Randomized Trial Of Decongestive Lymphatic Therapy For Breast Cancer

Because I had "intraductal" and "invasive" breast cancer -- when the cancer cells invade into the surrounding tissue -- I had a mastectomy with immediate reconstructive surgery. For the following six months I received chemotherapy treatment at the Sutter Cancer Center, where a supportive friend always sat with me as the drugs were administered intravenously.

The study was composed of two groups. The control group received the usual breast cancer care. The experimental group received the usual care and some additional components including four teaching sessions completed within the first month and regular follow-up calls. Intervention

Women who experience lymphedema after breast and lymph node removal often experience many physical and psychological struggles, that no one will quite understand unless you are the one living with the condition. More women are being diagnosed with breast cancer, or finding out they are carriers of the gene for breast cancer than ever before. Technology has allowed for earlier detection and better treatment options, with increasing survivor rates. As the survival numbers increase and more women are living with the aftermath of breast cancer treatment. Initial cancer treatment is not always life long, but the side effects to treatment can be. Women who experience lymphedema will likely experience a variety of emotional, physical, and psychological changes, some of theses changes are not able to be put in perspective until one researches it or experiences it for themselves.

Research Question: What is the effect of applying Kinesio© Tape to the lower extremity of patients with lymphedema secondary to gynecological cancer treatments?

She does not want to deal with having breast reconstruction surgery while she copes with treating the breast cancer.

Lymphedema is a chronic condition that has a lifelong effect on cancer survivors’ quality of life. Many previous studies reported that increase of lymphedema was associated with decrease quality of life, particularly, physical functioning such as functioning in domestic environment in the long period of time [20, 21, 22]. A previous study by Kwan, Jackson, Weir, Dingee, McGregor, and Olivotto [23] showed that patients with lymphedema report an impaired quality of life, as compared to survivors without lymphedema. Additionally, lymphedema exacts tremendous physical, psychological, social, spiritual, and emotional cost on breast cancer survivors experiencing it [24, 25]. Although swelling or edema within the tissue is not in itself painful, the stretching of nerve fibers

Lymphedema, with the associated swelling and pain, is a significant problem in breast cancer survivors. As a result, nurses should understand this complex problem so that they can inform breast cancer patients of their lifelong risk of developing this complication [10]To reduce/prevent lymphedema, nurses should educate breast cancer survivors to follow self-care regimen for controlling symptoms and avoiding exacerbation, such as performing daily skin care; wearing gloves during activities to prevent skin breaks; preventing injury in the affected side; preventing muscle strain; and promoting lymph drainage (i.e. elevate the affected arm, engage in regular, light aerobic exercise daily, maintain optimal body weight and wear a well-fitted compression garment when traveling by air) [25].

Radiation. Radiation therapy can be useful in all stages of breast cancer, however Stage I and II radiation therapy with lumpectomy is recommended. The ongoing research identifies without radiation treatment there is a relatively high chance of cancer recurrence up to 35%; with radiation as an adjuvant therapy the cancer risk decreases to 5-10% (MCGWC, 2007). Radiation treatment also accompanies a mastectomy if axillary lymph nodes test positive, a tumor is greater than five centimeters, or margin borders of the tumor are narrow between healthy cells and tumor cells (MCGWC, 2007).

The best treatment for lymphedema, complete decongestive therapy combines lifestyle changes with a number of effective therapies. It consists of 4 main parts, including:

Breast cancer is the second most commonly diagnosed cancer in American women and around 12 percent of women will develop invasive breast cancer in their lifetime.1 Patients have the choice of 5 different types of mastectomy: total mastectomy with removal of breast tissue without lymph node removal, modified radical mastectomy where the entire breast and axillary lymph nodes are removed, radical mastectomy where entire breast and chest muscles are removed, partial mastectomy frequently referred to as breast conservative surgery where only cancerous tissue is removed, or subcutaneous mastectomy where breast tissue is removed with conservation of the nipple and areola.2 The standard of care in the United States for women who have had mastectomy secondary to breast cancer is to receive a breast reconstruction.2 On top of a common but devastating diagnosis of breast cancer with fears of facing months of chemotherapy and radiation, most women also make the decision to beat the cancer with a mastectomy and reconstruction.

Around 2,600 women are diagnosed with breast cancer every year (Irish Cancer Society ,2015) however there is a 5-year relative survival estimate of 80% for breast cancer (HSE ,2015). As survivor rates rise we will see an increase of cancer related side effects in both the primary and acute care settings and one of these side effects is lymphedema.

Lymphedema is a chronic disease which can be caused by primary defect of the lymphatic system or secondary to external causes such as lymph node dissection, trauma, venous insufficiency, radiation and more. It manifests in swelling of a body part/s that may cause physical, social and emotional problems (1). The recommended conservative treatment for lymphedema is complex decongestive therapy which includes compression bandaging for 24 h in the intensive phase or wearing compression garment in the long-term phase of therapy, exercises, light massage and skin care. This treatment aims to reduce swelling, improve symptoms and improve function (2). Understanding whether a true change has occurred during the process of care is of utmost importance in lymphedema management secondary to cancer treatments.

The lymph nodes were checked because breast cancer cells are first most likely to spread through the lymphatic flow and normal venous flow. If there are presence of cancer cells in the lymph nodes that indicates lymph node involvement. And because the

Lymphatic massage was introduced in the 1930s by Danish physiotherapists Dr. Emil Vodder and his wife (Benjamin, 2010). His wife Astrid Vodder practiced naturopath. Emil Vodder studied at the University of Copenhagen for biology, botany, and mineralogy, later began showing interest in the physical medicine along with the lymphatic system. Vodder knew many scientists who had studied the mysterious “clear water” centuries ago, scientist such as Gaspare Aselli (1581–1626) who discovered the lacteal vessels in the lymphatic system, Jean Pecquet (1622-1674) described the cisterna chyli and the thoracic duct leading to the venous arch (Wittlinger, 2004). Olaus Rudbeck discovered the lymph vessels of the colon and rectum and confirmed that these vessels lead to the cisterna chyli as Aselli had described already. Rudbeck was the first who discovered that the lymph from the tissue runs into lymph vessels and to the thoracic duct back to the blood circulation. In the 18th century it was discovered that the whole body contained lymph vessels and that the task of the lymph vessel system is to absorb tissue liquid. Vodder and his wife moved to Paris, France in 1933 to practice the modality on his patients (Wittlinger, 2004). The concept of lymph drainage by massage therapy is similar to opening a valve of a tube filled with water and allowing the water to flow into another tube to release pressure and alleviate build up in the lymph nodes. The carefully circling pumping movements

While the completion of treatment is excitedly anticipated, many cancer survivors would still be disturbed by the emotional and physical tribulation of their breast cancer trajectory (Surbone & Peccatori, 2006). This is because, the impact of cancer remains long even after treatment ended. Besides the common issues that accompany any cancer diagnosis, breast cancer survivors also have to deal with exclusive concerns such as decreased sexual function, relationship issues, fears about genetic inheritability of cancer and complications from this disease such as lymphedema (Hodgkinson, Butow, Fuchs, et al., 2007). Therefore, the completion of treatment does not equate to lesser need for health care. Long term health issues related to breast cancer survivors have thus emerged as a public health concern.