ONS Guidelines™ for Cancer Treatment–Related Lymphedema

Armer, Jane M.; Ostby, Pamela L.; Ginex, Pamela; Beck, Malcolm L.; Deng, Jie; Fu, Mei R.; Lasinski, Bonnie B.; Lockwood, S.; Poage, Ellen; White, Joan; Maloney, Christine; Moriarty, Kerri A.; Vrabel, Mark

doi:10.1188/20.onf.518-538

Cited by 45 publications

(70 citation statements)

References 48 publications

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“…Pharmacological interventions (eg, NSAIDs, opioids) and behavioral strategies are commonly used for pain control in cancer patients. [11][12][13][14][15][16] Lymphedema treatments (e.g., manual lymph drainage, physical therapy, compression garments, upper extremity exercise, yoga) are used to control swelling. 11 Research is limited on the efficacy of interventions that target physiological factors (e.g., the compromised lymphatic drainage) to manage lymphatic pain, swelling, and lymphedema symptoms.…”

Section: Introductionmentioning

confidence: 99%

“…[11][12][13][14][15][16] Lymphedema treatments (e.g., manual lymph drainage, physical therapy, compression garments, upper extremity exercise, yoga) are used to control swelling. 11 Research is limited on the efficacy of interventions that target physiological factors (e.g., the compromised lymphatic drainage) to manage lymphatic pain, swelling, and lymphedema symptoms. The-Optimal-Lymph-Flow (TOLF) intervention, a patient-centered and nurse-led selfcare program, aims to promote lymph flow through the performance of therapeutic lymphatic exercises and strategies to achieve nutrition-balanced, portion-appropriate diet, adequate hydration, and proper sleep to minimize the risk of lymphedema.…”

Section: Introductionmentioning

confidence: 99%

“… 7 Without timely intervention in this early stage, lymphedema can progress into a chronic condition that no surgical or medical interventions can cure. 10 , 11 Thus, the effective management of lymphatic pain, swelling, and lymphedema symptoms is needed for breast cancer survivors with or without a diagnosis of lymphedema.…”

Section: Introductionmentioning

confidence: 99%

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The Effects of Kinect-Enhanced Lymphatic Exercise Intervention on Lymphatic Pain, Swelling, and Lymph Fluid Level

McTernan

Qiu

et al. 2021

Integr Cancer Ther

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Background: The-Optimal-Lymph-Flow (TOLF) intervention aims to promote lymph flow through therapeutic lymphatic exercises to relieve lymphatic pain, swelling, lymphedema symptoms, and to decrease lymph fluid levels among breast cancer survivors. To enhance the efficacy of the TOLF intervention, an innovative, intelligent, Kinect-enhanced lymphatic exercise intervention (Kinect-TOLF) was developed to teach patients to perform the lymphatic exercises correctly. Objectives: This feasibility trial aimed to determine the feasibility, usability, and effects of the Kinect-TOLF on lymphatic pain, swelling, lymphedema symptoms, and lymph fluid levels. Methods: A single-arm feasibility trial with a pre- and post-test design was employed to recruit 30 breast cancer survivors with persistent lymphatic pain or swelling. Patients received a single training session to learn how to perform the lymphatic exercises using the Kinect-TOLF program. Descriptive statistics, Wilcoxon signed-rank tests, t-test, Spearman’s rank correlation coefficients, linear regressions, and Cohen’s d were performed for data analysis. Qualitative data were assessed for common themes. Results: The Kinect-TOLF was effective in training patients to perform the lymphatic exercises correctly with high user satisfaction. Significant reductions were found in scores of lymphatic pain ( MedΔ = −1.00, CI = [−1.5, −0.1], P = .004), arm/hand swelling ( MedΔ = −1.00, CI = [−1.5, −0.5], P = .004), total swelling ( MedΔ = −1.5, CI = [−2.0, −1.0], P = .003), number of lymphedema symptoms ( MΔ = −3.8, CI = [−5.5, −2.1], P < .001), and lymphedema symptom severity ( MΔ = −5.3, CI = [−9.5, −1.1], P = .016). A significant reduction in lymph fluid levels was found in mean L-Dex scores ( MΔ = −2.68, CI = [−4.67, −0.69], P = .010). Greater decrease in mean L-Dex scores were found in patients with abnormal lymph fluid levels (L-Dex ≥ 7.1) ( MΔ = −5.19, CI = [−1.75, −8.63], P = .008). Patients’ qualitative feedback supported the results of the study. Conclusions: The Kinect-TOLF is safe, feasible, and effective in reducing lymphatic pain, swelling, lymphedema symptoms, and in decreasing lymph fluid levels. Future research should focus on a randomized clinical trial to confirm the unique or synergistic efficacy of the Kinect-TOLF in comparison with current lymphedema treatment and other forms of exercises or movement therapy. This study was registered in ClinicalTrials.gov with US ClinicalTrials.gov Identifier: NCT03999177.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Effects of Kinect-Enhanced Lymphatic Exercise Intervention on Lymphatic Pain, Swelling, and Lymph Fluid Level

McTernan

Qiu

et al. 2021

Integr Cancer Ther

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“…Lymphatic pain refers to a variety of pain sensations (i.e., pain/aching/soreness) accompanied by swelling in the ipsilateral body or upper limb due to a compromised lymphatic system following cancer treatment [15]. Lymphedema is a chronic and incurable condition caused by an abnormal accumulation of lymph fluid in the ipsilateral body or upper limb after cancer treatment [16]. Swelling and lymphedema reflect an inflammatory pathological condition [17,18].…”

Section: Introductionmentioning

confidence: 99%

“…As the cardinal symptoms of early-stage lymphedema, lymphatic pain and swelling (i.e., arm swelling and truncal swelling) are symptoms that often precede changes in limb size or girth or a lymphedema diagnosis [18]. Without timely intervention, this early disease stage can progress into lymphedema that no surgical or medical interventions can cure [16]. In addition, arm swelling defined by an objective measure of interlimb volume or circumference differences) and lymphedema severity (defined by Common Toxicity Criteria) were less correlated with quality of life than arm symptoms (e.g., arm pain and swelling) [19].…”

Section: Introductionmentioning

confidence: 99%

The Effects of Obesity on Lymphatic Pain and Swelling in Breast Cancer Patients

Axelrod

Guth

et al. 2021

Biomedicines

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Lymphatic pain and swelling due to lymph fluid accumulation are the most common and debilitating long-term adverse effects of cancer treatment. This study aimed to quantify the effects of obesity on lymphatic pain, arm, and truncal swelling. Methods: A sample of 554 breast cancer patients were enrolled in the study. Body mass index (BMI), body fat percentage, and body fat mass were measured using a bioimpedance device. Obesity was defined as a BMI ≥ 30 kg/m2. The Breast Cancer and Lymphedema Symptom Experience Index was used to measure lymphatic pain, arm, and truncal swelling. Multivariable logistic regression models were used to estimate the odds ratio (OR) with 95% confidence interval (CI) to quantify the effects of obesity. Results: Controlling for clinical and demographic characteristics as well as body fat percentage, obesity had the greatest effects on lymphatic pain (OR 3.49, 95% CI 1.87–6.50; p < 0.001) and arm swelling (OR 3.98, 95% CI 1.82–4.43; p < 0.001). Conclusions: Obesity is a significant risk factor for lymphatic pain and arm swelling in breast cancer patients. Obesity, lymphatic pain, and swelling are inflammatory conditions. Future study should explore the inflammatory pathways and understand the molecular mechanisms to find a cure.

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