Lymphedema Prophylaxis Utilizing Perioperative Education

摘要

The purpose is to evaluate perioperative training for lymphedema assessment and protection. The hypothesis is that structured perioperative training in lymphedema protection will decrease lymphedema, the episodes of infection, the time to detection of lymphedema and improve the QOL in patients undergoing axillary dissection and/or radiation therapy for breast cancer as compared to a control group. The specific questions (scope) are (1) what is the incidence of lymphedema and infection during the first three years after surgery among breast cancer patients who received perioperative training in lymphedema protection as compared to a control group; (2) What are the differences in the measured QOL among breast cancer patients during the first three years after surgery that received perioperative education in lymphedema protection as compared to a control group; (3) What are the retention of information on lymphedema protection, and the compliance with arm precautions among breast cancer patients who received perioperative lymphedema training as compared to a control group. Major Findings: The incidence of lymphedema was 60.1% with a majority occurring within the first year after surgery. Teaching LE protection methods did not reduce the incidence of LE nor improve QOL except at 24 months for those with LE. Those with LE also had increased knowledge of LE protection methods as compared to a control group but only significant at 6 months associated with a booster session. Significance: The LE rate is greater than reported in the literature primarily because prospective measurements were obtained including the first year after surgery when a majority of cases were observed. Other factors that may impact the occurrence of LE without regard to knowledge of protection measures include impaired lymphatic healing after surgery, persistence of activity despite knowing it may cause harm to the extremity, and uncontrolled hypertension which may increase the risk for LE.