CE ARTICLE: Recognizing and treating upper extremity lymphedema in postmastectomy/lumpectomy patients: A guide for primary care providers

Abstract

Purpose: To provide an overview of the lymphatics, physiology of lymphedema (LE), incidence, risks, and costs as well as a guide for the primary care provider on how to recognize the symptoms of LE, a review of current published treatment recommendations, and advice about making a referral to appropriate LE specialists. Data sources: Selected studies on diagnosing and treating LE in breast cancer patients following mastectomy/lumpectomy and evidence-based treatment guidelines. Conclusions: LE is the most common complication related to breast cancer treatment with an occurrence estimated between 10% and 60% depending on the parameters used for measurement. Most commonly, LE occurs within the first 3 years after breast cancer treatment, but the remaining cases happen beyond this period of time and can occur after many years. This means that significant numbers of patients with LE can present to primary care clinicians. Implications for practice: A patient who is treated for breast cancer will be followed for a time by the oncology team, but eventually, that patient will be discharged from the oncology practice and will be seen in primary care. Risk factors for developing LE include treatment-related (number of nodes removed and radiation to axilla), disease-related (stage and location of tumor), and patient-related (younger age, obesity, and comorbid conditions) factors. A systematic evaluation of any patient presenting with LE will assure accurate diagnosis and prompt treatment.According to cancer statistics for 2008, the number of people with a new diagnosis of breast cancer was estimated to be 184,450, with breast cancer deaths of 40,930. Breast cancer continues to be the most commonly diagnosed malignancy for women and the second most common cancer death (second to lung cancer). Although the incidence of breast cancer appears fairly stable, deaths from breast cancer are declining. This is a result of increases in quality screening (mammography) and ability to detect breast cancer in earlier stages. With this difference in rates of survival and incidence, it stands to reason that more people will be breast cancer survivors (Jemal et al., 2008).

The Effect of Education on Upper Extremity Function in Patients with Lymphedema after Breast Cancer Treatments

“…20,21 In our study, 12 of 38 patients (31.6%) had an infection at least once and at the most six times. Their increased frequency of infection increased the development of fibrotic tissue.…”

“…33 Radiation therapy caused destruction of the related tissues leading to fibrosis, which then leads to the restriction of shoulder movements. 20 Ozçinar et al identified statistically significant limitations in shoulder flexion, abduction, and internal and external rotation movements in the early period of breast cancer treatment (week 1). They also showed a significant limitation of the ongoing internal rotation measurements by 9-12 months after surgery.…”

“…The first of these groups includes the treatment-related risk factors (type of surgery, radiotherapy, or chemotherapy), the second includes diseaserelated risk factors (phase of pathological nodal involvement, affected number of lymph nodes, and tumor breast localization), and the third includes clinical-related risk factors (age, obesity, BMI, hypertension, history of infection, and the dominant extremity effective resistance). [20][21][22] According to Ozaslan et al, risk factors for the development of LE are infection, BMI, and the required use of hands for an hour or more in the course of working. 23 Risk factors of the patients in our study are consistent with the literature.…”

Complicated breast cancer–related lymphedema: evaluating health care resource utilization and associated costs of management

“…This relationship is well corroborated by existing literature. [18][19][20][21] Although neither the scope of this study nor its design were intended to critically analyze the influence of breast reconstruction on lymphedema development, breast reconstruction did not appear to affect risk in the present study. Prior research indicates an improvement in existing lymphedema and reduced the risk of primary lymphedema development with delayed breast reconstruction after oncologic resection [22][23][24] ; more recently, immediate reconstruction has also been reported to decrease risk.…”

A Single Blinded Randomized Controlled Clinical Trial on the Efficacy of Ozone Therapy on Breast Cancer-Related Lymphedema

“…The prevalence BCRL is between 12% and 28% (Meric et al, 2002;Ozaslan & Kuru, 2004;Clark, Sitzia, & Harlow, 2005). This variation can be explained in part by differences in the criteria used to define and diagnosis lymphedema (Quirion, 2010;Jain, Danoff, & Paul, 2010;Petrek & Heelan, 1998).…”