Congress Abstracts 2004

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SYMPTOM CLUSTERS OCCURRING WITH LYMPHEDEMA AFTER BREAST CANCER. Sheila H Ridner, PhD, RN, ACNP, Vanderbilt University School of Nursing, Nashville, TN.

Literature suggests that up to 28% of the 2 million United States breast cancer survivors seen by oncology nurses develop lymphedema in the affected arm.

Despite treatment that reduces limb volume, ongoing lymphedema related problems/symptoms interfere with QOL. The purpose of this study was to assess outcomes associated with lymphedema occurring after breast cancer treatment and determine if it occurs within a symptom cluster.

A revised version of the Lenz Theory of Unpleasant Symptoms served as the theoretical framework. This theory proposes that symptoms do not occur in isolation, they cluster, and all symptoms must be addressed to achieve maximum performance/function.

A convenience sample of 128 breast cancer survivors, 64 with breast cancer related lymphedema and 64 without breast cancer related lymphedema, age matched within three years, participated in this two-group, descriptive, mixed methods, correlational, cross-sectional study. Concurrent data on symptoms, sociodemographic, disease and treatment variables, and QOL were collected from all participants. Narrative comments about problems related to lymphedema were solicited from those with lymphedema.

Descriptive statistics, ANCOVA’s, partial correlations, and regression analyses were used. Thematic analysis of narrative commentary was conducted. Cronbach’s Alpha and Kuder-Richardson-20 were .78 or higher for all instruments used.

(1) Sociodemographic variables did not correlate with perceived arm size difference or actual limb volume difference; (2) BMI correlated with all outcome variables and mean symptom distress, mean symptom intensity, and lymphedema grade varied as a function of BMI; (3) individuals with lymphedema reported poorer QOL; (4) narrative comments revealed QOL, physical health, and psychological issues indicative of an interrupted life; and (5) participants with lymphedema experienced a cluster of symptoms that included alteration in limb sensation, loss of loss of confidence in body, decreased physical activity, fatigue, and psychological distress. A holistic approach to lymphedema management that addresses not only reduction of limb volume, but also altered sensations in limbs, enhancing body confidence, increasing physical activity, managing fatigue, and relieving psychological distress is needed. Research designed to gather more information about this symptom cluster and the influence of BMI on lymphedema development and symptoms is indicated.