The Factors Associated with Breast Cancer – Related Lymphedema Following Breast Surgery with Lymph Node Dissection
Main Article Content
Abstract
Purpose: To study the factors associated with breast cancer-related lymphedema among breast cancer patients after breast surgery with lymph node dissection.
Design: Descriptive correlation research
Method: The sample consisted of 148 breast cancer patients who underwent breast surgery with lymph node dissection for 1 year or more and visited 3 tertiary hospitals of the 4th health service region in Thailand. Purposive sampling was used. Data were collected by 4 questionnaires including, 1) demographic characteristic, 2) Lymphedema and Breast Cancer Questionnaire.3) receiving arm lymphedema information, and 4) lymphedema risk-reduction behavior. All questionnaires had content validity. The Cronbach’s alpha coefficients of the 2nd-4th questionnaires were .88, .82 and, .88 respectively. Arm circumference was measured at 6 points in two arms. The difference at > 2 cm in any point used to determine the arm lymphedema. Data were analyzed by using descriptive statistics, the point biserial correlation coefficients, chi-square and, Fisher exact tests.
Finding: The sample had a mean age of 59.52 years. (S.D.=11.22), The majority of them had breast cancer stage 2. (43.2%), The average postoperative period was 4.44 years. (S.D.=3.58), arm lymphedema was found in 51 cases (34.5 %). The factors that were associated with breast cancer – related lymphedema were radiotherapy (2=15.37, p < 0.001), surgery type (2=10.28, p < 0.05), and the overall score for risk reduction behaviors (rpb= -0.298,p< 0.001). Moreover, the symptoms reported were significantly associated with arm lymphedema (rpb = 0.577, p < 0.001).
Conclusion: Surgery type and radiotherapy were correlated with arm lymphedema. Therefore, appropriate nursing care to preventing arm lymphedema should be applied in this group of patients. Especially, promoting self-care behavior to reduce the risk of arm lymphedema together with assessing symptoms associated with arm lymphedema.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
ลิขสิทธิ์ของบทความที่ตีพิมพ์เป็นของวารสารพยาบาลศาสตร์ จุฬาลงกรณ์มหาวิทยาลัย ทั้งฉบับตีพิมพ์เป็นรูปเล่มและเอกสารออนไลน์
References
National Cancer Institute. Cancer in Thailand
volume IX 2013-2015. Bangkok: National
Cancer Institute Department of Medical
Services Ministry of Public Health; 2018.
Wanchai A, Armer JM, Stewart BR, Lasinski BB.
Breast cancer-related lymphedema:
A literature review for clinical practice.
International Journal of Nursing Sciences
; 3(2): 202-7.
Ridner SH. Breast cancer lymphedema:
pathophysiology and risk reduction
guidelines. Oncology nursing forum
; 29(9): 1285-93.
Fu MR, Axelrod D, Haber J. Breast-Cancer-
Related Lymphedema: Information,
Symptoms, and Risk-Reduction Behaviors.
Journal of Nursing Scholarship 2008;
(4): 341-8.
Fu MR, Axelrod D, Cleland CM, Qiu Z,
Guth AA, Kleinman R, et al. Symptom
report in detecting breast cancer-related
lymphedema. Breast Cancer: Targets and
Therapy 2015; 7: 345-52. Doi: 10.2147/
BCTT.S87854.
Armer JM, Stewart BR. Post-breast cancer
lymphedema: incidence increases from
to 30 to 60 months. Lymphology
; 43(3): 118-27.
Jung SY, Shin KH, Kim M, Chung SH,
Lee S, Kang HS, et al. Treatment
factors affecting breast cancer-related
lymphedema after systemic chemotherapy
and radiotherapy in stage II/III
breast cancer patients. Breast cancer
research and treatment 2014; 148(1):
-8.
Park JH, Lee WH, Chung HS. Incidence and
risk factors of breast cancer lymphedema.
Journal of Clinical Nursing 2008;
(11): 1450-9.
Geller BM, Vacek PM, O’Brien P, Secker-Walker
RH. Factors associated with arm swelling
after breast cancer surgery. Journal of
women’s health 2003; 12(9): 921-30.
Shahpar H, Atieh A, Maryam A, Fatemeh HS,
Massoome N, Mandana E, et al. Risk
factors of lymph edema in breast cancer
patients. International journal of breast
cancer 2013; 2013: 1-7.
Nguyen TT, Hoskin TL, Habermann EB,
Cheville AL, Boughey JC. Breast cancerrelated
lymphedema risk is related to
multidisciplinary treatment and not
surgery alone: results from a large
cohort study. Annals of surgical oncology
; 24(10): 2972-80.
Can AG, Eksioglu E, Bahtiyarca ZT, Cakcı FA.
Assessment of risk factors in patients
who presented to the outpatient clinic
for breast cancer-related lymphedema.
The journal of breast health 2016; 12(1):
–6. Doi: 10.5152/tjbh.2015.2801.
Ugur S, Arıcı C, Yaprak M, Mescı A, Arıcı GA,
Dolay K, et al. Risk factors of breast
cancer-related lymphedema. Lymphatic
research and biology 2013; 11(2): 72-5.
Armer JM, Radina ME, Porock D, Culbertson
SD. Predicting breast cancer-related
lymphedema using self-reported
symptoms. The Journal of Nursing
Research 2003; 52(6): 370-9.
Thongteratham N. Factors associated with
arm lymphedema in breast cancer
patients after axillary resection [Master’s
Thesis, Nursing Science Program].
Bangkok: Mahidol University; 2005.
Kwan ML, Shen L, Munneke JR, Tam EK,
Partee PN, Andre M, et al. Patient
awareness, and knowledge of breast
cancer-related lymphedema in a large,
integrated health care delivery system.
Breast cancer research and treatment
; 135(2): 591-602.
Fu MR, Chen CM, Haber J, Guth AA,
Axelrod D. The effect of providing
information about lymphedema on the
cognitive and symptom outcomes of
breast cancer survivors. Annals of
surgical oncology 2010; 17(7): 1847-53.
Suka M, Odajima T, Okamoto M, Sumitani M,
Igarashi A, Ishikawa H, et al. Relationship
between health literacy, health
information access, health behavior,
and health status in Japanese people.
Patient education and counseling 2015;
(5): 660-8.
Ridner SH, Montgomery LD, Hepworth JT,
Stewart BR, Armer JM. Comparison of
upper limb volume measurement
techniques and arm symptoms between
healthy volunteers and individuals with
known lymphedema. Lymphology 2007;
(1): 35-46.