A new study, published in the journal of Rehabilitation Oncology, highlights the progress in rehabilitation and physical therapy management of cancer-related lymphedema—including characteristics of patients who need extra support in practicing essential self-care.
Lymphedema is a complication of cancer treatment that occurs due to fluid buildup in soft tissue, resulting from damage to the lymphatic system. Patients with lymphedema experience painful swelling and limitation of function of the limbs or other areas.
Complex decongestive therapy (CDT) is the multi-modal treatment for lymphedema carried out by a skilled therapist. However, in order to optimally manage the condition, some components of CDT need to be carried out by the patient on a daily basis.
Self-care plays an important role for patients with lymphedema, and may include daily self-massage, skin care, compression therapy, and exercise. However, for some individuals with lymphedema, performing daily self-care poses a challenge.
A research team at Karolinska Institute, Stockholm, performed a study to identify characteristics of women who needed extra support to self-manage their lymphedema. The study included data on 88 Swedish women, average age 62 years–most with arm lymphedema after breast cancer treatment.
Nearly 60% of women in the study performed their self-care program almost every day–even though about half of the patients felt that self-care did not help much. Only about 20% of women who worked performed daily self-care at work.
A wide range of demographic, clinical, psychological and physical characteristics were significantly related to self-care practice. Factors associated with lower rates of daily self-care included low scores for well-being, body image, and self-esteem; ethnicity other than Swedish; depressed or anxious mood; and poor sleep quality.
"Our results emphasize the importance of focusing more on vulnerable individuals when it comes to instructions about self-care and to encourage women to perform continuous self-care," the researchers write.
They believe their findings support a "stepped-care" approach to working with women with lymphedema: basic help for all women, with stepwise progressive interventions for those in need of additional support.
Guest Editor Nicole L. Stout, DPT, CLT-LANA, FAPTA notes that the special issue of Rehabilitation Oncology appear two decades after a seminal report by the American Cancer Society on lymphedema management.
Since then, management of lymphedema has become "far more mainstream," with ongoing research, clinical practice guidelines, and improved access to specialist care. Other topics in the special issue include patient assessment, considerations for advanced training for physical therapy professionals in lymphedema care, and new imaging approaches.
Dr. Stout concludes, "The future is bright, the future is smart, and we must continue to seize on opportunities to advance novel approaches to lymphedema management."