Post-breast cancer lymphedema: understanding women's knowledge of their condition.

PURPOSE/OBJECTIVES: To investigate chronic condition representations and treatment choices among women with post-breast cancer lymphedema (LE) to understand their receipt and use of accurate medical information. DESIGN: Qualitative, template analysis. SETTING: Midsized midwestern city and surrounding rural areas. SAMPLE: 18 Caucasian women aged 37-87 years (mean = 58.8 years) with LE. METHODS: Telephone and face-to-face interviews, lasting 45-60 minutes, were conducted by research students and graduate nursing students. Interviews were audiotaped, professionally transcribed, and verified for transcription accuracy. Self-regulation theory as a template was applied to (a) understand participants' use of health information to cope with LE and (b) evaluate the accuracy of participants' health information that may have influenced participants' abilities to make appropriate prevention or treatment choices. MAIN RESEARCH VARIABLES: Participants' illness representations and coping strategies. FINDINGS: Participants were aware of the fundamental cause of their LE--breast cancer treatment. They also were conscious of other causes of symptom onset. These causes are supported by existing empirical evidence. Participants' treatment choices were consistent (e.g., use of compression treatment, massage, elevation, pumps, therapists and therapy centers, and positive attitude and faith) and inconsistent (e.g., effectiveness of exercise and medication in management of LE) with empirical evidence. CONCLUSIONS: Future research and practice should target the role of exercise as a cause of LE and as a treatment option, investigate allergic reactions as a possible catalyst of LE symptoms, work to improve diagnosis of LE and patient education, and examine the effectiveness of medications as a treatment method. IMPLICATIONS FOR NURSING: Review of LE risk factors in the postoperative period and continued assessment and education are vital to a comprehensive approach to post-breast cancer LE care.

Predicting breast cancer-related lymphedema using self-reported symptoms.

OBJECTIVES: This study aimed to determine the accuracy of using self-reported signs and symptoms to identify the presence of lymphedema as well as the usefulness of identifying clinically measurable lymphedema on the basis of certain symptoms elicited by the Lymphedema Breast Cancer Questionnaire (LBCQ). METHODS: This analysis used logistic regression to identify symptoms predictive of differences between symptom experiences of participants belonging to two distinct groups (study A): those with known post-breast cancer lymphedema (n = 40) and those in a control group of women with no history of breast cancer or lymphedema (n = 40). Symptoms in this model of best fit were used to examine their relation to limb circumferences of breast cancer survivors in a second independent data set (study B; n = 103) in which a diagnosis of known lymphedema was not previously determined using symptom experiences. RESULTS: The presence of lymphedema was predicted by three symptoms comprising a model of best fit for study A (c =.952): "heaviness in past year," "swelling now," and "numbness in past year." Using this model, prediction of absolute maximal circumferential limb difference (i.e., >or=2 cm) in study B showed that "heaviness in the past year" (p =.0279) and "swelling now" (p =.0007) were predictive. "Numbness in the past year" was not predictive. However, those with lesser limb differences reported this symptom more often. CONCLUSIONS: The findings suggest that changes in sensations may be indicators of early lymphedema or other treatment-related sequelae that must be assessed carefully at each follow-up visit and over time. A combination of symptom assessment and limb volume measurement may provide the best clinical assessment data for identifying changes associated with post-breast cancer lymphedema.