Vol. 27 • Issue 26
• Page 15
Surgery for breast cancer may include axillary node dissection or the removal and examination of lymph nodes in the underarm area near the affected breast. This procedure allows physicians to determine whether cancer has spread to the lymphatic system.
A common side effect of axillary node dissection is lymphedema, a swelling of the arm and/or hand on the same side as surgery caused by the buildup of lymphatic fluid. For breast cancer patients, lymphedema can occur at any time post-treatment. As such, experts at The Miriam Hospital in Providence, RI, have chosen to focus efforts on the educational aspect of survivorship.
"Until recently, the majority of our patients were breast cancer survivors who had already developed the condition in their arms and hands," explained Carrie Marcil, PT, LANA-CLT, outpatient rehabilitation supervisor.
Now, thanks to heightened awareness on the part of surgeons and oncologists, breast cancer patients are being educated in aggressive preventive techniques that can curtail the development of lymphedema.
Ellen Therrien, RN, works as a breast health navigator in the Adele R. Decof Comprehensive Cancer Center at The Miriam Hospital and refers her patients with lymphedema or potential lymphedema to the outpatient rehab center's lymphedema program. Therrien detects lymphedema early and continues to see patients for years to track their progress. This approach is especially important, as lymphedema may take years to develop and be detected. Therrien assesses patients for the earliest possible intervention.
Four therapists and one PTA in the outpatient center have been trained in lymphedema education, signs and symptoms of the condition and post-operative exercise. "On a patient's first
visit with us, we discuss lymphedema prevention and provide a handout with tips to reference," shared Janet Mahoney, PT. "Our goal is to reach as many patients as possible and to make them aware of the potential."
With the advent of breast-sparing surgery, Marcil has observed, physicians may not refer breast cancer survivors to therapy when only one node is taken during surgery.
Marcil believes that in general, physicians are not referring consistently or only when they see patients who exhibit signs and symptoms.
"Every single patient who has had lymph node dissection surgery followed by radiation needs lymphdema education, whether one node is removed or 10," Marcil said.
Although lymphedema cannot be cured, the condition can be treated and managed.
The treatment plan for lymphedema patients at The Miriam Hospital may include: manual lymphatic massage to gently direct fluid away from the impaired lymphatic areas; compression bandaging to help prevent fluid from returning to swollen areas; compression pump therapy to facilitate fluid movement toward the heart; and the application of compression garments to maintain reduced limb size.
The therapists teach patients exercises to keep the joints limber and educate about skin care to help patients understand the cause and appropriate treatment.
Depending on the patient's level of activity prior to treatment, she may return to low-level strength exercises six weeks following surgery.
Marcil advises using gravity, instead of weights, for strength exercises and slowly adding weights up to no more than 3 pounds.
An Ounce of Prevention
There are a few tactics that breast cancer survivors can employ to help reduce their chances of developing lymphedema:
• Keep the affected limb (the arm on the same side as the lymph node dissection) free from burns, rashes and insect bites.
• Never use the affected limb for blood pressure tests or injections, including acupuncture.
• Practice proper hygiene.
• Inspect the affected limb daily.
• Apply a compression arm sleeve during air travel.
• Avoid vigorous repetitive movements, such as scrubbing, pushing and pulling.
• Avoid heavy lifting. Never carry heavy handbags or bags with over-the-shoulder straps on your affected side.
• Don't wear tight jewelry or elastic bands around an affected finger or arm.
• Avoid extreme temperature changes when bathing or washing dishes. Protect your arm from the sun at all times.
• Maintain ideal body weight through a low-sodium, high-fiber diet, and avoid smoking and alcohol.
Rebecca Mayer, senior regional editor, can be reached at firstname.lastname@example.org.