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Hemati M, Rivaz M, Khademian Z. Lymphedema self-management mobile application with nurse support for post breast cancer surgery survivors: description of the design process and prototype evaluation. BMC Cancer 2024; 24:973. [PMID: 39118042 PMCID: PMC11308577 DOI: 10.1186/s12885-024-12744-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Self-management is the key to control breast cancer related lymphedema (BCRL). This study aimed to develop a mobile application with nurse support for lymphedema self-management and evaluate its usability from the patients' points of view. METHODS This applied developmental study was conducted on 87 women in a lymphedema clinic, Shiraz, Iran, May-November 2023. The study included three phases: development, distribution of the application and usability evaluation. In the development phase, the researchers developed application using the Java programming language. In distribution phase, the application was installed on the participants' phones. For usability evaluation, 87 patients completed the user satisfaction questionnaire after three months access to the application. Data was analyzed using descriptive and analytical statistics using SPSS software 22. P-value less than 0.05 was considered significant. RESULTS We designed a self-management application specific to BCRL that included ten unique modules mainly related to patient education, interaction with peers and nurse, self-management support, and settings. The application mean usability score was 7.72 ± 1.08. The usability dimensions of "screen" (8.06 ± 1.02) and "terminology and systems information" (7.29 ± 1.62) received the highest and lowest mean scores, respectively. CONCLUSION The application has new features to meet more patients' needs compared to what other existing lymphedema self-management applications already have addressed. The findings showed that the participants rated the application usability at the "good" level that is similar to some previous studies. Considering the unique nature of the application and its favorable usability, we recommend its use for BCRL self-management.
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Affiliation(s)
- Mehrvash Hemati
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mozhgan Rivaz
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Khademian
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
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Jeffs E, Ream E, Taylor C, Purushotham A, Bick D. Evidence for the clinical effectiveness of decongestive lymphoedema treatment for breast cancer-related arm lymphoedema, a systematic review. Support Care Cancer 2024; 32:568. [PMID: 39093326 PMCID: PMC11296965 DOI: 10.1007/s00520-024-08759-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 07/22/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE Early treatment is advised for breast cancer-related arm lymphoedema (BCRL), a common sequelae of breast cancer treatment. Expert guidance recommends two-phase decongestive lymphoedema treatment (DLT), although evidence is lacking for current treatment protocols and UK women are routinely offered self-treatment with hosiery. This systematic review considered evidence regarding treatment of early BCRL, that is, within 12 months of developing BCRL. METHODS A systematic review of evidence for clinical effectiveness of DLT for women with less than 12-month BCRL duration (early BCRL) was undertaken using the Joanna Briggs Institute (JBI) method. Studies included women with < 12-month or mean < 9-month BCRL duration; some studies reported only one eligible group. The original search was conducted in 2016 and updated in 2018 and 2022. Methodological quality of identified studies was assessed using JBI critical appraisal instruments. Outcomes of interest were extracted with eligible results displayed in narrative and tabular format. Strength of evidence was rated using the GRADE system. RESULTS Seven trials and three descriptive studies provided weak evidence (grade B) for effectiveness of DLT for early BCRL. Heterogeneous protocols limited comparison of findings. There was no evidence for the most effective treatment or treatment combination or optimal frequency or duration of treatment. CONCLUSION There is no evidence to justify change in current lymphoedema treatment, whether self-treatment with hosiery (UK) or two-phase DLT (other countries). Further research for the early BCRL population is required. IMPLICATIONS FOR CANCER SURVIVORS Women with early BCRL require early and effective treatment although this updated review shows there is still no evidence for what that treatment should be.
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Affiliation(s)
- Eunice Jeffs
- King's College London and Guy's & St Thomas' NHS Foundation Trust, London, UK.
| | - Emma Ream
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Cath Taylor
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Arnie Purushotham
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Debra Bick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Keskin Kavak S, Duran A, Ünsal Delialioğlu S, Aktekin L. Effect of Complex Decongestive Therapy on Quality of Life and Physical Parameters in Head and Neck Lymphedema. Laryngoscope 2024; 134:3152-3157. [PMID: 38308440 DOI: 10.1002/lary.31318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/02/2024] [Accepted: 01/12/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVE To assess the effect of complex decongestive therapy treatment (CDT) on quality of life, neck disability, cervical range of motion, and facial and neck lymphedema size using specific anatomical landmark points. METHODS This prospective study was conducted in a tertiary cancer center in Turkey. Thirty patients included in the study were treated with CDT for 21 days. The patients were evaluated before and after CDT with MD Anderson Cancer Center Head and Neck Lymphedema (MDACC HNC) staging system, The Neck Disability Index, European Organization for Research and Treatment of Cancer Quality of Life 30 (EORTC-QLOC30), Facial Composite score and Neck Circumferences, cervical range of motion. RESULTS Median follow-up was 7.2 months. After treatment of 30 patients significant cognitive function, emotional function, and social function (p < 0.001). After CDT treatment, the quality of life sub-parameters of EORTC QLQ-C30 showed significant improvement (p < 0.001). The facial composite score and neck circumferences indices showed significant improvement (p < 0.001). A decrease of 2% or more in the facial composite score and neck circumferences was observed in all patients participating in the study. CONCLUSION There have been few studies on the effectiveness of CDT on the EORTC QLQ-C30, facial composite score, and neck circumferences in head and neck lymphedema. In patients with head and neck lymphedema following head and neck cancer, our study demonstrated the positive effects of complex decongestive therapy (CDT) on neck disability, range of motion, quality of life, and facial and neck lymphedema tissue size. LEVEL OF EVIDENCE 4 Laryngoscope, 134:3152-3157, 2024.
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Affiliation(s)
- Songul Keskin Kavak
- Department of Physical Therapy and Rehabilitation, Ankara Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Arzubetül Duran
- Department of Ear Nose Throat, Ankara Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | | | - Lale Aktekin
- Physical Medicine and Rehabilitation Department, Ankara Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey, Ankara, Turkey
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Wang Y, Wei T, Li M, Wu P, Qiang W, Wang X, Shen A. Factors Influencing the Self-management of Breast Cancer-Related Lymphedema: A Meta-synthesis of Qualitative Studies. Cancer Nurs 2024:00002820-990000000-00249. [PMID: 38704740 DOI: 10.1097/ncc.0000000000001340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
BACKGROUND Patients with breast cancer have an estimated 14% to 60% risk of developing lymphedema after treatment. Self-management behavior strategies regarding lymphedema are essential in preventing and alleviating the severity of lymphedema. OBJECTIVE The aim of this study was to evaluate qualitative research evidence on the potential influencing factors for self-management behaviors of lymphedema in patients with breast cancer. METHODS A systematic search of 10 electronic databases was conducted to identify qualitative studies on patient experience of lymphedema self-management. The following databases were included and appraised using the Joanna Briggs Institute Critical Appraisal Checklist: Cochrane Library, PubMed, EMBASE, Web of Science, PsycINFO, Scopus, Cumulative Index to Nursing and Allied Health Literature, China National Knowledge Infrastructure, Wanfang Med Online, and Chinese Biomedical Database. RESULTS The literature search yielded 5313 studies, of which only 22 qualitative studies fulfilled the eligibility criteria. Five synthesized findings were derived encompassing personal characteristics, personal knowledge and experience, personal health beliefs, self-regulation skills and abilities, and social influences and support. CONCLUSIONS Patients with breast cancer are confronted with many challenges when performing self-management of lymphedema. Therefore, it is important to recognize potential facilitators and barriers to further offer practical recommendations that promote self-management activities for lymphedema. IMPLICATIONS FOR PRACTICE Healthcare professionals should receive consistent training on lymphedema management. On the basis of individual patient characteristics, tailored education and support should be provided, including transforming irrational beliefs, and improving related knowledge and skills, with the aim to promote self-management behaviors with respect to lymphedema.
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Affiliation(s)
- Ying Wang
- Author Affiliations: Tianjin Medical University Cancer Institute & Hospital, The First Department of Breast Surgery (Dr Y Wang and Ms Li); Tianjin Medical University Cancer Institute & Hospital, The Third Department of Breast Surgery (Ms Wei); Tianjin Medical University Cancer Institute & Hospital, Lymphedema Clinic (Ms Wu); and Tianjin Medical University Cancer Institute & Hospital, Nursing Department, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education (Mss Qiang and X Wang); and School of Nursing, Peking University Health Science Center (Ms Shen), Beijing, China
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Mullan LJ, Blackburn NE, Lorimer J, Semple CJ. Evaluating the effects of lymphoedema management strategies on functional status and health-related quality of life following treatment for head and neck cancer: Protocol for a systematic review. PLoS One 2024; 19:e0297757. [PMID: 38306345 PMCID: PMC10836692 DOI: 10.1371/journal.pone.0297757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/11/2024] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION/BACKGROUND Patients living with and after head and neck cancer often experience treatment-related consequences. Head and neck lymphoedema can be described as a common chronic side effect of head and neck cancer and recognised as a contributing factor to impairment of functional status, symptom burden and health-related quality of life. The effects of head and neck lymphoedema can limit patients' involvement in daily activities and alter their appearance, increasing symptom burden and negatively affecting health-related quality of life. OBJECTIVE The protocol outlines the rationale and aims for the systematic review. The main aim of the systematic review is to identify and systematically synthesise the literature on the effectiveness of head and neck lymphoedema management strategies, on both function status and health-related quality of life for head and neck cancer patients. METHODS AND ANALYSIS This protocol will be conducted according to the PRISMA-P guidelines. Electronic databases will be systematically searched using MEDLINE via Ovid and PubMed, CINAHL, Cochrane Central Register of Controlled Trials and Scopus. Inclusion criteria will involve intervention studies for head and neck lymphoedema management, English language, and adult human participants following head and neck cancer. The software Covidence will be used to export, manage, and screen results. Risk of bias and quality will be assessed in included studies using the Cochrane Handbook of Systematic Reviews of Intervention risk of bias and GRADE tools. A meta-analysis will be performed if there are sufficient homogenous studies. Alternatively, a narrative synthesis will be completed on study findings. ETHICS AND DISSEMINATION No ethical approval is required as the study does not involve patient and public involvement. The findings of the review will be disseminated in conferences and submitted for approval to be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42022378417. (S1 Appendix).
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Affiliation(s)
- Lauren J. Mullan
- School of Nursing, Institute of Nursing and Health Research, Ulster University, Belfast, United Kingdom
| | - Nicole E. Blackburn
- School of Health Sciences, Institute of Nursing and Health Research, Ulster University, Londonderry, United Kingdom
| | - Jill Lorimer
- Physiotherapy Department, Cancer Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Cherith J. Semple
- School of Nursing, Institute of Nursing and Health Research, Ulster University, Belfast, United Kingdom
- Cancer Services, South Eastern Health and Social Care Trust, Belfast, United Kingdom
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Yang W, Yang L, Mao S, Liu D, Wang L. Analysis of the effect of nursing care based on action research method on the prevention of postoperative lymphedema in breast cancer patients. Medicine (Baltimore) 2023; 102:e36743. [PMID: 38206748 PMCID: PMC10754543 DOI: 10.1097/md.0000000000036743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/30/2023] [Indexed: 01/13/2024] Open
Abstract
RATIONALE In recent times, the pervasive adoption of the action research method has garnered substantial attention both domestically and internationally. Its integration has traversed various domains of nursing research, nursing education, and nursing practice, yielding commendable outcomes. However, a notable gap persists, as this method remains untapped in the realm of nursing care concerning the prevention of postoperative lymphedema in breast cancer patients. DIAGNOSIS To employ the action research methodology in the context of patients undergoing axillary lymph node dissection surgery for breast cancer, aiming to investigate its impact on mitigating postoperative lymphedema and assessing its influence on the patient's quality of life, as well as levels of anxiety and depression postoperatively. INTERVENTION The study focused on breast cancer patients admitted to our hospital from January 2022 to December 2022. Among them, 44 patients from January to June constituted the control group, while 44 patients from July to December comprised the observation group. Conventional nursing measures were applied to the control group, whereas the observation group received nursing interventions rooted in the action research method. A comparative analysis was conducted between the 2 groups, assessing the incidence of postoperative lymphedema, daily life ability, as well as levels of anxiety and depression. OUTCOMES The prevalence of edema was notably reduced in the observation group (20.93%) compared to the control group (42.22%), with a statistically significant difference. Throughout the study, patients in both groups exhibited increased Barthel Index Scale scores from the study's initiation, and the scores for the observation group surpassed those of the control group, reaching statistical significance (P < .05). Furthermore, by the study's conclusion, anxiety and depression scores for patients in both groups were diminished compared to the study's commencement, and the observation group demonstrated significantly lower scores in anxiety and depression compared to the control group (P < .05). LESSONS The implementation of nursing care grounded in the action research methodology exhibits a capacity to diminish both the occurrence and intensity of postoperative lymphedema in breast cancer patients. Concurrently, it enhances the patients' daily life functionality and mitigates symptoms of anxiety and depression.
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Affiliation(s)
- Weijuan Yang
- Breast Surgery Department, Jiangsu Province Hospital, and the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Li Yang
- Breast Surgery Department, Jiangsu Province Hospital, and the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shuangwei Mao
- Breast Surgery Department, Jiangsu Province Hospital, and the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dandan Liu
- Breast Surgery Department, Jiangsu Province Hospital, and the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lili Wang
- Breast Surgery Department, Jiangsu Province Hospital, and the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Johnsson N, Strandberg S, Tuvesson H, Fagerström C, Ekstedt M, Lindberg C. Delineating and clarifying the concept of self-care monitoring: a concept analysis. Int J Qual Stud Health Well-being 2023; 18:2241231. [PMID: 37506372 PMCID: PMC10392281 DOI: 10.1080/17482631.2023.2241231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/22/2023] [Indexed: 07/30/2023] Open
Abstract
AIM To delineate and clarify the meaning of the concept of self-care monitoring from a patient perspective. METHODS A systematic search was performed in the databases ASSIA, CINAHL, PsycInfo, and PubMed (January 2016-September 2021). A selection of 46 peer-reviewed articles was included in the study and analysed using Rodgers' Evolutionary Method for Concept Analysis. RESULTS The following four attributes were identified: Tracking symptoms, signs, and actions, Paying attention, Being confident, and Needing routines, creating a descriptive definition: "Self-care monitoring is an activity that means a person has to pay attention and be confident and needs routines for tracking symptoms, signs, and action." The antecedents of the concept were shown to be Increased knowledge, Wish for independence, and Commitment. The concepts' consequences were identified as Increased interaction, Perceived burden, and Enhanced well-being. CONCLUSIONS This concept analysis provides extensive understanding of self-care monitoring from a patient perspective. It was shown that the concept occurs when a person practices self-care monitoring at home either with or without devices. A descriptive definition was constructed and presented with exemplars to encourage practice of the concept in various healthcare settings and could be of relevance to people with chronic illnesses or other long-term conditions.
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Affiliation(s)
- Natali Johnsson
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | | | - Hanna Tuvesson
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Cecilia Fagerström
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Mirjam Ekstedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
- Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden
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Qin Y, Lu J, Li S, Huang J, Teng W, Wu Y, Chen W, Wang L, Zhu W. Knowledge, Attitude, and Practice of Breast Cancer Patients Toward Lymphedema Complications: Cross-Sectional Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1910-1917. [PMID: 37640990 DOI: 10.1007/s13187-023-02357-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 08/31/2023]
Abstract
Breast cancer is commonly treated through surgical resection, but a common complication of the procedure is lymphedema of the upper limbs, which can significantly impact patients' daily life. This study aims to investigate the knowledge, attitude, and practice (KAP) of breast cancer patients with regard to lymphedema complications. This cross-sectional study was conducted by a self-administered questionnaire between August and October 2022 toward breast cancer patients in our Hospital of Traditional Chinese Medicine. A total of 529 breast cancer patients were enrolled, including 186 (35.16%) aged < 50 years old. Participants had moderate knowledge, attitudes, and practices with scores of 18.24 ± 3.145 (possible range: 0-30), 62.24 ± 10.260 (possible range: 17-85), and 63.27 ± 20.967 (possible range: 21-105), respectively. Multivariate logistic regression showed that high school/technical secondary school (OR = 1.880, 95% CI = 1.107-3.194, P = 0.019) and being retired (OR = 0.482, 95% CI = 0.245-0.947, P = 0.034) were independently associated with good knowledge. Knowledge (OR = 1.321, 95% CI = 1.222-1.428, P < 0.001) was independently associated with a good attitude. Furthermore, knowledge (OR = 1.262, 95% CI = 1.151-1.384, P < 0.001) and attitude (OR = 1.122, 95% CI = 1.085-1.160, P < 0.001) were independently associated with good practice. Breast cancer patients have moderate knowledge, attitudes, and practices regarding lymphedema complications. Effective education and self-management programs are needed to improve patients' KAP toward lymphedema.
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Affiliation(s)
- Yan Qin
- Department of Internal Medicine of TCM, Shanghai Municipal Hospital of Traditional Chinese Medicine affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, China
| | - Junjun Lu
- Department of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, China
| | - Shanze Li
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Jie Huang
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Wenjing Teng
- Department of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, China
| | - Yue Wu
- Department of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, China
| | - Wanqing Chen
- Department of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, China
| | - Lizhen Wang
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
- The Center of Acupuncture-Tuina and Rehabilitation, Shanghai Municipal Hospital of Traditional Chinese Medicine affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, China.
| | - Weikang Zhu
- Department of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, China.
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Shen A, Wu P, Qiang W, Fu X, Wang F, Zhu F, Pang L, Zhang L, Lu Q. Predicting lymphedema self-management behaviours in breast cancer patients: A structural equation model with the Integrated Theory of Health Behaviour Change. J Adv Nurs 2023; 79:4778-4790. [PMID: 37358074 DOI: 10.1111/jan.15759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 05/04/2023] [Accepted: 06/15/2023] [Indexed: 06/27/2023]
Abstract
AIMS To explore predictors of lymphedema self-management behaviours among Chinese breast cancer survivors based on the Integrated Theory of Health Behaviour Change, and to clarify the interrelationship among these variables. DESIGN Further analysis of a multicentre cross-sectional and survey-based study. METHODS A total of 586 participants with breast cancer were recruited from December 2021 to April 2022 in different cities in China. We used self-reported questionnaires to collect data. Descriptive analysis, bivariate analysis and structural equation model were performed. RESULTS The Integrated Theory of Health Behaviour Change is suitable for predicting lymphedema self-management behaviours. The final structural model showed good model fit. Social support, self-efficacy and lymphedema knowledge positively affected lymphedema self-management behaviours, directly and indirectly. Self-regulation acted as a crucial mediator between these variables and self-management. The direct path between social support and self-regulation was not significant. Lymphedema knowledge and social support also influenced self-management via illness perception, self-efficacy and self-regulation, sequentially. These variables explained 55.9% of the variance in lymphedema self-management behaviours. CONCLUSIONS The modified model based on the Integrated Theory of Health Behaviour Change fitted well in predicting lymphedema self-management behaviours among breast cancer patients. Lymphedema knowledge, illness perception, self-efficacy, social support and self-regulation directly and indirectly influenced lymphedema self-management behaviours. IMPACT This study provides a theoretical basis for the assessment and interventions of lymphedema self-management behaviours in breast cancer patients. Lymphedema self-management behaviours should be assessed regularly and comprehensively, taking these predictors into consideration to identify potential barriers. Further research is needed to explore effective interventions integrating these significant predictors. REPORTING METHOD This study was reported following Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies. PATIENT OR PUBLIC CONTRIBUTION No patient or public contributed to the design or conduct of the study, analysis or interpretation of the data, or in the preparation of the manuscript. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: This study focused on identifying and predicting mechanism of self-management based on a theory of behaviour change. The results can be applied among patients with other chronic diseases or high-risk populations, and inspire the assessment and interventions facilitating self-management behaviours. STUDY REGISTRATION This study was registered as an observational study at Chinese Clinical Trial Registry: http://www.chictr.org.cn (ChiCTR2200057084). IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE For breast cancer patients with poor lymphedema self-management behaviour, attention should be raised among nurses and involved healthcare staffs that lymphedema self-management is multi-faced. Strategies targeted at improving social support, self-regulation, knowledge, self-efficacy and illness perception should be also addressed in lymphedema self-management programs, to facilitate more effective improvement of lymphedema self-management behaviours.
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Affiliation(s)
- Aomei Shen
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Peipei Wu
- Lymphedema Clinic, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Wanmin Qiang
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Xin Fu
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Fangfang Wang
- Department of Nursing, Shanxi Provincial Cancer Hospital, Taiyuan, China
| | - Fei Zhu
- School of Nursing, Hebei University, Baoding, China
| | - Lisha Pang
- School of Nursing, Hebei University, Baoding, China
| | - Lichuan Zhang
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Qian Lu
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
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Shen A, Wu P, Qiang W, Zhu F, Zhang Z, Wang Y, Lu Q. Breast cancer survivors' experiences of barriers and facilitators to lymphedema self-management behaviors: a theory-based qualitative study. J Cancer Surviv 2023:10.1007/s11764-023-01497-9. [PMID: 37971555 DOI: 10.1007/s11764-023-01497-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Lifelong self-management plays a critical role in the prevention and management of lymphedema among breast cancer survivors. However, adherence to lymphedema self-management behaviors has remained suboptimal. Hence, we adopted a theory-informed method to elucidate the facilitators and barriers of lymphedema self-management for breast cancer survivors. METHODS In-depth semi-structured interviews were conducted between August and October 2022 in the lymphedema nursing clinic of a tertiary cancer hospital. The maximum variation sampling technique was used to ensure a diverse sample. The ITHBC (Integrated Theory of Health Behavior Change) framework was used to inform the interview outline and data analysis. Interview transcripts were coded line-by-line and mapped to domains in accordance with the ITHBC, using both deductive and inductive content analysis. RESULTS A total of 16 participants were interviewed (aged 35 to 67). Twenty-three themes (12 facilitators and 11 barriers) were mapped onto the three domains (knowledge and belief, social facilitation, and self-regulation skill and ability) of ITHBC as facilitators and barriers to lymphedema self-management. Three additional themes including limited treatment resources for lymphedema, inconvenience of lymphedema management, boredom and tedium of lymphedema self-management were categorized under the domain of other barriers. CONCLUSIONS Incorporating these findings into the ITHBC framework allows for a more systematic selection of theory-based strategies that may improve the design of effective lymphedema self-management interventions for breast cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Elucidating impact factors, especially facilitators and barriers, for lymphedema self-management adherence is essential for developing effective intervention programs to enhance breast cancer survivors' lymphedema self-management behaviors.
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Affiliation(s)
- Aomei Shen
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, Huanhuxi Road, Hexi District, Tianjin, China
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, China
| | - Peipei Wu
- Lymphedema Clinic, Tianjin Medical University Cancer Institute & Hospital, Huanhuxi Road, Hexi District, Tianjin, China
| | - Wanmin Qiang
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, Huanhuxi Road, Hexi District, Tianjin, China
| | - Fei Zhu
- School of Nursing, Hebei University, No. 342 Yuhua East Road, Lianchi District, Baoding, China
| | - Zijuan Zhang
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, China
| | - Ying Wang
- Department of Breast Cancer, Tianjin Medical University Cancer Institute & Hospital, Huanhuxi Road, Hexi District, Tianjin, China
| | - Qian Lu
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, China.
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Shen A, Wu P, Qiang W, Fu X, Zhu F, Pang L, Wang F, Lu Q. Factors associated with lymphedema self-management behaviours among breast cancer survivors: A cross-sectional study. J Clin Nurs 2023; 32:7330-7345. [PMID: 37491890 DOI: 10.1111/jocn.16833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 05/05/2023] [Accepted: 07/10/2023] [Indexed: 07/27/2023]
Abstract
AIMS AND OBJECTIVES The purpose of this empirical study was to explore the current status and associated factors of lymphedema self-management behaviours among Chinese breast cancer survivors. BACKGROUND Breast cancer-related lymphedema is a lifetime concern for survivors and is currently incurable. Lifetime lymphedema self-management takes a significant role in preventing development and progression of lymphedema. Understanding influencing factors of lymphedema self-management behaviours can help to develop targeted intervention programs. DESIGN A multicentre cross-sectional study. METHODS From December 2021 to April 2022, a convenience sample of 586 participants were recruited at four tertiary hospitals in four cities in China. Self-reported questionnaires were used to measure socio-demographic characteristics, disease-and treatment-related characteristics, lymphedema self-management behaviours, lymphedema knowledge, illness perception, self-efficacy, self-regulation and social support. Descriptive analysis, bivariate analysis and hierarchical multiple regression were conducted. This study was registered at Chinese Clinical Trial Registry (ChiCTR2200057084), and was reported followed the STROBE checklist. RESULTS Breast cancer survivors reported moderate level of lymphedema self-management behaviours. Promotion of lymph reflux management was ranked the least performed self-management behaviours, while the affected limb protection management ranked the most. 36.2% of self-management behaviours was explained by exercise regularly, level of attention on lymphedema prevention, unclear about the tumour stage (vs. stage I), knowledge, self-efficacy, emotional illness representation and social support. CONCLUSIONS Lymphedema self-management behaviours of breast cancer survivors was insufficient. Performance of lymphedema self-management varied with different socio-demographic characteristics, along with different levels of knowledge, self-efficacy, perception and social support. All these identified predictors should be reckoned in assessment and intervention of lymphedema self-management behaviours. RELEVANCE TO CLINICAL PRACTICE This study addressed that breast cancer survivors' lymphedema self-management behaviours should be promoted. Focusing on identified predictors, further lymphedema surveillance, knowledge education or social facilitation programs are recommended to enhance their self-management performance and adherence.
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Affiliation(s)
- Aomei Shen
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Peipei Wu
- Lymphedema Clinic, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Wanmin Qiang
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Xin Fu
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Fei Zhu
- School of Nursing, Hebei University, Baoding, China
| | - Lisha Pang
- School of Nursing, Hebei University, Baoding, China
| | - Fangfang Wang
- Department of Nursing, Shanxi Provincial Cancer Hospital, Taiyuan, China
| | - Qian Lu
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
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12
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Adam R, Nair R, Duncan LF, Yeoh E, Chan J, Vilenskaya V, Gallacher KI. Treatment burden in individuals living with and beyond cancer: A systematic review of qualitative literature. PLoS One 2023; 18:e0286308. [PMID: 37228101 DOI: 10.1371/journal.pone.0286308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 05/13/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Individuals with cancer are being given increasing responsibility for the self-management of their health and illness. In other chronic diseases, individuals who experience treatment burden are at risk of poorer health outcomes. Less is known about treatment burden and its impact on individuals with cancer. This systematic review investigated perceptions of treatment burden in individuals living with and beyond cancer. METHODS AND FINDINGS Medline, CINAHL and EMBASE databases were searched for qualitative studies that explored treatment burden in individuals with a diagnosis of breast, prostate, colorectal, or lung cancer at any stage of their diagnostic/treatment trajectory. Descriptive and thematic analyses were conducted. Study quality was assessed using a modified CASP checklist. The review protocol was registered on PROSPERO (CRD42021145601). Forty-eight studies were included. Health management after cancer involved cognitive, practical, and relational work for patients. Individuals were motivated to perform health management work to improve life-expectancy, manage symptoms, and regain a sense of normality. Performing health care work could be empowering and gave individuals a sense of control. Treatment burden occurred when there was a mismatch between the resources needed for health management and their availability. Individuals with chronic and severe symptoms, financial challenges, language barriers, and limited social support are particularly at risk of treatment burden. For those with advanced cancer, consumption of time and energy by health care work is a significant burden. CONCLUSION Treatment burden could be an important mediator of inequities in cancer outcomes. Many of the factors leading to treatment burden in individuals with cancer are potentially modifiable. Clinicians should consider carefully what they are asking or expecting patients to do, and the resources required, including how much patient time will be consumed.
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Affiliation(s)
- Rosalind Adam
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Revathi Nair
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom
| | - Lisa F Duncan
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Esyn Yeoh
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom
| | - Joanne Chan
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom
| | - Vaselisa Vilenskaya
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom
| | - Katie I Gallacher
- Institute of Health & Wellbeing, General Practice & Primary Care, University of Glasgow, Glasgow, United Kingdom
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Deveci Z, Karayurt Ö, Bilik O, Eyigör S. Development of the Breast Cancer Related Lymphedema Self-Care Scale. Clin Nurs Res 2023; 32:221-232. [PMID: 32757769 DOI: 10.1177/1054773820947980] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The purpose of study was to develop the Breast Cancer Related Lymphedema Self-Care Scale to evaluate the self-care practices of women with breast cancer-related lymphedema (BRCL); and to examine the psycholinguistic and psychometric characteristics of this scale. The item pool of the scale was created based on the literature in this descriptive study. Content validity, explanatory and confirmatory factor analyses used in evaluation of the validity; and item analyzes, the Cronbach's Alpha and Split Half analyzes were made for reliability in the study. The content validity index was found to be above 0.80. In the Explanatory Factor Analysis, a four-factor structure was obtained. In Confirmatory Factor Analysis, fit indices were found to be acceptable. Cronbach's Alpha coefficients of the sub-dimensions of the scale varied between 0.62 and 0.86. It was determined the Breast Cancer Related Lymphedema Self-Care Scale was a valid and reliable scale for women with BRCL.
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Affiliation(s)
- Zeynep Deveci
- PhD Student at Dokuz Eylul University, Institute of Health Sciences, Izmir, and Research Assistant at Pamukkale University, Faculty of Health Science, Nursing Department, Denizli, Turkey
| | - Özgül Karayurt
- Izmir University of Economics, Faculty of Health Science, Department of Nursing, Izmir, Turkey
| | - Ozlem Bilik
- Dokuz Eylul University, Nursing Faculty, Surgical Nursing Department, Izmir, Turkey
| | - Sibel Eyigör
- Ege University Faculty of Medicine, Department of Physical Therapy and Rehabilitation, Izmir, Turkey
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Yanardağ CH, Çürük GN, Karayurt Ö. Effects of selfcare and selected factors on the quality of life in women with breast cancer-related lymphedema. Support Care Cancer 2022; 31:22. [PMID: 36513943 DOI: 10.1007/s00520-022-07499-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 11/11/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study was performed to examine the effects of selfcare and selected factors on the quality of life in women with breast cancer-related lymphedema (BCRL). METHODS The study was descriptive and cross-sectional and included 101 women with BCRL. Data were gathered with a descriptive characteristics questionnaire, the Lymphedema Quality of Life Scale-Arm and the Breast Cancer-Related Lymphedema Selfcare Scale. Obtained data were analyzed with numbers, percentages, mean, and multiple regression analysis. RESULTS The lowest and the highest scores of the women with lymphedema (LE) on the Lymphedema Quality of Life Scale-Arm were 35 and 71 respectively with a mean of 52.63 ± 11.81. The lowest and the highest scores to be obtained from this scale are 20 and 80 respectively. The quality of life was predicted significantly and positively by time elapsing after the diagnosis of breast cancer and significantly and negatively by time elapsing after the diagnosis of LE and selfcare (p < 0.05). Other variables did not individually affect the quality of life (p > 0.05). CONCLUSION Since selfcare influences the quality of life, patients with BCRL should be given education and support for selfcare, the quality of their lives should be regularly evaluated, and interventions that enhance the quality of their lives should be conducted.
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Affiliation(s)
- Cansu Hazal Yanardağ
- Department of Operating Room Services Program, İzmir Kavram Vocational School, Izmir, Turkey
| | - Gülsüm Nihal Çürük
- Department of Nursing, Faculty of Health Sciences, Izmir University of Economics, Izmir, Turkey.
| | - Özgül Karayurt
- Department of Nursing, Faculty of Health Sciences, Izmir University of Economics, Izmir, Turkey
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15
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Chiaranai C, Chularee S, White JS. Lived Experience of Breast Cancer Survivors: A Phenomenological Study. J Nurs Res 2022; 30:e247. [PMID: 36121427 DOI: 10.1097/jnr.0000000000000518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Breast cancer (BrCa) is the most common cancer worldwide. Five-year survival rates among individuals with BrCa are the highest of all types of cancer, yet there is a paucity of knowledge about the experiences of survivors regarding living through their diagnosis and treatment. In-depth interviews and the systematic analysis of self-reported experiences may provide in-depth information about the BrCa survivorship experience. PURPOSE This qualitative study was designed to identify and elucidate the lived experiences of Thai women with BrCa who successfully completed their treatment program for BrCa and/or treatment with chemotherapy for over 5 years and are currently cancer-free. METHODS A phenomenological method was employed. Survivors of BrCa who met the inclusion criteria were purposively selected and invited to take part in the study. Study data were collected between January and March 2019. An open-ended, in-depth interview guide was used to direct the conversation concerning the participants' experiences and perceptions. Thematic analysis was used for data analysis. RESULTS Data saturation was reached after 12 interviews. The five themes derived from the data include (a) being distressed, (b) accepting treatments and seeking alternative treatments, (c) going through difficult times, (d) becoming a stronger person, and (e) becoming thankful. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The experiences and themes identified enhance scholarly understanding regarding the experience of survivors of BrCa. A true understanding of this experience enables healthcare providers to craft and deliver appropriate interventions that provide quality care and improve women's health, thereby enhancing their quality of life. The results of this study may contribute to the development of new theories by using different qualitative approaches such as grounded theory.
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Affiliation(s)
- Chantira Chiaranai
- PhD, RN, Associate Professor, Institute of Nursing, Suranaree University of Technology, Thailand
| | - Saranya Chularee
- PhD, RN, Assistant Professor, Institute of Nursing, Suranaree University of Technology, Thailand
| | - Jeranut Somchock White
- PhD, RN, Instructor, Adult Nursing Department, Boromarajonani College of Nursing, Nakhonratchasima, Thailand
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16
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Wei X, Lu Q, Shen A, Fu X, Zhang L, Wang Y, Wang Y. Development and psychometric evaluation of a lymphoedema self-management behaviour questionnaire for breast cancer patients. Eur J Cancer Care (Engl) 2022; 31:e13743. [PMID: 36259244 DOI: 10.1111/ecc.13743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 09/24/2022] [Accepted: 09/27/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The study was aimed to develop and evaluate a lymphoedema self-management behaviour questionnaire (LSMBQ) for breast cancer patients. METHODS The initial version of the behaviour questionnaire was developed based on the framework of self-management and the evidence summary of lymphoedema self-management. Two rounds of expert consultation were conducted to validate the questionnaire's content validity. A cross-sectional survey was then conducted in breast wards of two hospitals in China to evaluate the reliability and validity of this scale. Exploratory structural equation model was used to test the construct validity. T-test was used to analyse the known group validity. Structural equation model was applied to verify the relationship between self-efficacy, social support, and lymphoedema self-management behaviour to test the convergent validity. Also, the internal consistency reliability and test-retest reliability were evaluated. RESULTS The questionnaire's content validity was satisfactory. There were 22 items included in the LSMBQ for validation and 260 completed the survey. A six-factor structure with good construct validity was identified. The result of t-test verified that patients who knew the risk of lymphoedema and those who received lymphoedema health education had higher scores of lymphoedema self-management behaviours (P < 0.05), indicating that the questionnaire has good known group validity. The fitting results of the structural equation model indicated that the 22-item questionnaire had good convergent validity. Cronbach's alpha coefficients and test-retest reliability for the total questionnaire were 0.910 and 0.875, respectively. CONCLUSIONS The 22-item LSMBQ appears to have adequate reliability and validity to assess the lymphoedema self-management behaviours for breast cancer patients.
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Affiliation(s)
- Xiaoxia Wei
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Qian Lu
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Aomei Shen
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Xin Fu
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Lichuan Zhang
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Yujie Wang
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Yingxin Wang
- Division of General Surgery, Peking University First Hospital, Beijing, China
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17
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Torgbenu E, Luckett T, Buhagiar M, Requena CM, Phillips JL. Improving care for cancer-related and other forms of lymphoedema in low- and middle-income countries: a qualitative study. BMC Health Serv Res 2022; 22:461. [PMID: 35395942 PMCID: PMC8990607 DOI: 10.1186/s12913-022-07840-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lymphoedema is a common, distressing and debilitating condition that can be related to cancer and its treatment or other conditions. Little is known about current practices in the diagnosis, assessment and management of lymphoedema in low- and middle-income countries (LMIC). AIM To describe current practices in diagnosing, assessing and managing cancer-related and other forms of lymphoedema in LMIC, and related barriers and facilitators. METHODS An exploratory-descriptive qualitative study. Participants were lymphoedema experts or health care professionals identified via published lymphoedema papers and professional organizations respectively. Sampling was purposive to ensure a diversity of perspectives and experience. Data collection was via semi-structured telephone/video interviews, and questions canvassed participants' experiences and perceptions of lymphoedema care in LMIC. Interviews were audio-recorded and transcribed verbatim. Analysis proceeded via inductive coding before mapping codes to the World Health Organization's (WHO) Innovative Care for Chronic Conditions Framework. RESULTS Nineteen participants were interviewed, most of whom were physiotherapists (n = 11). Ten participants worked permanently in a LMIC, while the remainder were based in a high-income country (HIC) and had been involved in initiatives to improve lymphoedema care across multiple LMIC. Participants indicated that management of cancer versus non-cancer related lymphoedema was similar, but that pathways to care were more straight-forward for those receiving cancer care, leading to earlier diagnosis. Key facilitators to optimizing lymphoedema care in LMIC included: 1) joining forces to overcome lymphoedema-related stigma; 2) building workforce capabilities; and 3) partnering with patients and families to support self-management. Ideas for building workforce included developing health professional knowledge, supporting a commitment to multidisciplinary team care, and adapting HIC guidelines for lymphoedema care to LMIC. Partnering with patients and families to support self-management involved following the person-centred approach, establishing clear communication, promoting adherence to management, adapting management to available resources, and involving patient family and friends in lymphoedema care. CONCLUSION Raising community and health professional awareness regarding lymphoedema and its management is a key first step to improving care outcomes. Resources for clinicians and patients/families developed for lymphoedema care in HIC need to be adapted for low resource settings.
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Affiliation(s)
- Eric Torgbenu
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney NSW, Sydney, Australia. .,School of Allied Sciences, Department of Physiotherapy and Rehabilitation Sciences, University of Health and Allied Sciences, Ho, Ghana.
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney NSW, Sydney, Australia
| | - Mark Buhagiar
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney NSW, Sydney, Australia.,Catholic Diocese of Parramatta, Parramatta, NSW, Australia
| | | | - Jane L Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney NSW, Sydney, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Australia
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18
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Zhang Y, Li N, Chen J, Luo X, Li M, Yan J. Breast Cancer-Related Lymphedema Risk-Management Behaviors Among Chinese Breast Cancer Survivors and Relationships with Socio-Demographic and Clinical Characteristics: A Longitudinal Study. Patient Prefer Adherence 2022; 16:797-808. [PMID: 35370404 PMCID: PMC8965334 DOI: 10.2147/ppa.s356750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/14/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We sought to determine changes in breast cancer-related lymphedema (BCRL) risk-management behaviors in the six-month period after surgery among Chinese breast cancer survivors and to explore the relationship between their socio-demographic and clinical characteristics and these behaviors. PATIENTS AND METHODS A longitudinal study design was adopted. Females aged ≥18 years with a first breast cancer diagnosis and who had undergone modified radical mastectomy were recruited from a cancer hospital in China. Respondents with a history of other malignant tumors, mental illness, or cognitive impairment were excluded from the study. Socio-demographic and clinical factors were assessed at baseline. BCRL risk-management behaviors were assessed with the Lymphedema Risk-Management Behavior Questionnaire (LRMBQ) and Functional Exercise Adherence Scale (FEAS) in the first, third, and sixth months after surgery. Repeated-measures analysis of variance was used to examine changes in BCRL risk-management behaviors over the three study time periods, and a generalized linear mixed model was used to determine socio-demographic and clinical factors associated with BCRL risk-management behaviors. RESULTS A total of 166 participants completed all three assessments. The scores of the total LRMBQ and its "Skin care" and "Lifestyle" subscales did not change significantly, but those of the "Avoidance of limb compression and injury" and "Other matters requiring attention" subscales changed over the three study time periods. Additionally, scores of the total FEAS and most of its subscales changed over the three study time periods. Furthermore, BCRL risk-management behaviors were significantly related to patients' geographic residence, education level, and tumor stage. CONCLUSION Some dimensions of BCRL risk-management behaviors changed over time, and several socio-demographic and clinical factors are related to BCRL risk-management behaviors. It is recommended that health care professionals consider the dynamic nature of BCRL risk-management behaviors and related factors when planning health education and promotion interventions.
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Affiliation(s)
- Yue Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Na Li
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province, People’s Republic of China
| | - Jing Chen
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Xia Luo
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Mingfang Li
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Jun Yan
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
- Correspondence: Jun Yan, School of Nursing, Sun Yat-sen University, No. 74, Zhongshan II Road, Guangzhou, Guangdong Province, People’s Republic of China, Tel +86-13416347847, Email
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McNeely ML, Dolgoy ND, Rafn BS, Ghosh S, Ospina PA, Al Onazi MM, Radke L, Shular M, Kuusk U, Webster M, Campbell KL, Mackey JR. Nighttime compression supports improved self-management of breast cancer-related lymphedema: A multicenter randomized controlled trial. Cancer 2021; 128:587-596. [PMID: 34614195 DOI: 10.1002/cncr.33943] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/11/2021] [Accepted: 06/28/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lymphedema is a prevalent long-term effect of breast cancer treatment associated with reduced quality of life. This study examined the efficacy of nighttime compression as a self-management strategy for women with chronic breast cancer-related lymphedema. METHODS Th authors conducted a parallel 3-arm, multicenter, randomized trial. Women were recruited from 3 centers in Canada and randomized to group 1 (daytime compression garment alone [standard care]), group 2 (daytime compression garment plus nighttime compression bandaging), or group 3 (daytime compression garment plus the use of a nighttime compression system garment). The primary outcome was the change in excess arm volume from the baseline to 12 weeks. Participants from all groups used a nighttime compression system garment from weeks 13 to 24. RESULTS One hundred twenty women were enrolled, 118 completed the randomized trial, and 114 completed the 24-week follow-up. The rates of adherence to nighttime compression were 95% ± 15% and 96% ± 11% in the compression bandaging and nighttime compression system groups, respectively. After the intervention, the addition of nighttime compression was found to be superior to standard care for both absolute milliliter reductions (P = .006) and percentage reductions (P = .002) in excess arm lymphedema volume. Significant within-group changes were seen for quality of life across all groups; however, no between-group differences were found (P > .05). CONCLUSIONS The trial demonstrated a significant improvement in arm lymphedema volume from the addition of nighttime compression whether through the application of compression bandaging or through the use of a nighttime compression system garment. LAY SUMMARY Lymphedema is swelling that occurs in the arm on the side of the surgery for breast cancer. Lymphedema occurs in approximately 21% of women. Lymphedema tends to worsen over time and can result in recurrent infections in the arm, functional impairment, and pain. Currently, treatment consists of intensive treatments to reduce the swelling followed by regular use of a compression sleeve during the day. This study examined and found a benefit from the addition of nighttime compression (whether through self-applied compression bandaging or through the use of a nighttime compression system garment) to the use of a daytime compression sleeve.
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Affiliation(s)
- Margaret L McNeely
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada.,Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - Naomi D Dolgoy
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Bolette Skjodt Rafn
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sunita Ghosh
- Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - Paula A Ospina
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Mona M Al Onazi
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Lori Radke
- Tom Baker Cancer Centre, Alberta Health Service, Calgary, Alberta, Canada
| | - Mara Shular
- Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - Urve Kuusk
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marc Webster
- Tom Baker Cancer Centre, Alberta Health Service, Calgary, Alberta, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - John R Mackey
- Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
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20
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Breast cancer-related lymphedema patient and healthcare professional experiences in lymphedema self-management: a qualitative study. Support Care Cancer 2021; 29:8027-8044. [PMID: 34226959 DOI: 10.1007/s00520-021-06390-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Breast cancer-related lymphedema (BCRL) self-management plays an important role in the lymphedema therapy. However, clinical knowledge of BCRL self-management remains minimal. This study aims to explore the experience surrounding lymphedema self-management from the perspectives of BCRL patients and healthcare professionals. METHODS Semi-structured interviews were implemented with BCRL patients and healthcare professionals. Audio-recordings of interviews were transcribed verbatim and thematic analysis was undertaken to analyze the interview data. RESULTS Thirteen BCRL patients (aged 34-65 years) and nine healthcare professionals (2 physicians, 4 nurses, and 3 lymphedema therapists) were interviewed. Five themes emerged from interviews with participants: knowledge-attitude-practice surrounding lymphedema self-management, emotional reactions towards lymphedema self-management, factors influencing lymphedema self-management, support needs for lymphedema self-management, healthcare professional support of BCRL self-management. CONCLUSIONS This study showed knowledge-attitude-practice, feelings, influencing factors, roles, dilemmas, and support needs regarding BCRL self-management. Greater effort is required for healthcare professionals to strengthen the lymphedema self-management. Providing more educational program and holistic support, and strengthening the facilitators and controlling the barriers might benefit promoting lymphedema self-management. Likewise, healthcare professionals need adequate training to be able to meet patients' self-management support needs.
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Self-care practices, patient education in women with breast cancer-related lymphedema. Turk J Phys Med Rehabil 2021; 67:187-195. [PMID: 34396069 PMCID: PMC8343163 DOI: 10.5606/tftrd.2021.5022] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 04/01/2020] [Indexed: 11/28/2022] Open
Abstract
Objectives
This study aims to evaluate self-care practices, sociodemographic and clinical factors that affect self-care and patient education among women with breast cancer-related lymphedema (BCRL).
Patients and methods
This descriptive, cross-sectional study included a total of 102 women with BCRL (median age: 59 years; range, 35 to 80 years) who received lymphedema (LE) treatment at least once between July 2014 and May 2016. A Sociodemographic and Clinical Characteristics Form and the Lymphedema Self-care Survey were used to collect data via face-to-face interviews.
Results
The median LE self-care practices score for women was 10 (range, 5 to 14). A total of 39.1% of the women implemented regular self-care. A statistically significant relationship was found between the score for perceived benefit of LE self-care and the score for self-care practice. No statistically significant difference was found among the self-care scores of the women with LE in terms of sociodemographic and clinical factors, except for education status. A total of 90.2% of the women with LE received self-care education, mostly from a physical therapy specialist and a physiotherapist. There was a statistically significant difference among self-care scores between patients who were educated and uneducated about LE.
Conclusion
It is recommended that healthcare professionals should educate patients diagnosed with breast cancer to reduce LE risk and promote the implementation of self-care practices following the breast cancer surgery. Interventions should be made to increase the perceived benefits and reduce the perceived barriers and burden towards self-care behaviors to prevent and manage LE.
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Pajero Otero V, García Delgado E, Martín Cortijo C, Toribio Rubio V, Guijarro Cano MJ, Calvo Bóveda C, Martín-Arriscado Arroba C, Avendaño Coy J. Development and Evaluation of a Satisfaction Questionnaire About Therapeutic Textile Devices Used for Breast Cancer-Related Lymphedema. Lymphat Res Biol 2021; 20:203-212. [PMID: 33902319 DOI: 10.1089/lrb.2020.0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: There is a need for an appropriate instrument to measure the satisfaction of patients about therapeutic textile devices used for breast cancer-related lymphedema (BCRL). Methods and Results: A new satisfaction questionnaire about therapeutic textile devices used for BCRL was developed and psychometrically tested. An approach to criterion validity by contrast of hypothesis was made. Different average scores were expected depending on the type of therapeutic textile device: Kinesio taping, compression garment, and multilayer low-stretch bandage. Items were analyzed in nine phases: apparent validity, missing responses, internal consistency, factor analysis, reproducibility, confirmation of factor analysis, contrast of hypothesis, variability, and time for completion. One hundred fifty women were sampled in a consecutive order. A final questionnaire was drafted that fulfilled the validation hypothesis, including 20 items that explored 4 dimensions: mood, patient comfort, patient compliance, and perceived benefits. The total Cronbach's α was 0.87. The intraclass correlation coefficient was 0.93 for test-retest and 0.91 for inter-rater. Neither ceiling nor floor effects were observed. The average burden for the respondent and interviewer was 5.6 (standard deviation [SD] = 3.8) and 2.2 (SD = 1.3) minutes, respectively. Conclusion: This preliminary analysis supports the content validity, reliability, and validity of construct of the questionnaire.
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Affiliation(s)
- Violeta Pajero Otero
- Department of Rehabilitation, 12 de Octubre University Hospital, Madrid, Spain.,Department of Physical Medicine and Rehabilitation, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University, Madrid, Spain.,Member of InveCuid +12 Research Group, imas12, Madrid, Spain
| | - Esther García Delgado
- Department of Rehabilitation, 12 de Octubre University Hospital, Madrid, Spain.,Department of Physical Medicine and Rehabilitation, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University, Madrid, Spain
| | - Concepción Martín Cortijo
- Department of Rehabilitation, 12 de Octubre University Hospital, Madrid, Spain.,Department of Physical Medicine and Rehabilitation, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University, Madrid, Spain
| | - Virginia Toribio Rubio
- Department of Rehabilitation, 12 de Octubre University Hospital, Madrid, Spain.,Department of Physical Medicine and Rehabilitation, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University, Madrid, Spain
| | - María Jesús Guijarro Cano
- Department of Rehabilitation, 12 de Octubre University Hospital, Madrid, Spain.,Department of Physical Medicine and Rehabilitation, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University, Madrid, Spain
| | | | | | - Juan Avendaño Coy
- Member of Toledo Physiotherapy Research Group (GIFTO), Castilla-La Mancha University, Toledo, Spain.,Faculty of Nursing and Physiotherapy, Castilla-La Mancha University, Toledo, Spain
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23
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Arikan Dönmez A, Kuru Alici N, Borman P. Lived Experiences for Supportive Care Needs of Women with Breast Cancer-Related Lymphedema: A Phenomenological Study. Clin Nurs Res 2020; 30:799-808. [PMID: 32955348 DOI: 10.1177/1054773820958115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This descriptive phenomenological study was conducted to explore the lived experiences for supportive care needs of women with breast cancer-related lymphedema. Purposive sampling was used to recruit participants. In-depth, semi-structured interviews were conducted to collect data. Thematic analysis method was used for data analysis. Data saturation was achieved after interviewing 19 participants. The study was divided into four main themes and nine subthemes: physical (caused by difficulties in performing household chores, limitations in performing self-care activities, and challenges in shopping), psychosocial (being addicted to someone else in daily life, uncertainty about the future, social, and religious support), healthcare systems and information (attention from healthcare professionals, education and lifestyle advices, and access to healthcare sources), and financial supportive care needs. Women experience various SCNs in their daily lives. Provision of supportive care from both family members or others and healthcare professionals could ease the daily lives, improve physical, and psychosocial well-being.
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Affiliation(s)
| | | | - Pınar Borman
- Hacettepe University, Ankara, Turkey.,Ankara City Hospital, Ankara, Turkey
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24
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Omidi Z, Kheirkhah M, Abolghasemi J, Haghighat S. Effect of lymphedema self-management group-based education compared with social network-based education on quality of life and fear of cancer recurrence in women with breast cancer: a randomized controlled clinical trial. Qual Life Res 2020; 29:1789-1800. [PMID: 32152817 PMCID: PMC7295820 DOI: 10.1007/s11136-020-02455-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Breast cancer-related lymphedema (BCRL) and its associated symptoms harm the quality of life (QoL) of cancer survivors and can stimulate fear of cancer recurrence (FCR). Self-management education for lymphedema has been introduced as an effective method in controlling FCR. This study investigates the effect of lymphedema group-based education compared to the social network-based and control group on QoL and FCR in breast cancer patients. METHODS This three-arm clinical trial studied 105 patients with breast cancer-related lymphedema referred to Seyed_Khandan rehabilitation center. Sampling was done by random allocation method in blocks of 3 with 35 subjects in each group. All subjects received routine lymphedema treatments. The group-based education (GE) and social network-based education (SNE) groups received self-management education in the clinic and Telegram™ messenger channel, respectively. Impairment in QoL and mean score of FCR were assessed before, immediately after, and three months after the intervention by using the Persian version of Lymphedema Life Impact Scale (LLIS) and Fear of Progression Questionnaire-Short Form (FoPQ-SF), respectively. Mixed-model ANOVA was applied for statistical analysis. RESULTS There was a significant time effect on total LLIS (P = 0.007), psychosocial (P = 0.038) and functional (P = 0.024) subscale changes in three groups of study. Interaction between the main effect of group and time on psychosocial subscale changes was statistically significant (P = 0.017). The multicomparison results illustrated that the main effect of time, the main effect of group, and interaction of them on the mean score of FCR were P = 0.084, P = 0.380, and P = 0.568, respectively. CONCLUSION Despite no significant reduction in the FCR score, results showed the improvement of most QoL aspects after three months of intervention. Although the social network-based education method was effective, the group-based education method was more beneficial. Applying these educational methods in lymphedema treatment protocols needs cost-effectiveness studies. TRIAL REGISTRATION This study was registered at the Iranian Registry of Clinical Trials (IRCT2017052834176N1).
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Affiliation(s)
- Zahra Omidi
- Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Masoomeh Kheirkhah
- Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Jamileh Abolghasemi
- Department of Biostatistics, School of Public Health, Iran University of Medical Science, Tehran, Iran
| | - Shahpar Haghighat
- Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran.
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25
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Paiva ADCPC, Elias EA, Souza ÍEDO, Moreira MC, Melo MCSCD, Amorim TV. Cuidado de enfermagem na perspectiva do mundo da vida da mulher-que-vivencia-linfedema-decorrente-do-tratamento-de-câncer-de-mama. ESCOLA ANNA NERY 2020. [DOI: 10.1590/2177-9465-ean-2019-0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo Desvelar sentidos da mulher na vivência do linfedema decorrente do tratamento de câncer de mama e analisar propostas de cuidado na perspectiva do mundo da vida dessa mulher. Método Estudo fenomenológico, fundamentado no referencial teórico e metodológico de Martin Heidegger. Os cenários de pesquisa foram o Hospital Ascomcer e a Fundação Cristiano Varella, ambos em Minas Gerais, Brasil. Procedeu-se entrevista fenomenológica com 13 mulheres que vivenciavam o linfedema por câncer de mama. Resultados As mulheres mostraram-se envergonhadas e chateadas com o braço sem estética. Ficam deprimidas, perdem a autoestima e tentam disfarçar, mas nem sempre é possível. Em alguns momentos, preferem não sair de casa. Sentem dificuldade de comprar roupas que se ajustem no braço edemaciado. O ser-aí-mulher-que-vivencia-o-linfedema-em-decorrência-do-tratamento-de-câncer-de-mama revela-se na aparência e na impessoalidade. O linfedema implica em mudanças físicas visíveis a todos, porém está oculta as dificuldades vividas pelo ser-mulher no cotidiano assistencial. Conclusão e implicações para a prática Cabe ao Enfermeiro considerar a percepção da mulher sobre si mesma em relação a sua imagem corporal para ampliar a sua prática profissional e buscar repensar estratégias de cuidado que aumentem a autoestima e melhorem sua qualidade de vida.
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26
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Bertsch T. Evaluation of a novel night-time compression garment: a prospective observational study. Br J Community Nurs 2018; 23:535-541. [PMID: 30398919 DOI: 10.12968/bjcn.2018.23.11.535] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This prospective, single-centre, observational study set out to evaluate the clinical performance and safety of JOBST Relax®, a custom-made compression garment, when worn by a series of patients with lymphoedema during resting hours and at night. Patients were recruited after undergoing complete decongestive therapy (CDT) and wore the night-time compression garment for 21 days as part of their compression therapy regimen. Questionnaires were used to capture their views on parameters such as the garment's comfort, ease of use, fit, ability to avoid excessive heat and perspiration, its effect on their quality of life and their overall satisfaction with it. Occurrences of erythema, skin rash, skin dryness and pain were also evaluated. Ninety-one patients completed the study. Most perceived the night-time compression garment to be 'very good' or 'good' in terms of its ease of use and comfort, its ability to control their oedema and its effect on their quality of sleep. The prevalence of erythema, skin rash, skin dryness and pain was reduced when compared with baseline. Patients also reported that the night-time garment reduced their dependence on others and improved their quality of life. Overall, most rated their satisfaction with the garment as 'very good' or 'good'. Patients reported a high level of satisfaction with both the garment and the comfort associated with it when wearing it frequently.
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Affiliation(s)
- Tobias Bertsch
- Senior Consultant, Földi Clinic, Specialist Lymphology Clinic, European Centre for Lymphology, Black Forest, Germany
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27
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Moffatt CJ, Aubeeluck A, Franks PJ, Doherty DC, Mortimer P, Quere I. Psychological Factors in Chronic Edema: A Case-Control Study. Lymphat Res Biol 2018; 15:252-261. [PMID: 28937923 DOI: 10.1089/lrb.2017.0022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To examine psychological health and perceived social support in patients with chronic edema (CE). METHODS AND RESULTS A random sample of 107 patients with CE was group matched for age and gender with 102 community controls. The cases had swelling of the arm (38%) and leg (61%) and midline swelling (14%). Cases were more likely to be single or divorced/separated (p = 0.041) and have reduced mobility (p < 0.001). They had significantly poorer overall health related quality of life (HRQoL), in particular physical functioning (p = 0.003); role physical (p < 0.001); general health (p = 0.026); vitality (p = 0.015); social function (p = 0.007); and role emotional (p = 0.041). EQ5-D health index scores were significantly reduced in cases by 13 points (p = <0.001, 95% confidence interval 5.8, 21.6). Cases had similar sized social networks to the control group (5.8 vs. 6.6 p = 0.49), but had lower total perceived social support scores (67.8 vs. 76.1 p = 0.018). CE patients used significantly fewer coping strategies (COPE scale) than controls with regard to the following: active coping (p = 0.024); planning (p < 0.001); and use of instrumental support (p = 0.006). Significantly higher levels of coping were used in restraint (p = 0.031), positive reinterpretation and growth (p < 0.001); acceptance (<0.001); denial (p < 0.001); mental disengagement (p < 0.001); behavioral disengagement (<0.001); substance abuse (p = 0.010); and humor (p < 0.001). CONCLUSIONS Patients with CE have poorer health and greater impact on many aspects of HRQoL. Perceived social support is reduced. Deficits in social function combined with perceived reduction in support, and reduced mental health and emotional scores indicate the risk of psychological issues. Systems of care should offer an environment to address these issues.
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Affiliation(s)
- Christine J Moffatt
- 1 Division of Nursing, School of Health Sciences, Royal Derby Hospital, The University of Nottingham , Derby, United Kingdom
| | - Aimee Aubeeluck
- 1 Division of Nursing, School of Health Sciences, Royal Derby Hospital, The University of Nottingham , Derby, United Kingdom
| | - Peter J Franks
- 2 Centre for Research and Implementation of Clinical Practice , London, United Kingdom .,3 Division of Nursing and Healthcare, Faculty of Medicine, University of Glasgow , Glasgow, United Kingdom
| | - Debra C Doherty
- 2 Centre for Research and Implementation of Clinical Practice , London, United Kingdom
| | - Peter Mortimer
- 4 St. George's University of London , London, United Kingdom
| | - Isabelle Quere
- 5 Medecine Vasculaire, EA2992, Universite Montpellier I , CHU Saint Eloi, Montpellier, France
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28
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Abstract
BACKGROUND The diagnosis and treatment of breast cancer may negatively affect the quality of life (QOL) of women. OBJECTIVES The aim of this study is to assess QOL in women with breast cancer who were treated with or without chemotherapy and to identify factors associated with improved or worsening QOL in these women. METHODS This cross-sectional study enrolled 112 women who were treated with chemotherapy (CTX group, with 85 [75.9%] women) or without chemotherapy (non-CTX group, with 27 [24.1%] women) for breast cancer. The Short-Form Health Survey (SF-36) assessed QOL and the Hospital Anxiety and Depression scale assessed anxiety and depression. RESULTS The overall mean SF-36 score was below 50 in all domains. Relative to CTX women, non-CTX women were significantly older (P = .001) and more likely to engage in physical exercise (P = .002). The non-CTX group had higher scores in the Physical Functioning (P = .001) and Role-Physical (P = .0009) domains of the SF-36 relative to the CTX group, and the fluoruracil + epirubicin + cyclophosphamide group had significantly lower scores in the SF-36 domains Physical Functioning (P = .009) and Role-Physical (P = .02). CONCLUSION Chemotherapy treatment for breast cancer worsens QOL in the Physical Functioning and the Role-Physical domains of the SF-36 relative to women treated without chemotherapy. IMPLICATIONS FOR PRACTICE Nurses should assess Physical Functioning and the Role-Physical before treatment, as a woman who was not physically active before breast cancer is not likely to become physically active after treatment. Establishing support groups and providing educational sessions about the disease and its management, supportive care can improve the QOL of this population.
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29
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Bakar Y, Tuğral A. Lower Extremity Lymphedema Management after Gynecologic Cancer Surgery: A Review of Current Management Strategies. Ann Vasc Surg 2017; 44:442-450. [PMID: 28483624 DOI: 10.1016/j.avsg.2017.03.197] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 03/23/2017] [Accepted: 03/28/2017] [Indexed: 11/26/2022]
Abstract
Lymphedema can be described as an accumulation of protein-rich fluid in interstitial spaces. It affects patients in multiple aspects. Gynecologic cancer survivors might experience lower extremity lymphedema after cancer surgery or treatment. In literature, most of the studies have been performed on upper extremity lymphedema. As gynecologic cancer malignancies have increased in the recent years, treatment options and related complications have been gaining attention in studies. In this manner, this review focused on the management of lower extremity lymphedema after gynecologic surgery. Studies indicated that the incidence of lower extremity lymphedema ranges between 2.4% and 41% after pelvic lymph node dissection in patients with gynecologic malignancies. Thus, management of lower extremity lymphedema in patients after gynecologic cancer surgery is an important issue. Complex decongestive therapy method is still the gold standard of lymphedema management. Controlling, evaluating, and preventing the risk factors are also substantial points; hence, it is very important to provide accurate knowledge in the management of lower extremity lymphedema.
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Affiliation(s)
- Yeşim Bakar
- Lymphedema Education and Management Department, Abant Izzet Baysal University, School of Physical Therapy and Rehabilitation, Bolu, Turkey
| | - Alper Tuğral
- Lymphedema Education and Management Department, Abant Izzet Baysal University, School of Physical Therapy and Rehabilitation, Bolu, Turkey.
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30
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Bowenwork for symptom management of women breast cancer survivors with lymphedema: A pilot study. Complement Ther Clin Pract 2016; 25:142-149. [DOI: 10.1016/j.ctcp.2016.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 08/23/2016] [Accepted: 09/15/2016] [Indexed: 11/22/2022]
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31
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Deng J, Murphy BA. Lymphedema self-care in patients with head and neck cancer: a qualitative study. Support Care Cancer 2016; 24:4961-4970. [DOI: 10.1007/s00520-016-3356-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 07/11/2016] [Indexed: 11/24/2022]
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32
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Jeffs E, Purushotham A. The prevalence of lymphoedema in women who attended an information and exercise class to reduce the risk of breast cancer-related upper limb lymphoedema. SPRINGERPLUS 2016; 5:21. [PMID: 26759760 PMCID: PMC4703592 DOI: 10.1186/s40064-015-1629-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 12/17/2015] [Indexed: 11/22/2022]
Abstract
Breast cancer-related upper limb lymphoedema (BCRL) affects approximately 20 % of women undergoing axillary intervention. Women who attended a “reducing your risk of lymphoedema” class, including exercise instruction, anecdotally reported positive BCRL outcomes. The aim of this study was to examine BCRL outcomes and perceived benefit for attendees at a “reducing your risk of lymphoedema” class between 2000 and 2005. A cross-sectional study was conducted in two parts: (1) self-report questionnaire regarding lymphoedema status and benefit received from class and exercise programme; (2) clinical evaluation and objective measurement to confirm BCRL. 46 women completed questionnaires; 40 continued to clinical evaluation and objective measurement. BCRL prevalence defined as ≥10 % excess limb volume was only 5 %, although clinician judgement identified 23 % with arm lymphoedema and 8 % with lymphoedema limited to the hand. Clinician judgement correlated highly with patient self-report (Kappa = 0.833, p = 0.000). All women found the class beneficial, reporting increased confidence to return to normal life and a wide range of activities/exercise. We conclude that prevalence of BCRL should be determined by both clinical judgement and objective measurement to avoid underestimation. The benefit of group education with a lymphoedema expert and of exercise instruction should be further explored, and the potential for exercise to reduce BCRL prevalence should be examined.
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Affiliation(s)
- E Jeffs
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, Waterloo Campus, 57 Waterloo Road, London, SE1 8WA UK
| | - A Purushotham
- Guy's and St Thomas NHS Foundation Trust, Guy's Hospital, 3rd Floor Bermondsey Wing, Great Maze Pond, London, SE1 9RT UK
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