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      A Survey of the Status of Awareness of Lymphedema in Breast Cancer Patients in Busan-Gyeongnam, Korea

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          Abstract

          Objective

          To support the establishment of lymphedema education plans and the actual practice of education by investigating the current lymphedema awareness status of Korean breast cancer patients.

          Methods

          cross-sectional population survey was conducted in 116 breast cancer patients in the Busan-Gyeongnam area. The survey included questions regarding demographic characteristics, breast cancer-related lymphedema (BCRL) risk factors, and characteristics and treatments of the disease. Some of the items were scored to determine the level of awareness. The items that affect the awareness of lymphedema were investigated by statistical analysis.

          Results

          Eighty-one of the 116 patients answered that they had heard of lymphedema, and 30 of them (25.86%) had received explanations about the possibility of lymphedema before surgery. Only 20 patients (17.25%) knew that lymphedema is not a completely curable disease, 24 patients (20.68%) thought that lymphedema does not require any treatment, and only 56 patients (48.27%) knew that lymphedema is treated in the Department of Rehabilitation Medicine. The main factors that affected patients' awareness of lymphedema were their age, chemotherapy, duration of breast cancer, and lymphedema treatment history.

          Conclusion

          The majority of survey participants who were breast cancer patients either lacked awareness of BCRL or had false ideas about it, indicating the inadequate level of education provided for lymphedema. In the case of breast cancer diagnosis, early and continuous education for future management is essential, and the framework for the provision of education including education protocols related to age, disease duration, and lymphedema treatment is needed.

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          Most cited references 20

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          Incidence and risk of arm oedema following treatment for breast cancer: a three-year follow-up study.

          Breast-cancer-related lymphoedema is a chronic condition with estimates of incidence ranging from 6 to 83%. Lymphoedema has been associated with a variety of risk factors. However, this evidence has suffered from methodological weaknesses, and so has had little impact upon clinical practice. To examine incidence and risk factors [hospital skin puncture, surgical procedure, Body Mass Index (BMI), age, axillary node status, number of axillary nodes removed, radiotherapy and surgery on dominant side] for breast cancer-related arm lymphoedema. Prospective observational study, with measurement of limbs pre-operatively and at regular intervals post-operatively. We recruited 251 women who had surgical treatment for breast cancer that involved sampling, excision or biopsy of axillary nodes, aged > or = 18 years, and free of advanced disease and psychological co-morbidities. Of these, 188 (74.9%) were available for 3-year follow-up. At follow-up, 39 (20.7%) had developed lymphoedema. Hospital skin puncture (vs. none) (RR 2.44, 95%CI 1.33-4.47), mastectomy (vs. wide local excision or lumpectomy) (RR 2.04, 95%CI 1.18-3.54), and BMI > or = 26 (vs. BMI 19-26) (RR 2.02, 95%CI 1.11-3.68) were the only significant risk factors. Lymphoedema remains a significant clinical problem, with 1:5 women in this sample developing the condition following treatment for breast cancer. Risk factors are identified in the development of lymphoedema that should be taken into account in clinical practice.
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            Health-related quality of life with lymphoedema: a review of the literature.

            This article reviews qualitative and quantitative studies that evaluate health-related quality of life (HRQoL) in lymphoedema. Qualitative studies reveal a number of factors that can affect HRQoL. These include a lack of understanding of lymphoedema by health professionals and poor information provided to patients. Emotional responses include shock, fear, annoyance, frustration and negative body image. Treatment can be costly in terms of time and disruption to lifestyle. Quantitative studies show that patients with lymphoedema experience greater levels of functional impairment, poorer psychological adjustment, anxiety and depression than the general population. Increased limb volume is poorly related to the impact of lymphoedema on the patient. Factors leading to deficits in quality of life include the frequency of acute inflammatory episodes, the presence of pain, skin quality, lymphoedema in the dominant hand and reduced limb mobility. There is some evidence that the adoption of patient-centred guidelines can improve quality of life in patients with breast-cancer-related lymphoedema. HRQoL is an important outcome in the management of patients with lymphoedema. Further studies must examine how lymphoedema impacts on patients other than those with breast-cancer-related lymphoedema and the consequences to patients of different approaches to care.
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              The psychological morbidity of breast cancer-related arm swelling. Psychological morbidity of lymphoedema.

              The psychological morbidity, functional impairment, and disturbance in psychosocial adjustment to illness was evaluated in relation to breast cancer-related arm swelling. Fifty women with breast cancer-related arm swelling were matched with 50 control subjects for age, duration since treatment, and type of treatment received. All study participants were free from active disease and had been treated more than 1 year ago. Patients with arm swelling showed greater psychological morbidity at formal psychiatric interview, impaired adjustment to illness as evaluated by the Psychosocial Adjustment to Illness Scale, and greater impairment of physical functioning. Patients with arm swelling in relation to breast cancer experienced functional impairment, psychosocial maladjustment, and increased psychological morbidity. These findings have implications for management of breast cancer.
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                Author and article information

                Journal
                Ann Rehabil Med
                Ann Rehabil Med
                ARM
                Annals of Rehabilitation Medicine
                Korean Academy of Rehabilitation Medicine
                2234-0645
                2234-0653
                August 2015
                25 August 2015
                : 39
                : 4
                : 609-615
                Affiliations
                [1 ]Department of Physical Medicine & Rehabilitation, Kosin University College of Medicine, Busan, Korea.
                [2 ]Department of Preventive Medicine, Kosin University College of Medicine, Busan, Korea.
                [3 ]Department of Psychiatry, Kosin University College of Medicine, Busan, Korea.
                Author notes
                Corresponding author: Ho Joong Jeong. Department of Physical Medicine & Rehabilitation, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan 602-702, Korea. Tel: +82-51-990-6156, Fax: +82-51-990-3181, jhjpmr@ 123456naver.com
                Article
                10.5535/arm.2015.39.4.609
                4564709
                Copyright © 2015 by Korean Academy of Rehabilitation Medicine

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Original Article

                Medicine

                lymphedema, breast neoplasms, education

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