol Neonatal Nurs. 2014; 43(3):382-98. DOI: 10.1111/1552-6909.12300. View

Grada A, Phillips T . Lymphedema: Pathophysiology and clinical manifestations. J Am Acad Dermatol. 2017; 77(6):1009-1020. DOI: 10.1016/j.jaad.2017.03.022. View

Okutsu A, Koiyabashi K . Effects of Mobile Phone Usage in Supporting Leg Lymphedema Self-care. J Rural Med. 2015; 9(2):74-85. PMC: 4310151. DOI: 10.2185/jrm.2884. View

10.

Olson R, Howard F, Turnbull K, Munroe D, Zirul C, Manji R . Prospective evaluation of unmet needs of rural and aboriginal cancer survivors in Northern British Columbia. Curr Oncol. 2014; 21(2):e179-85. PMC: 3997450. DOI: 10.3747/co.21.1729. View

11.

Beesley V, Eakin E, Steginga S, Aitken J, Dunn J, Battistutta D . Unmet needs of gynaecological cancer survivors: implications for developing community support services. Psychooncology. 2007; 17(4):392-400. DOI: 10.1002/pon.1249. View

12.

Brown J, Chu C, Cheville A, Schmitz K . The prevalence of lymphedema symptoms among survivors of long-term cancer with or at risk for lower limb lymphedema. Am J Phys Med Rehabil. 2012; 92(3):223-31. PMC: 4391393. DOI: 10.1097/PHM.0b013e31826edd97. View

13.

Iwamitsu Y, Shimoda K, Abe H, Tani T, Okawa M, Buck R . Anxiety, emotional suppression, and psychological distress before and after breast cancer diagnosis. Psychosomatics. 2005; 46(1):19-24. DOI: 10.1176/appi.psy.46.1.19. View

14.

Reyes-Gibby C, Anderson K, Morrow P, Shete S, Hassan S . Depressive symptoms and health-related quality of life in breast cancer survivors. J Womens Health (Larchmt). 2011; 21(3):311-8. PMC: 3326444. DOI: 10.1089/jwh.2011.2852. View

15.

Loprinzi P, Cardinal B, Winters-Stone K, Smit E, Loprinzi C . Physical activity and the risk of breast cancer recurrence: a literature review. Oncol Nurs Forum. 2012; 39(3):269-74. DOI: 10.1188/12.ONF.269-274. View

16.

K Symvoulakis E, Anyfantakis D, Lionis C . Primary lower limb lymphedema: a focus on its functional, social and emotional impact. Int J Med Sci. 2010; 7(6):353-7. PMC: 2962263. DOI: 10.7150/ijms.7.353. View

17.

Cooper J, Loeb S, Smith C . The primary care nurse practitioner and cancer survivorship care. J Am Acad Nurse Pract. 2010; 22(8):394-402. DOI: 10.1111/j.1745-7599.2010.00528.x. View

18.

Kroenke K, Strine T, Spitzer R, Williams J, Berry J, Mokdad A . The PHQ-8 as a measure of current depression in the general population. J Affect Disord. 2008; 114(1-3):163-73. DOI: 10.1016/j.jad.2008.06.026. View

19.

Hodgson P, Towers A, Keast D, Kennedy A, Pritzker R, Allen J . Lymphedema in Canada: a qualitative study to help develop a clinical, research, and education strategy. Curr Oncol. 2011; 18(6):e260-4. PMC: 3224034. DOI: 10.3747/co.v18i5.787. View

20.

Rockson S, Rivera K . Estimating the population burden of lymphedema. Ann N Y Acad Sci. 2008; 1131:147-54. DOI: 10.1196/annals.1413.014. View