Congress Abstracts 2003

55

LYMPHEDEMA FOLLOWING BREAST CANCER TREATMENT, INCLUDING SENTINEL LYMPH NODE BIOPSY. Jane Armer, RN, PhD, Mei R. Fu, RN, MS, CNS, PhD(c), Donna A. Williams, PhD, Deidre D. Wipke-Tevis, RNC, PhD, Davina Porock, PhD, Jean M. Wainstock, RN, MS, FNP, AOCN®, Eris Zagar, RN, MS(N), AOCN^®, and Lisa Jacobs, MD, University of Missouri, Columbia, MO.

Purpose/Objectives: To compare breast cancer lymphedema (LE) occurrence and signs and symptoms among those with/without LE; and those who underwent axillary lymph node dissection (ALND), sentinel lymph node biopsy (SLNB), combined SLNB and ALND (Both), or neither as part of breast cancer diagnosis.

Design: Concurrent descriptive-comparative cross-sectional four-group design.

Sample: Convenience sample of 102 women treated for breast cancer. Methods: Sequential circumferential measurements at five selected upper extremity sites were used to determine the presence of LE (> 2 cm differences). Signs and symptoms were elicited by interview using an investigator-developed tool. Retrospective chart review was carried out to verify lymph node-related diagnostic/treatment procedures.

Data Analysis: Descriptive statistics were utilized, followed by Shapiro-Wilk test; Fisher’s Exact test; signed rank test; Wilcoxan Rank Sum tests, and Chi-square tests.

Findings: Based on node group, LE occurred as follows: 43.3% (29 of 67) of women who underwent ALND alone; 22.2% (2 of 9) of those who underwent SLNB alone; 25.0% (3 of 12) of those with both; and 22.2% (2 of 9) with neither (p = 0.37). Ten reported signs and symptoms were related (p < 0.01) to LE occurrence. LE-related symptoms were reported by all node groups. Among the node groups, three symptoms were more common (p < 0.01): larger arm size, firmness/tightness, and numbness. Tenderness was frequently reported among all four node groups (p > 0.05).

Conclusions: Although statistically nonsignificant, 43.3% of women who underwent ALND were found to have LE, a clinically relevant observation. Overall, the proportion of women who experienced LE-related signs and symptoms was higher among women who underwent ALND versus SLNB. However, numbness and tenderness frequently were reported by those undergoing ALND, SLNB or both; and by women without LE. These may be related to breast cancer surgery and not LE.

Implications For Nursing: Findings from this study can assist nurses in educating women with breast cancer about LE risk factors as well as early detection and management of LE. Symptom assessment and sequential circumferential arm measurements are recommended to evaluate limb changes subjectively and objectively concurrent with each breast cancer survivor’s follow-up care.