Objective This systematic review aimed to evaluate the level of evidence of contemporary peer-reviewed literature published from 2004–2011 on the psychosocial impact of lymphedema. Methods Eleven electronic databases were searched and 1,311 articles retrieved; 23 met inclusion criteria. Twelve articles utilized qualitative methodology and 11 employed quantitative methodology. An established quality assessment tool was used to assess the quality of the included studies. Results The overall quality of the 23 included studies was adequate. A critical limitation of current literature is the lack of conceptual or operational definitions for the concept of psychosocial impact. Quantitative studies showed statistically significant poorer social well-being in persons with lymphedema, including perceptions related to body image, appearance, sexuality, and social barriers. No statistically significant differences were found between persons with and without lymphedema in the domains of emotional well-being (happy or sad) and psychological distress (depression and anxiety). All 12 of the qualitative studies consistently described negative psychological impact (negative self-identity, emotional disturbance, psychological distress) and negative social impact (marginalization, financial burden, perceived diminished sexuality, social isolation, perceived social abandonment, public insensitivity, non-supportive work environment). Factors associated with psychosocial impact were also identified. Conclusions Lymphedema has a negative psychosocial impact on affected individuals. The current review sheds light on the conceptualization and operationalization of the definitions of psychosocial impact with respect to lymphedema. Development of a lymphedema-specific instrument is needed to better characterize the impact of lymphedema and to examine the factors contributing to these outcomes in cancer and non-cancer-related populations.

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Mdm2, an E3 ubiquitin ligase, negatively regulates the tumor suppressor p53. In this study, we utilized a conditional Mdm2 allele, Mdm2FM, and a CreER Tamoxifen inducible recombination system to examine the effects of global Mdm2 loss in adult mice. Two different Tamoxifen injection regimens caused 100% lethality of Mdm2FM/−;CreER mice. Both radio-sensitive and radio-insensitive tissues were impaired. Strikingly, a large number of radio-insensitive tissues, including the kidney, liver, heart, retina and hippocampus, exhibited various pathological defects. Similar Tamoxifen injections in older (16–18 month old) Mdm2FM/−;CreER mice showed abnormalities only in the kidney. In addition, transcriptional activation of p21, Puma and multiple senescence markers in young (2–4 month old) mice following loss of Mdm2 was dampened in older mice. All phenotypes were p53-dependent as Mdm2FM/−;p53−/−;CreER mice subjected to the same Tamoxifen regimens were normal. Our findings implicate numerous possible toxicities in many normal tissues upon use of cancer therapies that aim to inhibit Mdm2 in tumors with wild type p53.

Continuing education in principles of palliative care for advanced dementia is necessary for currently practicing nursing staff and should be developed according to their educational background and needs.