Nurses Design Proactive, Patient-Centered Program to Reduce Lymphedema Risk

Mei R. Fu, PhD, RN, ACNS-BC, FAAN

A pilot study of an educational and behavioral program conducted by researchers at the New York University College of Nursing has successfully reduced the risk of lymphedema in breast cancer patients who have undergone axillary lymph node dissection or sentinel lymph node biopsy.

Of the 134 women who completed the educational and behavioral Optimal Lymph Flow program, 97% maintained and improved their preoperative limb volume and body mass index (BMI) at 12 months after surgery.

Findings of the study entitled “Proactive Approach to Lymphedema Risk Reduction: A Prospective Study” was published first online in the Annals of Surgical Oncology (May 2014).

“The Optimal Lymph Flow Program promotes lymph flow and optimal [BMI] by empowering, rather than inhibiting, how survivors live their lives,” Mei R. Fu, PhD, RN, ACNS-BC, FAAN, lead researcher of the pilot study, said in a news release. “Its underlying premise is ‘what to do’ rather than ‘what to avoid.”

Lymphedema is characterized by an accumulation of lymph fluid in the interstitial spaces of the affected limb, leading to chronic ipsilateral limb swelling causing 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 a year after breast cancer surgery. Two established risk factors for lymphedema are compromised lymphatic drainage and higher BMI.

Of the 140 patients enrolled in 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 program consisted of 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). To maintain their preoperative BMI, the women were offered nutritional instructions and encouraged to follow a balanced, portion-appropriate diet.

Limb volume change assessed by an 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.

Following the 12 months, no patients exceeded a 10% increase in limb volume, and no patients reported injury or discomfort associated with The Optimal Lymph Flow program at any follow-up visit, according to the investigators.

“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. “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.”

The investigators also reported that nearly 90% of the women studied said 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.