April 1, 2005

Lymphedema study reveals lingering problems for patients

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Larry Goldberg

Lymphedema study reveals lingering problems for patients

Patients who are diagnosed with lymphedema as a result of treatment for breast cancer face a much different battle than patients who are diagnosed with breast cancer alone, according to findings from a comparison study by a researcher in the Vanderbilt University School of Nursing.

“There were some rather distinct differences in psychological and physical symptoms experienced by women with chronic lymphedema than those who didn't have it,” said Sheila Ridner, Ph.D., R.N., research associate in Nursing and primary investigator in the study.

Ridner examined and interviewed 149 breast cancer patients. Seventy-four had been previously diagnosed with lymphedema and the other 75 did not have the condition. Lymphedema is the accumulation of fluid in the arm on the same side in which a patient was treated for breast cancer. Ridner said it's not a condition caused by a problem that occurs during surgery or radiation; it results from damage to the lymphatic system that can happen as a consequence of standard breast cancer treatment. “Why some women develop it and others do not is not well understood,” she said.

Ridner measured the arms of each person for comparison. Fluid in an arm affected by lymphedema was measured using a Lymphometer, which works by placing electrodes on the patient's hand and foot to determine the amount of fluid in the arm.

When looking at differences in physical symptoms, Ridner noticed body mass index, or BMI, played a role for some patients with lymphedema. “Women with a larger BMI who had lymphedema had more difficulty keeping the arm size under control medically and experienced more complications. They had more symptoms and they were more intense.” Ridner said there are several possible physiological explanations. For starters, she said being larger puts more stress on the arm in general, and high blood pressure associated with obesity can increase the amount of fluid retained in the arm of someone with lymphedema.

Psychological symptoms among patients with lymphedema were also measurably different. “I measured the volume in both of their arms and also asked them to tell me what they thought the difference to be. Even if the arm was medically controlled, the bigger the difference the women perceived between the lymphedema arm and their other arm, the more symptoms were reported,” Ridner said. Other psychological issues ranged from a loss of confidence in their body image to overall psychological distress. “This is a chronic illness, that, in addition to the arm swelling, brings other issues that need to be addressed,” said Ridner.

She said oncology nurses and other health care providers can help patients tackle some of those issues. “There is a gap. And the gap, I think, has to do with what we perceive as helpful education may not be the education they need,” said Ridner.

Although there is no known preventive measure for patients to avoid developing lymphedema after treatment for breast cancer, Ridner said the risk increases with more aggressive treatment in cases of advanced disease. “Women who have sentinel node biopsy and do not have radiation to the axilla have a decreased risk of developing lymphedema.”

Ridner’s next research projects involve measuring fluid in the arms of patients with lymphedema using several different tools, and examining the differences before and after therapy to determine how blood flow might be effected. She also plans to examine whether fluid measurement correlates with symptoms and is currently recruiting healthy women for an arm measurement study. For more information on this study, contact Ridner at 322-0831.