Journal of Lymphoedema最新文献

The American Lymphedema Framework Project (AFLP) surveyed lymphoedema therapists in the US in 2009 to describe their preparation, patient population and care practices. In the autumn of 2018, the survey was expanded to trained therapists worldwide to describe and compare current and past therapist characteristics and practices. The updated 2009 survey was distributed via Qualtrics to US and international therapists. The current analysis includes over 950 completed surveys. Preliminary results showed: country: US (n=672/922 [73%]); Canada (n=92[10%]); United Kingdom (n=42[5%]); Australia (n=28[3%]); gender: identifying as female (n=633/676 [93%]); mean age: 47yrs (range 21-76); discipline: physical therapist [45%], occupational therapist [31%], massage therapist [24%]); mean practice years: 10.7yrs (range 0-41); and practice setting: hospital out-patient clinic (47%); private practice (38%); hospital in-patient (13%); home care/hospice (9%). Further 2009-2018 comparative analyses will be shared. Understanding characteristics and practices of lymphoedema therapists and patients will help stakeholders meet under- and unmet needs of this population.

Background: Many clinicians recognise the importance of the patient's role in treating and managing lymphoedema and that optimal outcomes depend on patients' compliance to treatment, or a prescribed daily lymphoedema care regimen. Such a widespread belief can be called a 'compliance paradigm'.

Aims: To ascertain whether breast cancer survivors with lymphoedema have the same concept of compliance as clinicians to characterise their experiences.

Methods: Using a descriptive phenomenological method, 34 participants were recruited and 102 interviews completed.

Results: The findings of the study reveal that, from the perspective of breast cancer survivors, managing lymphoedema is broader than compliance to treatment. The women actively structured their lives to make lymphoedema management feasible by incorporating it into a daily routine. The study offers an alternative insight into the compliance approach to lymphoedema management and it is important for researchers and clinicians to be aware that breast cancer survivors do not consider compliance to treatment as part of their daily lymphoedema care.

Conclusions: In research and practice, it may be more appropriate to assess the presence or absence of breast cancer survivors' intentions, effective and ineffective strategies, and barriers to effective strategies.

BACKGROUND: Quantification of lymphoedema (LE) has been problematic, and the reported incidence of LE varies greatly among women treated with surgery and radiation for breast cancer. AIMS: This study aims to describe LE occurrence over time among breast cancer survivors using four diagnostic criteria based on three measurement techniques. METHODS: Limb volume and symptom assessment data were followed after surgery every three months for 12 months, then every six months for 30 months. Limb volume changes (LVC) were measured by circumferences and by perometry, and by symptom experience via interview. Standard survival analysis methods identified when the criteria indicating LE were met. RESULTS: Trends in LE occurrence are reported for data from 211 participants. At 30 months post-treatment, LE incidence ranged from 41-91%, with 2cm being the highest estimation method and self-reported signs and symtoms (SS) the lowest. CONCLUSIONS: This 30-month analysis supports the previous 12-month analysis in finding the 2cm criteria as the most liberal definition of LE. Self-reporting of heaviness and swelling, along with 10% LVC, represented the most conservative definitions (41% and 45%, respectively).

BACKGROUND: Diagnosis of post-breast cancer lymphoedema is difficult because of inconsistent measurement approaches, measurement reliability and validity, and lymphoedema definition and criterion. AIMS: To examine lymphoedema occurrence using a body mass index (BMI)-adjusted limb volume change (LVC) as a potentially sensitive alternative criterion for assessment and diagnosis of lymphoedema. Secondary aims were to examine the risk of lymphoedema occurrence in relation to post-operative swelling and limb dominance and the cancer-affected side. METHODS: The volume calculated from circumferences of 193 breast cancer survivors was used to analyse lymphoedema assessment. A change ≥5% in affected-arm volume over percent change in BMI in comparison to pre-operative baseline was considered indicative of lymphoedema. RESULTS: For all participants, 63% met the 5% BMI-adjusted LVC criterion. Dominant limb and cancer-affected side were significantly related to lymphoedema occurrence only in those whose BMI ≥30 (p=0.02), while post-operative swelling significantly increased the lymphoedema risk irrespective of BMI (p=0.01). CONCLUSIONS: The proposed 5% BMI-adjusted LVC criterion provides a more sensitive estimation of post-breast cancer lymphoedema occurrence.

Background: Little attention has been given to the impact of lymphoedema on breast cancer survivors' work experience.

Aims: To describe the experience of work of breast cancer survivors with lymphoedema.

Methods: A descriptive phenomenological method was used. Sixty-six in-depth interviews were completed with 22 participants in the United States.

Results: Three essential themes illuminating the meaning of working for breast cancer survivors with lymphoedema emerged, namely: having a visible sign of disability or a need for help; having physical limitations that made some women handicapped, while others felt inconvenienced; and, finally, some women had constant worries while others felt fortunate.

Conclusions: Women endured emotional distress at work. Women whose jobs required heavy lifting and constant use of the affected limb, suffered profoundly from the physical and functional impact of having lymphoedema. Future research should focus on interventions that help employers to understand breast cancer survivors with lymphoedema and improve their working conditions.

BACKGROUND: Improvements in breast cancer treatment and early diagnosis are leading to increasing numbers of breast cancer survivors, many of whom are experiencing upper limb lymphoedema as a post-treatment outcome. Current management techniques of breast cancer-related lymphoedema produce uneven results, signifying a need for research in this area. AIMS: To assess the symptom management practices of breast cancer survivors experiencing cancer-related lymphoedema by identifying and quantifying self-care management practices. METHODS: The Lymphoedema Breast Cancer Questionnaire (LBCQ) was given to 40 breast cancer survivors with either self- or medical diagnosis of upper limb lymphoedema ipsilateral to the breast treated for cancer. RESULTS: Findings revealed three main themes: recommended management techniques, pharmaceutical treatments, and lay symptom management techniques. Further categorisation suggested that clusters of similar related symptoms (e.g. heaviness, aching, tenderness, and tightness/firmness) tend to be managed or not managed in similar ways. CONCLUSIONS: Healthcare professionals need to recognise the scope and diversity of self-management practices that breast cancer survivors choose in managing their lymphoedema symptoms. A critical next step is the rigorous evaluation of the effectiveness of these self-management modalities.