Volume 16, Issue 1, April 2005
     
Coordinator’s Message
Newsletter Focuses on Melanoma and Associated Lymphedma


Marjorie Whitman, RN, MSN, AOCN®
Columbia, MO
whitmandale@mchsi.com


Greetings to all continuing and new SIG members! This year marks the 30th anniversary of ONS and the 16th year of the Lymphedema Management SIG. Awareness of lymphedema on the part of healthcare professionals is increasing. Patients have benefited greatly from improved information about prevention and treatment and affiliation with support groups and the National Lymphedema Network (NLN). Given the prevalence of breast cancer and the ongoing risk for lymphedema, breast cancer-associated lymphedema is increasingly the focus of research and treatment. This issue of the newsletter will focus on lymphedema associated with melanoma. Melanoma is a malignancy of melanocytes commonly found in the basal layers of the epidermis and in the eye. These migrating cells also are found in the meninges, alimentary and respiratory tracts, and lymph nodes. Melanoma spreads through layers of skin and through lymph channels from the primary tumor; surgical diagnosis and treatment involve wide local excision (WLE) and regional lymph node biopsy. Even with the minimally invasive surgical procedure of sentinel lymph node biopsy, the resulting lymphatic disruption combined with WLE creates a risk for lymphedema. Therefore, I am grateful to reprint an article featured in LymphLink titled “Lymphedema in Patients With Melanoma.” The authors reviewed and critiqued research on the incidence of melanoma-associated lymphedema.

 
The Lymphedema Management SIG Newsletter is produced by members of the
Lymphedema Management SIG and ONS staff and is not a peer-reviewed publication.

Special Interest Group Newsletter  April 2005
 
   

Coordinator’s Message
Newsletter Focuses on Melanoma and Associated Lymphedma

Marjorie Whitman, RN, MSN, AOCN®
Columbia, MO
whitmandale@mchsi.com


Greetings to all continuing and new SIG members! This year marks the 30th anniversary of ONS and the 16th year of the Lymphedema Management SIG. Awareness of lymphedema on the part of healthcare professionals is increasing. Patients have benefited greatly from improved information about prevention and treatment and affiliation with support groups and the National Lymphedema Network (NLN). Given the prevalence of breast cancer and the ongoing risk for lymphedema, breast cancer-associated lymphedema is increasingly the focus of research and treatment. This issue of the newsletter will focus on lymphedema associated with melanoma. Melanoma is a malignancy of melanocytes commonly found in the basal layers of the epidermis and in the eye. These migrating cells also are found in the meninges, alimentary and respiratory tracts, and lymph nodes. Melanoma spreads through layers of skin and through lymph channels from the primary tumor; surgical diagnosis and treatment involve wide local excision (WLE) and regional lymph node biopsy. Even with the minimally invasive surgical procedure of sentinel lymph node biopsy, the resulting lymphatic disruption combined with WLE creates a risk for lymphedema. Therefore, I am grateful to reprint an article featured in LymphLink titled “Lymphedema in Patients With Melanoma.” The authors reviewed and critiqued research on the incidence of melanoma-associated lymphedema. Also in this issue, Lila Courtney, ARNP-C, AOCN®, an oncology nurse and member of the Lymphedema SIG, offers a personal essay about her experience with melanoma and lymphedema. We appreciate her willingness to share her expertise and experience. Attention to this issue will raise nurses’ awareness and guide future interactions with patients treated for melanoma. To join the NLN and receive the quarterly newsletter, call 510-208-3200, visit www.lymphnet.org, or e-mail nln@lymphnet.org.

I hope to see you at the ONS 30th Annual Congress in Orlando, FL. We will meet as a SIG on Thursday, April 28, at 5:15 pm. We are delighted to welcome Sheila H. Ridner, PhD, RN, ACNP, as the new coordinator of the Lymphedema Management SIG at that meeting. The SIG is looking for people to nominate for coordinator-elect next year, so please share any good candidates.

 
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Special Interest Group Newsletter  April 2005
 
   

Lymphedema in Patients With Melanoma



Janice N. Cormier, MD, MPH
Department of Surgical Oncology
University of Texas M.D. Anderson Cancer Center
Houston, TX
jcormier@mdanderson.org

Latunya Davidson
Department of Surgical Oncology
University of Texas M.D. Anderson Cancer Center
Houston, TX

Wendy J. Evans
Sinclair School of Nursing and Ellis Fischel Cancer Center
University of Missouri-Columbia
Columbia, MO

Jane M. Armer
Sinclair School of Nursing and Ellis Fischel Cancer Center
University of Missouri-Columbia
Columbia, MO

Note. This article originally appeared in volume 17, Issue 1, 2005, of LymphLink. Reprinted with permission.

Melanoma is a growing public health problem with an estimated 132,000 cases diagnosed annually worldwide (World Health Organization, 2004). It is the sixth most common malignancy among Americans (American Cancer Society, 2004) and accounts for more than 79% of all skin cancer-related deaths (Geller & Annas, 2003; Trask et al., 2001). Fortunately, the majority of patients diagnosed with melanoma present with early-stage disease that is cured by surgical excision alone. For others, presenting with regional or distant metastatic disease, the prognosis is not as favorable. The most critical factors for determining the prognosis of patients with melanoma are primary tumor thickness and the status of regional lymph nodes. Both of these elements are incorporated into the American Joint Committee on Cancer staging system for melanoma (American Joint Committee on Cancer, 2002).

Surgical Treatment
The most important information for determining surgical treatment of melanoma is the thickness (Breslow thickness), which is measured in millimeters and is determined by pathologic examination of a biopsy of the primary tumor. Current surgical guidelines (National Comprehensive Cancer Network, 2004) include a wide local excision (WLE) of the primary tumor. Regional lymph nodes are the most common first site of melanoma metastases. Over the last decade, sentinel lymph node (SLN) biopsy has emerged as a reliable technique for identifying micrometastatic disease in clinically negative regional lymph node basins. SLN biopsy is a highly accurate, minimally invasive surgical procedure based on the theory that lymphatic metastases associated with melanoma follow an orderly progression through lymph channels from the primary tumor to a particular lymph node (designated the “sentinel” lymph node) before spreading into other regional (“nonsentinel”) lymph nodes (Reintgen et al., 1994).

Current guidelines outlined by the National Comprehensive Cancer Network for the treatment of patients with melanoma recommend SLN biopsy for all patients with primary melanomas greater than 1 mm thickness and subsets of patients with high-risk thin (< 1 mm) melanomas (Ak, Stokkel, Bergman, & Pauwels, 2000). In patients with an SLN that tests negative for presence of cancer, no further surgical therapy is recommended. In patients with metastases identified in the SLN, a complete lymph node dissection is performed. This combination of surgical treatments, a WLE of a primary tumor along with SLN biopsy and possible subsequent complete lymph node dissection, results in multiple sites of lymphatic disruption.

Unlike axillary (“armpit”) node dissection for patients with breast cancer, which includes dissection of level I and II lymph nodes, axillary node dissection for patients with melanoma of the upper extremity or trunk includes the routine dissection of level I, II, and III lymph nodes. Level III lymph nodes are the highest axillary nodes (apical). A standard lymph node dissection for patients with lower extremity or truncal melanomas draining to the inguinal region includes the removal of lymph nodes located in the inguinofemoral (groin) region. In addition, subsets of patients with melanoma with bulky nodal disease undergo an additional deep pelvic dissection.

The surgical treatment of melanoma results in varying degrees of lymphatic disruption resulting in a lifetime risk for developing lymphedema. It is postulated that lymphedema may occur more frequently in patients with melanoma because of: (1) multiple surgical sites (e.g., primary tumor excision on an extremity in conjunction with lymph node biopsy or dissection), (2) extent of nodal dissections, and (3) anatomic sites, particularly the lower extremity, which may be at increased risk due to physiologic reasons.

Review of the Literature
The data estimating the incidence of lymphedema in patients with melanoma are far from complete. We have systematically reviewed the literature and found a total of 25 studies performed between 1972 and 2004 pertaining to melanoma and lymphedema. Of these 25 studies, 12 (48%) were retrospective, 10 (40%) prospective, 2 (8%) clinical trials, and 1 (4%) a case series. As with the reported incidence of postsurgical lymphedema for patients with breast cancer (Passik & McDonald, 1998; Petrek & Heelan, 1998), the reported incidence of lymphedema in patients with melanoma varies widely, with reported rates ranging from 2% to 67%. The disparity likely relates to the heterogeneity of the reports, which will be discussed below.

Measurement Methods
Volume measurement using water displacement historically has been regarded as the most sensitive and accurate measure; however, clinicians rarely use this cumbersome approach (Petlund, 1991; Tierney, Aslam, Rennie, & Grace, 1996). Two of the 25 studies used water displacement alone (James, 1982) or in combination with circumference measurements (Baas et al., 1992). Circumference measurements were utilized in five of the studies (Holmes et al., 1977; Karakousis, Heiser, & Moore, 1983; Lawton, Rasque, & Ariyan, 2002; Papachristou & Fortner, 1977; Urist, Maddox, Kennedy, & Balch, 1983). The remaining 15 studies reported on lymphedema in patients with melanoma using clinical definitions with no objective measurement criteria.

Lymphedema Classification
In one study in which significant lymphedema was defined as greater than 1 inch difference (measured at the ankle or midcalf) between the affected and unaffected limb, lymphedema was reported in 80% of patients five years after surgery (Papachristou & Fortner, 1977). Two other studies reported rates of 21%–26% when 2–4 cm (Urist et al., 1983) or 3–4.5 cm (Karakousis et al., 1983) differences were used as criteria.

Surgical Procedures
In 235 patients who underwent SLN biopsy in the axillary or inguinofemoral region, only 5 patients (2%) were reported to have lymphedema on an average of six weeks after surgery (range of 2–10 weeks) (Wrone et al., 200). Three studies reported lymphedema in 20%–45% of patients undergoing inguinofemoral dissections, with no difference noted between superficial dissections alone or in combination with deep pelvic dissections (Baas et al., 1992; Karakousis & Driscoll, 1994; Stevens et al., 2000).

Postoperative wound complications often are associated with extensive nodal dissections, particularly in the inguinal region. Seven studies reported postoperative wound complications, including cellulitis in 6%–33% of patients (Baas et al., 1992; Ingvar, Erichsen, & Jonsson, 1984; Karakousis & Driscoll, 1994; Lawton et al., 2002; Serpell, Carne, & Bailey, 2003; Strobbe, Jonk, Hart, Nieweg, & Kroon, 1999; Urist et al., 1983).

Anatomic Variation—Upper Versus Lower Extremity
It is difficult to make direct comparisons of rates of lymphedema at various anatomic sites among studies given the heterogeneity of the reports. Of the studies that examined lymphedema associated with axillary versus inguinofemoral nodal dissections, similar trends were noted. The reported range of upper extremity lymphedema was 5%–8% (Shaw & Koea, 1992; Urist et al., 1983) compared to 14%–29% for lower extremity lymphedema (Lawton et al., 2002; Serpell et al., 2003). It appears from these reports that the incidence of lower extremity lymphedema may be twice as high as upper extremity lymphedema.

Time Horizon
It has been noted that breast cancer lymphedema studies with the shortest follow-up (12 months) report the lowest incidence (6%) (Petrek & Heelan, 1998), whereas studies with the longest follow-up have the highest incidence. Similar trends are noted in this review, with the lowest lymphedema rates (upper and lower extremity) noted in studies that examined patients six months postoperatively (Wrone et al., 2000), whereas the highest incidence (67%, lower extremity lymphedema) had the longest follow-up (20 years) (Papachristou & Fortner, 1977). High rates (44%) also were noted when lymphedema was defined as swelling lasting more than six months (Beitch & Balch, 1992).

Discussion
All people diagnosed with melanoma are at a lifetime risk of developing lymphedema because of the extensive lymphatic disruption associated with surgical treatment. Lymphedema and its sequelae are much-understudied morbidities associated with cancer treatment, particularly in patients with melanoma. In patients with breast cancer, lymphedema has been described as an overlooked, underdiagnosed, and undertreated condition, which, other than tumor recurrence, is the most feared effect of treatment (Disa & Petrek (2001)). The same likely can be said of melanoma and lymphedema.

Lymphedema is a significant problem. In addition to the symptoms and risks, the associated challenges also may lead to post-treatment psychosocial distress. Although researchers have documented the psychological sequelae of breast cancer treatment (Tobin, Lacey, Meyer, & Mortimer, 1993), we know little about such issues in patients with melanoma, especially those that may involve lymphedema of the lower extremity. A conclusion by Maunsell, Brisson, and Deschenes (1993) still stands: “The impact of lymphedema problems on patient quality of life has not been quantitatively assessed.” This research has been hampered by the traditional view that quality of life is less important than the eradication of cancer and detection of recurrence. Unfortunately, lack of attention to lymphedema by health professionals has not only meant that many people go undiagnosed and fail to receive basic preventive information (Maunsell et al.), but this lack of attention also has hindered the development of effective psychosocial and physiological therapeutic interventions.

Early detection and intervention hold the greatest promise of reducing this widespread condition (Petrek, Pressman, & Smith, 2000; Rockson, 1998). The range of findings in the literature reflects inconsistent criteria for defining lymphedema, small studies, retrospective analyses, and short follow-up. We must clearly identify epidemiological and clinical factors associated with risk and incidence to build a foundation for preventive interventions.

References

Ak, I., Stokkel, M.P., Bergman, W., & Pauwels, E.K. (2000). Cutaneous malignant melanoma: Clinical aspects, imaging modalities and treatment. European Journal of Nuclear Medicine, 27, 447–58.

American Cancer Society. (2004). Cancer facts and figures, 2004. Atlanta, GA: Author.

American Joint Committee on Cancer. (2002). Cancer staging handbook from the AJCC cancer staging manual. Heidelberg, NY: Springer.

Baas, P.C., Schraffordt Koops, H., Hoekstra, H.J., van Bruggen, J.J., van der Weele, L.T., & Oldhoff, J. (1992). Groin dissection in the treatment of lower-extremity melanoma. Short-term and long-term morbidity. Archives of Surgery, 127, 281–286.

Beitch, P., & Balch, C. (1992). Operative morbidity and risk factor assessment in melanoma patients undergoing inguinal lymph node dissection. American Journal of Surgery, 164, 462–466.

Disa, J., & Petrek, J. (2001). Rehabilitation after treatment for cancer of the breast. In V. Devita, S. Hellman, & S. Rosenberg (Eds.), Cancer: Principles and practice of oncology (pp. 1717–1725). Philadelphia: Lippincott Williams and Wilkins.

Geller, A.C., & Annas, G.D. (2003). Epidimiology of melanoma and nonmelanoma skin cancer. Seminars in Oncology Nursing, 19, 2–11.

Holmes, E.C., Moseley, H.S., Morton, D.L., Clark, W., Robinson D., & Urist, M.M. (1977). A rational approach to the surgical management of melanoma. Annals of Surgery, 186, 481–490.

Ingvar, C., Erichsen, C., & Jonsson, P.E.. (1984). Morbidity following prophylactic and therapeutic lymph node dissection for melanoma-A comparison. Tumori, 70, 529–533.

James, J.H. (1982). Lymphoedema following ilio-inguinal lymph node dissection. Scandinavian Journal of Plastic and Reconstructive Surgery, 16, 167–171.

Karakousis, C.P., & Driscoll, D.L. (1994). Groin dissection in malignant melanoma. British Journal of Surgery, 81, 1771–1774.

Karakousis, C.P., Heiser, M.A., & Moore, R.H. (1983). Lymphedema after groin dissection. American Journal of Surgery, 145, 205–208.

Lawton, G., Rasque, H., & Ariyan, S. (2002). Preservation of muscle fascia to decrease lymphedema after complete axillary and ilioinguinofemoral lymphadenectomy for melanoma. Journal of the American College of Surgeons, 195, 339–351.

Maunsell, E. Brisson, J., & Deschenes, L. (1993). Arm problems and psychological distress after surgery for breast cancer. Canadian Journal of Surgery, 36, 315–320.

National Comprehensive Cancer Network. (2004). Clinical practice guidelines in oncology. Retrieved from www.nccn.org.

Papachristou, D., & Fortner, J.G. (1977). Comparison of lymphedema following incontinuity and discontinuity groin dissection. Annals of Surgery, 185, 13–16.

Passik, S.D., & McDonald, M.V. (1998). Psychosocial aspects of upper extremity lymphedema in women treated for breast carcinoma. Cancer, 83(12, Suppl. American), 2817–2820.

Petlund, C.F. (1991). Volumetry of limbs. In W.I. Olszewski (Ed.), Lymph stasis: Pathophysiology, diagnosis and treatment (pp. 444–451). Boston: CRC Press.

Petrek, J.A., & Heelan, M.C. (1998). Incidence of breast carcinoma-related lymphedema. Cancer, 83(12, Suppl. American), 2776–2781.

Petrek, J.A., Pressman, P.I., & Smith, R.A. (2000). Lymphedema: Current issues in research and management. CA: A Cancer Journal for Clinicians, 50, 292–307.

Reintgen, D., Cruse, C.W., Wells, K., Berman, C., Fenske, N., Glass, F., et al. (1994). The orderly progression of melanoma nodal metastases. Annals of Surgery, 220, 759–767.

Rockson, S.G. (1998). Precipitating factors in lymphedema: Myths and realities. Cancer, 83(12, Suppl. American), 2814–2816.

Serpell, J.W., Carne, P.W., & Bailey, M. (2003). Radical lymph node dissection for melanoma. ANZ Journal of Surgery, 73, 294–299.

Shaw, J.H.F., & Koea, J. (1992). Morbidity of lymphadenectomy for melanoma. Surgical Oncology Clinics of North America, 1, 195–203.

Stevens, G., Thompson, J.F., Firth, I., O'Brien, C.J., McCarthy, W.H., & Quinn, M.J. (2000). Locally advanced melanoma: Results of postoperative hypofractionated radiation therapy. Cancer, 88, 88–94.

Strobbe, L.J., Jonk, A., Hart, A.A., Nieweg, O.E., & Kroon, B.B. (1999). Positive iliac and obturator nodes in melanoma: Survival and prognostic factors. Annals of Surgical Oncology, 6, 255–262.

Tierney, S., Aslam, M., Rennie, K., & Grace, P. (1996). Infrared optoelectronic volumetry, the ideal way to measure limb volume. European Journal of Vascular and Endovascular Surgery, 12, 412–417.

Tobin, M.B., Lacey, H.J., Meyer, L., & Mortimer, P.S. (1993). The psychological morbidity of breast cancer-related arm swelling. Psychological morbidity of lymphoedema. Cancer, 72, 3248–3252.

Trask, P.C., Paterson, A.G., Hayasaka, S., Dunn, R.L., Riba, M., & Johnson, T. (2001). Psychosocial characteristics of individuals with non-stage IV melanoma. Journal of Clinical Oncology, 19, 2844–2850.

Urist, M.M., Maddox, W.A., Kennedy, J.E., & Balch, C.M. (1983). Patient risk factors and surgical morbidity after regional lymphadenectomy in 204 melanoma patients. Cancer, 51, 2152–2156.

World Health Organization. (2004). Intersun-Global UV project. Geneva, Switzerland: Author.

Wrone, D.A., Tanabe, K.K., Cosimi, A.B., Gadd, M.A., Souba, W.W., & Sober, A.J. (2000). Lymphedema after sentinel lymph node biopsy for cutaneous melanoma: A report of 5 cases. Archives of Dermatology, 136, 511–514.

 
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Special Interest Group Newsletter  April 2005
 
   

Nurse Uses Her Personal Battle With Lymphedema to Help Educate Patients


Lila Courtney, ARNP-C, AOCN®
courtnel@mercyhealth.com


I have a personal as well as professional interest in lymphedema. I was diagnosed in 1972 with malignant melanoma on my left forearm. The standard care at that time was a wide excision with lymph node dissection. Nothing was mentioned to me at that time regarding the possibility of lymphedema down the road or at all. I was not given any instructions regarding what I should or should not do to prevent lymphedema.

Ten years later, I developed lymphedema and went back to my surgeon. He sent me for physical therapy, and they bandaged me with an ace bandage, and I was fitted with a compression sleeve. No education was done at that time either. To be fair, that was more than 20 years ago, and hopefully that would be different now. Unfortunately, I learned to care for my lymphedema on my own, by trial and error.

My compression sleeve did not work well because my hand would turn blue and get numb because of the double compression at my wrist where the sleeve and gauntlet met. No one knew how to prevent that, so I went without the compression sleeve. You can’t work as a nurse with a blue and numb left hand.

Needless to say, I continued like that and suffered two bouts of cellulitis, which luckily resolved with oral antibiotics. Of course, with each infection, the lymphedema became worse. One of the physical therapists in my hospital has primary lymphedema, and we were talking one day at work regarding lymphedema, and she told me she was taking classes on how to assess and treat lymphedema and had proposed a lymphedema clinic at our hospital.

Long story made short, we now have a lymphedema clinic available at our hospital, and I was her first official patient. Our clinic provides manual lymph drainage (MLD) and bandaging. I have used MLD and bandaging and now use a Reid sleeve. The sleeve is very efficient to use. It greatly reduces the time it takes me at the end of the day to put on the Reid sleeve instead of bandaging. In addition, the breast center nurse has an educational component regarding lymphedema in her postoperative instructions. The physical therapy department has a two-hour education program designed to prevent lymphedema in our patients with breast cancer. We try to encourage all of our patients with breast cancer to attend.

When I perform follow-up examinations on my patients with breast cancer, I assess for lymphedema and take the opportunity to remind them how to prevent lymphedema, recognize it if they get it, and where to get assistance. They seem to respond positively to me because they know that I live with lymphedema every day and know what I am talking about.

We have come a long way in the 33 years since my original surgery with the advent of sentinel node biopsy, and my hope is that everyone who has the potential for developing lymphedema will receive the necessary information to prevent it before it starts.

 
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Special Interest Group Newsletter  April 2005
 
   

Editor’s Message
Spotlight on the “Voice of Patients With Lymphedema”

Ellen Poage, RN, BSN, MPH, LMT, CLT
Fort Myers, FL
egpoage@mac.com


In the last newsletter, I named specific attendees at the 2004 National Lymphedema Network (NLN) conference who regularly contribute to the Lymphedema SIG Newsletter. But I failed to mention Saskia Thiadens, RN, conference director and founder of the NLN and the ONS Lymphedema Management SIG. I wondered, when this was brought to my attention, why this happened. I realize that Saskia is not just an attendee. Saskia is the NLN and the voice of patients with lymphedema. The Lymphedema Management SIG is in its 16th year. This is a summary of an interview I had with Saskia on February 25, 2005. Since 1987, in some form or another, Saskia has been working tirelessly for patient care for lymphedema. Her curriculum vitae is impressive; she was born in Holland, attended university in nursing and midwifery, and then came to the United States, where she started a career in nursing, mostly emergency room nursing. Although she arrived in New York, she moved to San Francisco, CA, in the early 1970s.

By 1982, Saskia owned and operated Aurora Manor, a recovery center for patients who had undergone cosmetic and reconstructive surgery. The first time she encountered lymphedema, the patient had a memorable case. It was a massive arm, and this triggered her initial interest in lymphedema. She immediately sensed that something was wrong that this arm could be so neglected. She spoke with a physician from the University of California, wanting to know whether this condition "had a name." She began treating such cases in any way she could. Although from Holland, she was not aware of the strides Europeans were making in this field. She just did what she could with bandaging, skin care, and, later, pumps. In early 1987, she closed the postoperative clinic and opened Aurora Medical Lymphedema Clinic. She still did not realize the enormity of the problem, but it fascinated her. She also created her nonprofit organization, the NLN, in 1988. Robert Lerner, MD, was one of her original collaborators; as a vascular physician, he was dealing with the same problems. In 1989, Saskia was in contact with Marlys Witte, MD, who told her about the International Society of Lymphology conference to be held in Tokyo, Japan. She went and was the first clinical nurse to participate. The others were researchers. They didn’t know what to do with her. But she accomplished the most important point, she met all of the lymphology leaders, all of whom would continue to be mentors and friends and supporters of her and her conferences in years to come.

The interesting thing about Saskia is that she always keeps the focus on patient care. One of her proudest accomplishments was at the 1993 International Society of Lymphology (ISL) conference in Washington, DC. Saskia said she would attend, but only if she could bring 40 patients. The researchers were not interested; after all, ISL is a medical professional conference, not a patient conference. They finally allowed her to come, and this was the start of the patient clinic, with Saskia as the moderator. The medical panel was made up of major researchers who solved very compelling lymphedema problems. Saskia brought only very complex cases. The evening was so successful that it was repeated the next evening. Since then, Saskia always has included patients at NLN conferences, and, to this day, even ISL has patient clinic events.

Saskia is by nature a problem solver. She knew that the problem with lymphedema was lack of awareness. So she single-handedly introduced people to lymphedema. She has published more than 25 times and has made more than 50 presentations. The NLN currently has more than 6,000 members, and its newsletter, LymphLink, is on volume 17. More than 200 treatment centers are listed. The NLN had its first conference in 1994 in San Francisco, and the 10th biennial conference was in Reno, NV, in 2004.

Early on, Saskia realized that oncology nurses need to be involved in lymphology, so she started presenting to ONS with questions such as, “What are you doing for lymphedema?” In 1993, ONS was starting focus groups for all aspects of cancer. Saskia was there to represent lymphedema. Eventually, the focus group progressed into a SIG, the Lymphedema Management SIG, because of Saskia’s persistence and hard work. She completes what she sets out to accomplish.

Asked what should be the present focus of the SIG, Saskia responded that the SIG should declare a position on lymphedema for ONS. In addition, ONS should offer preconference instructional sessions before each annual conference, she said. After educating patients, educating healthcare workers is the focus of the NLN. Saskia said that nurses play a pivotal role in patients with lymphedema; nurses should educate patients before and after surgery, educate patients about lymphedema do’s and don’ts, and assess patients for lymphedema by identifying signs and symptoms and referring.

Recently, Saskia experienced “being a patient.” She underwent gynecologic surgery followed by chemotherapy and radiation, completed in January 2005. After the initial shock, she just proceeded forward. She said she is “absolutely not afraid.” This is how she approaches all things. She describes herself as a caretaker. She is determined to find a solution; she “needs answers.” She makes a decision and resolutely takes action. She also describes herself as “a pusher of new things.” We are all better because of this determined character.

 
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Special Interest Group Newsletter  April 2005
 
   

News From ONS



Why Should You Attend the ONS 30th Annual Congress?
Because it’s the one conference that will meet all of your professional learning needs. Held April 28–May 1 in Orlando, FL, this year’s event includes four days filled with sessions focusing on the issues affecting you and your patients in today’s cancer-care arena. Plus, special preconference programming, including the ONS Chemotherapy and Biotherapy Courses, the Radiation Therapy Course, and certification reviews, will enhance your Congress experience. For more information, visit www.ons.org/meetings/congress05/index.shtml.

2005 Oncology Nursing Day and Month Kits Are Here!
Begin preparing now for the 2005 Oncology Nursing Day and Month celebration starting Thursday, April 28, with the new nursing month kit from ONS. You can view the contents online or download the entire kit, including the new color poster. Go to www.ons.org/membership/nursemonth.shtml to get started!

Updated Radiation Manual Is Available
Supporting the ongoing efforts of radiation oncology nurses, this new, third edition provides you with expanded coverage on issues such as patient education, radiation protection, and more. Also included are new sections on evidence-based practice, new technology, clinical trials, and much more. Go to http://esource.ons.org/productdetails.aspx?sku=INPU0549 for more information and to order your copy.

Get the Latest in Priority Symptom Management (PRISM) Information
This new series of four Web casts offers timely research insights on topics key to your everyday practice. In addition, you can earn free continuing education credits when you attend each Web cast and complete and return your evaluation. Topics include sleep and fatigue in children and adolescents with cancer, computerized symptom and quality-of-life assessment, telephone support interventions, and hot flash physiology in breast cancer. Each Web cast is worth 1.2 contact hours. Visit http://onsopcontent.ons.org/education/webcasts/prism04/.

Coming Soon!
Providing an in-depth review of general and oncology nursing management principles, Nursing Management: Principles and Practice is designed to guide the practice and development of nurse managers involved with cancer care. An expert roster of contributors addresses topics such as leadership development, financial management, staff development and continuing competency, accreditation, and much more. Order your copy now and take advantage of a special new publication price. For details, visit http://esource.ons.org/ProductDetails.aspx?sku=INPU0553.

New Package Provides Discount on Standards of Practice
Save 20% when you order all four standards of oncology nursing from ONS: standards of oncology nursing practice, nursing education, oncology education, and the advanced practice nursing standards. Go to http://esource.ons.org/ProductDetails.aspx?sku=KTPU0007 for information on this valuable package deal.

Are You New to Oncology?
If so, enroll in the Cancer Basics online course series. This new, four-part, online series will provide you with a fundamental understanding of cancer care. If you are an experienced cancer professional, it will serve as a valuable review. For complete information or to register, visit http://onsopcontent.ons.org/education/distanceeducation/cancerbasics/index.shtml.

Check Out the Redesigned Evidence-Based Practice Resource Area
Use the Evidence-Based Practice Resource Area as your guide to identify, critically appraise, and use evidence to solve clinical problems. Be sure to check out the new format, which allows for much easier use and navigation. Visit http://onsopcontent.ons.org/toolkits/evidence/index.shtml.

Editor’s Choice
The Coping with Chemo Webisodes is a series of short, animated, Web-based movies that speak to teenagers in their own language about issues ranging from diagnosis to the side effects of chemotherapy and feeling out of place among peers. Visit www.slsb.org/chemo/.

 
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Special Interest Group Newsletter  April 2005
 
   

Membership Information

SIG Membership Benefits

  • Network with colleagues in an identified subspecialty area around the country.
  • Contribute articles for your SIG’s newsletter.
  • Participate in discussions with other SIG members.
  • Contribute to the future path of the SIG.
  • Share your expertise.
  • Support and/or mentor a colleague.
  • Receive information about the latest advancements in treatments, clinical trials, etc.
  • Participate in ONS leadership by running for SIG coordinator-elect or join SIG work groups.
  • Acquire information with a click of a mouse at http://sig.ons.wego.net/index.v3page;jsessionid=l5nhe8e4qt77?v2_group=0&p=4918, including
    • Educational opportunities for your subspecialty
    • Education material on practice
    • Calls to action
    • News impacting or affecting your specific SIG
    • Newsletters
    • Communiqués
    • Meeting minutes.
Join a Virtual Community

A great way to stay connected to your SIG is to join its Virtual Community. It’s easy to do so. All you will need to do is
  • Log on to the ONS Web site (http://www.ons.org/).
  • Select “Membership” from the tabs above.
  • Then, click on “ONS Chapters and Special Interest Groups.”
  • Scroll down to “Visit the ONS Special Interest Groups (SIG) Virtual Community” and click.
  • Now, select “Find a SIG.”
  • Locate and click on the name of your SIG from the list of all ONS SIGs displayed.
  • Once the front page of your SIG’s Virtual Community appears on screen, select “New User” from the top left. (This allows you to create log-in credentials.)
  • Type the required information into the text fields as prompted.
  • Click “Join Group” (at the bottom right of the text fields) when done.

    Special Notices
    • If you already have log-in credentials generated from the ONS Web site, use this information instead of attempting to generate new information.
    • If you created log-in credentials for the ONS Web site and wish to have different log-in information, you will not be able to use the same e-mail address to generate your new credentials. Instead, use an alternate e-mail address.
Subscribe to Your SIG’s Virtual Community Discussion Forum

All members are encouraged to participate in their SIG’s discussion forum. This area affords the opportunity for exchange of information between members and nonmembers on topics specific to all oncology subspecialties. Once you have your log-in credentials, you are ready to subscribe to your SIG’s Virtual Community discussion forum. To do so,
  • Select “Log In,” located next to “New User,” and enter your information.
  • Next, click on the “Discussion” tab on the top right of the title bar.
  • Now, select “Featured Discussion” from the left drop-down menu.
  • Locate and select “Subscribe to Discussion” inside the “Featured Discussion” section.
  • Go to “Subscription Options” and select “Options.”
  • When you have selected and entered all required criteria, you will receive a confirmation message.
  • Click “Finish.”
  • You are now ready to begin participating in your SIG’s discussion forum.
Participate in Your SIG’s Virtual Community Discussion Forum
  • First, log in. (This allows others to identify you and enables you to receive notification [via e-mail] each time a response or new topic is posted.)
  • Click on “Discussion” from the top title bar.
  • Select “Featured Discussion” from the left drop-down menu.
  • Click on any posted topic to view contents and post responses.
Sign Up to Receive Your SIG’s Virtual Community Announcements

As an added feature, members also are able to register to receive their SIG’s announcements by e-mail.
  • From your SIG’s Virtual Community page, locate the “Sign Up Here to Receive Your SIG’s Announcements” section. This appears above the posted announcements section.
  • Select the “Click Here” feature, which will take you to a link to subscribe.
  • Once the “For Announcement Subscription Only” page appears on screen, select how you wish to receive your announcements.
    • As individual e-mails each time a new announcement is posted
    • One e-mail per day comprised of all new daily announcements posted
    • Opt-out, indicating that you will frequently browse your SIG’s Virtual Community page for new postings
  • Enter your e-mail address.
  • Click on “Next Page.”
  • Because you have already joined your SIG’s Virtual Community, you will receive a security prompt with your registered user name already listed. Enter your password at this prompt and click “Finish.”
  • This will bring up a listing of your SIG’s posted announcements. Click on “My SIG’s Page” to view all postings in their entirety or to conclude the registration process and begin browsing.
 
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Special Interest Group Newsletter  April 2005
 
   

Lymphedema Management SIG Officers

Coordinator
Marjorie Whitman, RN, MSN, AOCN®
2505 Black Cherry Ct.
Columbia, MO 65201-3539
573-441-8636 (H)
573-884-4544 (fax)
whitmandale@mchsi.com

Coordinator-Elect
Sheila H. Ridner, PhD, RN, ACNP
1405 E. Riverwood Dr.
Nashville, TN 37216-2317
615-262-4687 (H)
615-343-8204 (fax)
sheila.ridner@vanderbilt.edu

 

Editor
Ellen Poage, RN, BSN, MPH, LMT, CLT
1326 Wales Dr.
Ft. Myers, FL 33901-7742
239-278-4930 (H)
egpoage@mac.com

ONS Publishing Division Staff
Keightley Amen, BA
Copy Editor
412-859-6258
kamen@ons.org

Know someone who would like to receive a print copy of this newsletter?
To print a copy of this newsletter from your home or office computer, click here or on the printer icon located on the SIG Newsletter front page. Print copies of each online SIG newsletter also are available through the ONS National Office. To have a copy mailed to you or another SIG member, contact Membership/Leadership Administrative Assistant Carol DeMarco at cdemarco@ons.org or 866-257-4ONS, ext. 6230.

To view past newsletters, click here.

ONS Membership/Leadership Team Contact Information

Angie Stengel, Director of Membership/Leadership
astengel@ons.org
412-859-6244

Diane Scheuring, Manager of Member Services
dscheuring@ons.org
412-859-6256

Carol DeMarco, Membership/Leadership Administrative Assistant
cdemarco@ons.org
412-859-6230

The Oncology Nursing Society (ONS) does not assume responsibility for the opinions expressed and information provided by authors or by Special Interest Groups (SIGs). Acceptance of advertising or corporate support does not indicate or imply endorsement of the company or its products by ONS or the SIG. Web sites listed in the SIG newsletters are provided for information only. Hosts are responsible for their own content and availability.

Oncology Nursing Society
125 Enterprise Dr.
Pittsburgh, PA 15275-1214
866-257-4ONS
412-859-6100
www.ons.org

 
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