The prevalence of lymphoedema in women who attended an information and exercise class to reduce the risk of breast cancer-related upper limb lymphoedema.

E Jeffs,A Purushotham

doi:10.1186/s40064-015-1629-8

Abstract

Breast cancer-related upper limb lymphoedema (BCRL) affects approximately 20 % of women undergoing axillary intervention. Women who attended a “reducing your risk of lymphoedema” class, including exercise instruction, anecdotally reported positive BCRL outcomes. The aim of this study was to examine BCRL outcomes and perceived benefit for attendees at a “reducing your risk of lymphoedema” class between 2000 and 2005. A cross-sectional study was conducted in two parts: (1) self-report questionnaire regarding lymphoedema status and benefit received from class and exercise programme; (2) clinical evaluation and objective measurement to confirm BCRL. 46 women completed questionnaires; 40 continued to clinical evaluation and objective measurement. BCRL prevalence defined as ≥10 % excess limb volume was only 5 %, although clinician judgement identified 23 % with arm lymphoedema and 8 % with lymphoedema limited to the hand. Clinician judgement correlated highly with patient self-report (Kappa = 0.833, p = 0.000). All women found the class beneficial, reporting increased confidence to return to normal life and a wide range of activities/exercise. We conclude that prevalence of BCRL should be determined by both clinical judgement and objective measurement to avoid underestimation. The benefit of group education with a lymphoedema expert and of exercise instruction should be further explored, and the potential for exercise to reduce BCRL prevalence should be examined.

Highlights

Lymphoedema is a common consequence of breast cancer treatment affecting approximately 20 % of women undergoing axillary intervention, with the majority developing swelling within 2 years (Disipio et al 2013)
A further three women (8 %) had lymphoedema limited to the hand, self-reported; the overall cliniciandetermined prevalence of Breast cancer-related upper limb lymphoedema (BCRL) was 30 %
When determined by clinician judgement, we found 23 % prevalence of arm lymphoedema, which increased to 30 % prevalence with inclusion of lymphoedema limited to the hand, with a median 4.8 % excess limb volume (ELV)

Summary

Introduction

Lymphoedema is a common consequence of breast cancer treatment affecting approximately 20 % of women undergoing axillary intervention, with the majority developing swelling within 2 years (Disipio et al 2013). The impact of breast cancer-related upper limb lymphoedema (BCRL) on the survivor is significant, including physical changes, impairment to function and daily life activities, challenges for work, social and leisure activities, and financial implications Women in the UK at risk of developing BCRL are routinely offered verbal and written advice regarding care and use of the arm (e.g. leaflets from Breast Cancer Care, Lymphoedema Support Network, Macmillan Cancer Support), with many services offering additional group education sessions. As part of a review of breast cancer care at our hospital we wished to explore the potential impact on BCRL outcome of a proactive approach to advice and education regarding exercise. The role of exercise and movement to influence lymphatic and venous drainage is well recognised (Foldi and Foldi 2012; Lymphoedema Framework 2006; Jeffs and Purushotham SpringerPlus (2016)5:21

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Conclusion