0
No votes yet
Article
Open Access Article

Demystifying Lymphedema: Development of the Lymphedema Putting Evidence Into Practice® Card

Ellen Poage
Marybeth Singer
Jane Armer
Melanie Poundall
M. Jeanne Shellabarger
CJON 2008, 12(6), 951-964 DOI: 10.1188/08.CJON.951-964

Download the 2014 revision to Putting Evidence Into Practice interventions for fatigue for free at https://cjon.ons.org/file/14001/download by Fu et al., CJON, 18(6, Suppl.), 68-79.

Cancer treatment is the leading cause of lymphedema in developed countries. Development and severity of lymphedema have a significant impact on comfort, psychological distress, and overall quality of life. Incidence statistics have ranged from 5%-60%, with onset of symptoms ranging from immediately after treatment to 30 years after treatment. Oncology nurses caring for patients throughout the cancer trajectory have a critical role to play in early assessment of risk, prompt identification of lymphedema, and implementation of evidence-based, individualized treatment plans in collaboration with therapists. As part of an Oncology Nursing Society (ONS) project team, the authors of this article undertook a review of current literature to identify effective interventions for the treatment of secondary lymphedema. Following the guidelines established by the ONS Evidence-Based Practice Resource Team, the authors evaluated current clinical practice guidelines, systematic reviews, and research studies conducted since 1998. The team reviewed and synthesized the literature and developed evidence tables and a Putting Evidence Into Practice® (PEP) card. The data were reviewed by experts in the field of lymphedema management. The lymphedema ONS PEP card, a user-friendly, succinct summary of interventions, was released at the 33rd Annual ONS Congress in May 2008.

References 

Activa Health Care. (n.d.). Lymphedema. Retrieved November 21, 2007, from <a target="_blank" href='http://www.activahealthcare.co.uk/content/conditions/lymphoedema.html?t=...

Ahmed, R. L., Thomas, W., Yee, D., & Schmitz, K. H. (2006). Randomized controlled trial of weight training and lymphedema in breast cancer survivors. <i>Journal of Clinical Oncology</i>, 24(18), 2765-2772.

Armer, J. M., Radina, M. E., Porock, D., & Culbertson, S. D. (2003). Predicting breast cancer related lymphedema using self-reported symptoms. <i>Nursing Research</i>, 52(6), 370-379.

Armer, J. M., & Stewart, B. R. (2005). A comparison of four diagnostic criteria for lymphedema in a post-breast cancer population. <i>Lymphatic Research and Biology</i>, 3(4), 208-217.

Badger, C., Preston, N., Seers, K., & Mortimer, P. (2004). Physical therapies for reducing and controlling lymphoedema of the limbs. <i>Cochrane Database of Systematic Reviews</i>, 4, CD003141.

Bani, H. A., Fasching, P. A., Lux, M. M., Rauh, C., Willner, M., Eder, I., et al. (2007). Lymphedema in breast cancer survivors: Assessment and information provision in a specialized breast unit. <i>Patient Education and Counseling</i>, 66(3), 311-318.

Barclay, J., Vestey, J., Lambert, A., & Balmer, C. (2006). Reducing the symptoms of lymphoedema: Is there a role for aromatherapy? <i>European Journal of Oncology Nursing</i>, 10(2), 140-149.

Bernard, P. (2008). Management of common bacterial infections of the skin. <i>Current Opinion in Infectious Disease</i>, 21(2), 122-128.

Bicego, D., Brown, K., Ruddick, M., Storey, D., Wong, C., & Harris, S. R. (2006). Exercise for women with or at risk for breast cancer-related lymphedema. <i>Physical Therapy</i>, 86(10), 1398-1405.

Braunwald, E., Fauci, A., Kasper, D., Hauser, S., Longo, D., & Jameson, J. (2001). <i>Harrison's principles of internal medicine</i> (15th ed.). New York: McGraw Hill.

British Lymphology Society. (1999). <i>Guidelines for the use of MLD and SLD.</i> Retrieved November 21, 2007, from <a target="_blank" href='http://www.lymphoedema.org/bls/membership/guidelines.htm'>http://www.lym...

Browning, C. (1997). <i>Lymphoedema: Prevalence, risk factors, and management: A review of research.</i> Kings Cross, Australia: NHMRC National Breast Cancer Center.

Carati, C. J., Anderson, S. N., Gannon, B. J., & Piller, N. B. (2003). Treatment of postmastectomy lymphedema with low-level laser therapy. <i>Cancer</i>, 98(6), 1114-1122.

Casley-Smith, J. R., & Casley-Smith, J. R. (1996). Lymphedema initiated by aircraft flights. <i>Aviation, Space, and Environmental Medicine</i>, 67(1), 52-56.

Centers for Disease Control and Prevention. (2008). Body mass index. Retrieved July 31, 2008, from <a target="_blank" href='http://www.cdc.gov/nccdphp/dnpa/healthyweight/assessing/bmi/index.htm'>h...

Courneya, K. S., Mackey, J. R., Bell, G. J., Jones, L. W., Field, C. J., & Fairey, A. S. (2003). Randomized controlled trial of exercise training in postmenopausal breast cancer survivors. Cardiopulmonary and quality of life outcomes. <i>Journal of Clinical Oncology</i>, 21(9), 1660-1668.

de Rezende, L. F., Franco, R. L., de Rezende, M. F, Beletti, P. O., Morais, S. S., & Gurgel, M. S. (2006). Two exercise schemes in postoperative breast cancer: Comparison of effects on shoulder movement and lymphatic disturbance. <i>Tumori</i>, 92(1), 55-61.

Didem, K., Ufuk, Y. S., Serdar, S., & Zumre, A. (2005). The comparison of two different physiotherapy methods in treatment of lymphedema after breast surgery. <i>Breast Cancer Research and Treatment</i>, 93(1), 49-54.

Foldi, E. (1998). The treatment of lymphedema. <i>Cancer</i>, 83(Suppl. 12), 2833-2834.

Forner-Cordero, I., Navarro-Monsoliu, R., Munoz-Langa, J., Alcober-Fuster, P., & Rel-Monza, P. (2007). Use of a nanocrystalline silver dressing on lymphatic ulcers in patients with chronic lymphoedema. <i>Journal of Wound Care</i>, 16(5), 235-239.

Gordon, K., & Mortimer, P. (2007). A guide to lymphedema. <i>Expert Review of Dermatology</i>, 2(6), 741-752.

Gothard, L., Stanton, A., MacLaren, J., Lawrence, D., Hall, E., Mortimer, P., et al. (2004). Non-randomized phased II trial of hyperbaric oxygen therapy in patients with chronic arm lymphedema and tissue fibrosis after radiotherapy for early breast cancer. <i>Radiotherapy and Oncology</i>, 70(3), 217-224.

Greene, A. K., Borud, L., & Slavin, S. A. (2005). Blood pressure monitoring and venipuncture in the lymphedematous extremity. <i>Plastic and Reconstructive Surgery</i>, 116(7), 2058-2059.

Hamner, J. B., & Fleming, M. D. (2007). Lymphedema therapy reduces the volume of edema and pain in patients with breast cancer. <i>Annals of Surgical Oncology</i>, 14(6), 1904-1908.

Harris, S. R., & Niesen-Vertommen, S. L. (2000). Challenging the myth of exercise induced lymphedema following breast cancer: A series of case reports. <i>Journal of Surgical Oncology</i>, 74(2), 95-98.

Indelicato, D. J., Grobmyer, S. R., Newlin, H., Morris, C. G., Haigh, L. S., Copeland, E. M., et al. (2006). Delayed breast cellulitis: An evolving complication of breast conservation. <i>International Journal of Radiation Oncology, Biology, Physics</i>, 66(5), 1339-1346.

International Society of Lymphology. (2003). The diagnosis and treatment of peripheral lymphedema. Consensus document of the International Society of Lymphology. <i>Lymphology</i>, 36(2), 84-91.

Jeffs, E. (2006). Treating breast cancer-related lymphoedema at the London Haven: Clinical audit results. <i>European Journal of Oncology Nursing</i>, 10(1), 71-79.

Johansson, K., Lie, E., Edkahl, C., & Lindfeldt, J. (1998). A randomized study comparing manual lymph drainage with sequential pneumatic compression for treatment of postoperative arm lymphedema. <i>Lymphology</i>, 31(2), 56-64.

Jones, S., Bowler, P. G., & Walker, M. (2005). Antimicrobial activity of silver containing dressings is influenced by dressing conformability with wound surface. <i>Wounds</i>, 17(90), 263-270.

Kaviani, A., Fateh, M., Yousefi Nooraie, R., Alinagi-Zadeh, M. R., & Ataie-Fashtami, L. (2006). Low-level laser therapy in management of postmastectomy lymphedema. <i>Lasers in Medical Science</i>, 21(2), 90-94.

Kolden, G. G., Strauman, T. J., Ward, A., Kuta, J., Woods, T. E., Schneider, K. L., et al. (2002). A pilot study of group exercise training (GET) for women with primary breast cancer: Feasibility and health benefits. <i>Psycho-Oncology</i>, 11(5), 447-456.

Koul, R., Dufan, T., Russell, C., Guenther, W., Nugent, Z., Sun, X., et al. (2007). Efficacy of complete decongestive therapy and manual lymphatic drainage on treatment-related lymphedema in breast cancer. <i>International Journal of Radiation Oncology, Biology, Physics</i>, 67(3), 841-846.

Lymphatic Research Foundation. (2006). Lymphedema glossary. Retrieved January 9, 2008, from <a target="_blank" href='http://www.lymphnotes.com/gloss.php'>http://www.lymphnotes.com/gloss.php...

Lymphoedema Framework. (2006). <i>Best practice for the management of lymphedema: An international perspective.</i> London: MEP Ltd.

Mahamaneerat, W. K., Shyu, C. R., Stewart, B. R., & Armer, J. M. (in press). Post-op swelling and lymphoedema following breast cancer treatment: A baseline-comparison BMI-adjusted approach. <i>Journal of Lymphoedema.</i>

McNeely, M. L., Magee, D. J., Lees, A. W., Bagnall, K. M., Haykowsky, M., & Hanson, J. (2004). The addition of manual lymph drainage to compression therapy for breast cancer related lymphedema: A randomized controlled trial. <i>Breast Cancer Research and Treatment</i>, 86(2), 95-106.

Mitchell, S. A., & Friese, C. R. (n.d.). Weight of evidence. Retrieved September 14, 2008, from <a target="_blank" href='http://www.ons.org/outcomes/tables/sleep/woe.shtml'>http://www.ons.org/o...

Mortimer, P. S. (1998). The pathophysiology of lymphedema. <i>Cancer</i>, 83(Suppl. 12), 2798-2802.

Moseley, A. L., Carati, C. J., & Piller, N. B. (2007). A systematic review of common conservative therapies for arm lymphoedema secondary to breast cancer treatment. <i>Annals of Oncology</i>, 18(4), 639-646.

National Lymphedema Network Medical Advisory Committee. (2006). <i>Position statement of the National Lymphedema Network. Topic: Treatment.</i> Retrieved November 21, 2007, from <a target="_blank" href='http://www.lymphnet.org/pdfDocs/nlntreatment.pdf'>http://www.lymphnet.or...

National Lymphedema Network Medical Advisory Committee. (2008a). <i>Position statement of the National Lymphedema Network. Topic: Air travel.</i> Retrieved January 9, 2008, from <a target="_blank" href='http://www.lymphnet.org/pdfDocs/nlnairtravel.pdf'>http://www.lymphnet.or...

National Lymphedema Network Medical Advisory Committee. (2008b). <i>Position statement of the National Lymphedema Network. Topic: Exercise.</i> Retrieved January 9, 2008, from <a target="_blank" href='http://www.lymphnet.org/pdfDocs/nlnexercise.pdf'>http://www.lymphnet.org...

National Lymphedema Network Medical Advisory Committee. (2008c). <i>Position statement of the National Lymphedema Network. Topic: Lymphedema risk reduction practices.</i> Retrieved January 9, 2008, from <a target="_blank" href='http://www.lymphnet.org/pdfDocs/nlnriskreduction.pdf'>http://www.lymphne...

Oncology Nursing Society. (2008). Lymphedema definition list. Retrieved November 11, 2008, from <a target="_blank" href='http://www.ons.org/outcomes/volume4/lymphedema.shtml'>http://www.ons.org...

Petrek, J. A., & Heelan, M. C. (1998). Incidence of breast carcinoma-related lymphedema. <i>Cancer</i>, 83(Suppl. 12), 2776-2781.

Ridner, S. H. (2002). Breast cancer lymphedema: Pathophysiology and risk reduction guidelines. <i>Oncology Nursing Forum</i>, 29(9), 1285-1295.

Ridner, S. H., & Dietrich, M. S. (2008). Self-reported co-morbid conditions and medication usage in breast cancer survivors with and without lymphedema <i>Oncology Nursing Forum</i>, 35(1), 57-63.

Ridner, S. H., Mongtomery, L. D., Hepworth, J. T., Stewart, B. R., & Armer, J. M. (2007). Comparison of upper limb volume measurement techniques and arm symptoms between healthy volunteers and individuals with known lymphedema. <i>Lymphology</i>, 40(1), 35-46.

Ries, L. A., Melbert, D., Krapcho, M., Stinchcomb, D. G., Howlander, N., Horner, M. J., et al. (Eds.). (2007). SEER cancer statistics review, 1975-2005. National Cancer Institute. Retrieved November 4, 2008, from <a target="_blank" href='http://seer.cancer.gov/csr/1975_2005'>http://seer.cancer.gov/csr/1975_20...

Sandel, S. L., Judge, J. O., & Landry, N. (2005). Dance and movement program improves quality of life measures in breast cancer survivors. <i>Cancer Nursing</i>, 28(4), 301-309.

Shaw, C., Mortimer, P., & Judd, P. A. (2007). A randomized controlled trial of weight reduction as a treatment for breast cancer-related lymphedema. <i>Cancer</i>, 110(8), 1868-1874.

Soran, A., D'Angelo, G., Begovic, M., Ardic, F., Harlak, A., Samuel Wieand, H., et al. (2006). Breast cancer-related lymphedema—What are the significant predictors and how do they affect the severity of lymphedema? <i>Breast Journal</i>, 12(6), 536-543.

Stout-Gergich, N. L., Pfalzer, L. A., McGarvey, C., Springer, B., Gerber, L. H., & Soballe, P. (2008). Preoperative assessment enables the early diagnosis and successful treatment of lymphedema. <i>Cancer</i>, 112(12), 2809-2819.

Swedborg, I. (1984). Effects of treatment with an elastic sleeve and intermittent pneumatic compression in post-mastectomy patients with lymphoedema of the arm. <i>Scandanavian Journal of Rehabilitation Medicine</i>, 16(1), 35-41.

Szuba, A., Achalu, R., & Rockson, S. G. (2002). Decongestive lymphatic therapy for patients with breast carcinoma-associated lymphedema. <i>Cancer</i>, 95(11), 2260-2267.

Teas, J., Cunningham, J. E., Cone, L., Jansen, K., Raghavan, S. K., Nitcheva, D. K., et al. (2004). Can hyperbaric oxygen therapy reduce breast cancer treatment-related lymphedema? A pilot study. <i>Journal of Womens Health</i>, 13(9), 1008-1018.

Vignes, S., Porcher, R., Arrault, M., & Dupuy, A. (2007). Long-term management of breast cancer-related lymphedema after intensive decongestive physiotherapy. <i>Breast Cancer Research and Treatment</i>, 101(3), 285-290.

Williams, A. F., Vadgama, A., Franks, P. J., & Mortimer, P. S. (2002). A randomized controlled crossover study of manual lymphatic drainage therapy in women with breast cancer-related lymphoedema. <i>European Journal of Cancer Care</i>, 11(3), 254-261.

Woods, M. (2003). The experience of manual lymph drainage as an aspect of treatment for lymphoedema. <i>International Journal of Palliative Nursing</i>, 9(4), 336-342.

Zuther, J. E. (2005). <i>Lymphedema management: The comprehensive guide for practitioners.</i> New York: Thieme Medical Publishers.