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From Cancer Patient to Cancer Survivor: Lost in Transition
BOX 3-5 Case Study: Lymphedema
Shop owner Catherine Pascucci had three lymph nodes removed and a lumpectomy and radiation treatment for breast cancer 3 years ago. After her surgery, she returned to her fragrance shop, lifting boxes and ringing sales, never knowing that she was at risk for lymphedema. About 3 months after cancer surgery, she noticed her bracelet was tight, but her breast surgeon attributed her swollen arm to a reaction to a bug bite. Months later, another doctor told her about lymphedema, and she sought treatment. She now undergoes regular physical therapy treatments and wears compression bandages to control the swelling.
SOURCE: Adapted from Parker-Pope (2004).
There have been relatively few well-designed, randomized trails to test the range of therapies that are available to treat lymphedema (Badger et al., 2004a,b,c). Nonpharmacologic treatments, such as massage and exercise (manual lymphatic drainage), use of elastic compression garments, and a technique called complex physical therapy or complex decongestive therapy, appear to be effective therapies for lymphedema (Kligman et al., 2004). These complex therapies involve skin care, manual lymphatic drainage, and low-stretch compression bandaging followed by a fitted compression garment when the edema has plateaued (Sparaco and Fentiman, 2002). Pharmacologic interventions (e.g., anticoagulants, diuretics) have not been shown to be effective in treating lymphedema itself (Loprinzi et al., 1999; Sparaco and Fentiman, 2002; Kligman et al., 2004), but certain medications may help alleviate discomfort, infection, or other side effects associated with lymphedema (Erickson et al., 2001). Avoidance of activities and factors known to trigger lymphedema (e.g., having blood pressure checked or blood drawn) can reduce its development (NCCN, 2004a) (Box 3-5). The role of exercise and prevention (e.g., use of low-pressure sleeve at specified times of arm use) in reducing the occurrence of lymphedema among women with breast cancer is being examined (Paskett, 2003). Obesity is a risk factor for lymphedema, and maintenance of a healthy weight is recommended (Johansson et al., 2002). Areas in need of further research include assessments of the value of prevention, early diagnosis, surveillance strategies, and treatment (Erickson et al., 2001). (See Chapter 4, Appendix 4D for a description of the delivery of rehabilitation services, including lymphedema services.)