0
No votes yet
Article

Prospective Protocol for Lymphedema Education and Surveillance in a Breast Health Center

Mary Haley-Emery
Wendy Schmitz-Johnson
CJON 2014, 18(5), 27-31 DOI: 10.1188/14.CJON.S2.27-31

Participation in the ONS Foundation-supported Breast Cancer Survivorship Quality Measures Set pilot study indicated less than optimal assessment and educational practices for lymphedema surveillance at one author's institution. This finding led staff to expand on nursing practice associated with lymphatic dysfunction and to propose a surveillance tool that is easy to use in a busy clinical setting. Based on current trends in lymphatic surveillance, arm measurements were used to assess for relative percentage differences compared to baseline. The referral threshold for lymphedema diagnosis was set at a 10% relative difference in circumferential measurements, pre- and postoperatively, as well as during the survivorship period. Enhanced education efforts, inclusive of staff and patients, will be established throughout the continuum of care. As lymphedema research and standard of care consensus become established, this surveillance model will be adapted in accordance with evidence-based practice guidelines.

References 

American Cancer Society. (2014). <i>Breast cancer facts and figures 2013-2014.</i> Retrieved from <a target="_blank" href='http://www.cancer.org/research/cancerfactsstatistics/index'>http://www.c...

Ancukiewicz, M., Miller, C.L., Skolny, M.N., O'Toole, J., Warren, L.E., Jammallo, L.S., … Taghian, A.G. (2012). Comparison of relative versus absolute arm size change as criteria for quanitifying breast cancer-related lymphedema: The flaws in current studies and the need for universal methodology. <i>Breast Cancer Research and Treatment, 135</i>, 145-152. doi:10.1007/s10549-012-2111-8

Armer, J.M., & Stewart, B.R. (2010). Post-breast cancer lymphedema: Incidence increases from 12 to 30 to 60 months. <i>Lymphology, 43</i>, 118-127.

Bernas, M.J., Askew, R.L., Armer, J.M., & Cormier, J.N. (2010). Lymphedema: How do we diagnose and reduce the risk of this dreaded complication of breast cancer treatment? <i>Current Breast Cancer Reports, 2</i>, 53-58. doi:10.1007/s12609-1010-0009-1

Caban, M. (2002). Trends in the evaluation of lymphedema. <i>Lymphology, 35</i>, 28-38.

Dylke, E.Y., Yee, J., Ward, L.C., Foroughi, N., & Kilbreath, S.L. (2012). Normative volume difference between the dominant and nondominant upper limbs in healthy older women. <i>Lymphatic Research and Biology, 10</i>(4), 182-188. doi:10.1089/lrb.201.0011

Fessele, K., Yendro, S., & Mallory, G. (2014). Setting the bar: Developing quality measures and education programs to define evidence-based, patient-centered, high-quality care. <i>Clinical Journal of Oncology Nursing, 18</i>(Suppl.), 7-11. doi:10.1188/14.CJON.S2.7-11

Fleysher, L. (2010). Keeping breast cancer survivors lymphoedema-free. <i>British Journal of Nursing, 19</i>, 826-830.

Foldi, M., & Foldi, E. (2006). <i>Foldi's textbook of lymphology for physicians and lymphedema therapists.</i> Munich, Germany: Elsevier, Urban, and Fischer.

Fu, M.R., Ridner, S.H., & Armer, J. (2009). Post-breast cancer lymphedema: Part 2. <i>American Journal of Nursing, 109</i>(8), 34-41. doi:10.1097/01.NAJ.0000358492.91678.78

Gray, R.E., Fitch, M., Greenberg, M., Hampson, A., Doherty, M., & Labreque, M. (1998). The information needs of well, long-term survivors of breast cancer. <i>Patient Education and Counseling, 33</i>, 245-255. doi:10.1016/S0738-3991(98)00024-X

Hayes, S., Di Sipio, T., Rye, S., Lopez, J.A., Saunders, C., Pyke, C., … Newman, B. (2011). Prevalence and prognostic significance of secondary lymphedema following breast cancer. <i>Lymphatic Research and Biology, 9</i>, 135-141. doi:10.1089/lrb.2011.0007

O'Toole, J., Jammallo, L.S., Skolny, M.N., Miller, C.L., Elliott, K., Specht, M.C., & Taghian, A.G. (2013). Lymphedema following treatment for breast cancer: A new approach to an old problem. <i>Critical Reviews in Oncology/Hematology, 88</i>, 437-446. doi:10.1016/j.critrevonc.2013.05.001

Reed, K. (1993). <i>Betty Neuman: The Neuman Systems Model.</i> Newbury Park, CA: Sage.

Runowicz, C.D. (1998). Lymphedema: Patient and provider education: Current status and future trends. <i>Cancer, 83</i>(12, Suppl. American), 2874-2876.

Sherman, K.A., & Koelmeyer, L. (2011). The role of information sources and objective risk status on lymphedema risk-minimization behaviors in women recently diagnosed with breast cancer [Online exclusive]. <i>Oncology Nursing Forum, 38</i>, E27-E36. doi:10.1188/11.ONF.E27-E36

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, 11</i>, 254-251. doi:10.1046/j.1365-2354.2002.00312.x

Zuther, J., & Norton, S. (2013). <i>Lymphedema management: The comprehensive guide for practitioners.</i> New York, NY: Thieme Medical Publishers.