Congress Abstracts 2005

91

LOWER EXTREMITY LYMPHEDEMA IN THE GYNECOLOGIC PATIENT. Kathleen Appollo, RN, BSN, OCN^®, Memorial Sloan-Kettering Cancer Center, New York, NY.

Lower extremity lymphedema (LEL) can be a debilitating side effect of surgery with lymphadenectomy and/or radiation therapy in the treatment of gynecologic malignancies. One retrospective survey suggests that LEL occurs in as many as 18% of women after gynecologic cancer treatment.

Information is available about upper extremity lymphedema after surgery for breast cancer; however, a review of the literature reveals limited information about prevention and treatment for LEL. Anecdotally, many women perceive that they did not receive adequate education about the possibility of LEL after treatment. The discouragement they experience in coping with dysfunction and body image changes may lead to a compromised quality of life.

Patient education for LEL may be inadequate because the primary patient educator, the nurse, lacks knowledge of LEL. This presentation will review the risks, causes, prevention strategies and treatment of LEL. It will also provide nursing assessment criteria and interventions to use in the immediate post-operative period and at follow-up visits. The benefits and limitations of physical therapy and lymphedema specialist’s treatments will be discussed. Preventive strategies include the need for early post-operative mobility, meticulous hygiene, nail and skin care, properly fitted foot ware, and prompt attention to cuts and pressure points to avoid infection. Severe lymphedema may be lessened with elevation of the extremity, use of fitted support hose, prompt treatment of infection, and early referral for physical therapy. Dietary and lifestyle changes as well as referral to support groups may be valuable coping strategies.

LEL may occur months or years after gynecologic surgery. Therefore, ongoing assessment and surveillance is necessary at every outpatient visit. Since lymphedema may herald a recurrence of cancer, nurses must be knowledgeable in deciphering the cause, especially after a long disease free interval.

This presentation reviews the risks, preventive and treatment strategies about LEL in the gynecologic patient. The information may also be pertinent to a patient having surgery with lymphadenectomy or abdominal or pelvic radiation in malignancies of the genitourinary or gastrointestinal systems or lymphoma or melanoma.