Financial cost of lymphedema borne by women with breast cancer

Psycho-Oncology Published by John Wiley & Sons Ltd.Objective: Our study examines the financial cost of lymphedema following a diagnosis of breast cancer and addresses a significant knowledge gap regarding the additional impact of lymphedema on breast cancer survivors. Methods: An online national survey was conducted with 361 women who had either breast cancer without lymphedema (BC) (group 1, n = 209) or breast cancer with lymphedema (BC+LE) (group 2, n = 152). Participant recruitment was supported by the Breast Cancer Network Australia and the Australasian Lymphology Association. Results: Both breast cancer and lymphedema result in significant out-of-pocket financial costs borne by women. Of patients with BC+LE, 80% indicated that their breast cancer diagnosis had affected them financially compared with 67% in the BC group (P \u3c .020). For patients with lymphedema, over half (56%) indicated that this specific additional diagnosis to their breast cancer affected them financially and that costs increased with lymphedema severity. The cost of compression garments formed a large proportion of these costs (40.1%). The average number of attendances to a therapist each year was 5.8 (range, 0-45). Twenty-five patients (16.4%) had an episode of cellulitis in the past year. The incidence of cellulitis was 7.7% in 91 patients with subclinical or mild lymphedema compared with 29.5% of 61 patients with more extensive lymphedema (P \u3c .001). The average out-of-pocket financial cost of lymphedema care borne by women was A$977 per annum, ranging from A$207 for subclinical lymphedema to over A$1400 for moderate or severe lymphedema. Conclusions: This study identifies an additional detrimental effect of lymphedema on women in terms of financial costs

The Role of information sources and objective risk status on lymphedema risk-minimization behaviors in women recently diagnosed with breast cancer

Purpose/Objectives: To assess the role of education sources and objective risk status on knowledge and practice of lymphedema risk-minimization behaviors among women recently diagnosed with breast cancer. Research Approach: Prospective survey. Setting: A hospital in Sydney, Australia. Participants: 106 women recently diagnosed with breast cancer at increased risk for developing lymphedema following lymph node dissection. Methodologic Approach: A questionnaire administered at the time of surgery and three months after surgery measured demographics, lymphedema knowledge, lymphedema information sources used, and adherence to risk-minimization recommendations. Main Research Variables: Lymphedema knowledge, source of information used, objective lymphedema risk, and adherence to risk-minimization behaviors. Findings: Knowledge was high and increased over time. Lymphedema information from the clinic (e.g., brochures, nursing staff) was the most cited source. Adherence to recommendations was moderate; nonadherence was mostly for behaviors requiring regular enactment. Regression analysis revealed that only receipt of information from nursing staff and lymphedema knowledge three months after surgery were significant predictors of risk-minimization behaviors. Conclusions: Exposing women to lymphedema risk information at the time of breast cancer diagnosis facilitates increased awareness and enactment of risk-minimization behaviors. Nursing staff play a key role in disseminating this information and in convincing women to perform the recommendations. Interpretation: Provision of lymphedema education by breast clinic staff is critical to ensure that women realize the importance of early detection and treatment. Reminder booster sessions by nursing staff may be beneficial particularly for longer-term knowledge retention and adherence to recommended behaviors.9 page(s

Psychosocial predictors of adherence to lymphedema risk minimization guidelines among women with breast cancer

Background The effective management of lymphedema risk following breast cancer surgery and treatment requires enactment of simple behavioural strategies, including regularly checking for early lymphedema symptoms. Adopting a broad self-regulatory perspective, our aim for this study was to identify psychological factors associated with adherence to these risk management strategies. Methods Women (N=98) recently diagnosed with breast cancer and scheduled for breast and lymph node surgery completed questionnaires prior to surgery and at 3months post-surgery. Variables assessed included demographics, cognitive belief variables in relation to lymphedema and its management (perceived negative consequences, perceived lymphedema controllability, self-efficacy, perceived personal risk, perceived self-regulatory ability to manage risk-related distress), lymphedema knowledge, trait anxiety and adherence to lymphedema risk management recommendations. Results Greater adherence was associated bivariately with greater beliefs in lymphedema controllability, self-efficacy, perceived consequences and perceived self-regulatory ability. Linear regression analyses revealed that only greater beliefs in the controllability of lymphedema and self-regulatory ability, as well as greater knowledge, were predictive of greater adherence to risk management strategies. Conclusions This study highlights the importance of underlying beliefs as determinants of whether a woman who is informed and knowledgeable about lymphedema risk and its management will undertake the recommended risk management actions. Along with raising awareness of lymphedema and its risk management, health professionals should promote positive beliefs among women regarding the controllability of lymphedema through early-detection/early-treatment approaches. In addition, educational approaches should aim to enhance a woman's beliefs in her ability to adhere to these risk management recommendations over time.7 page(s

Monitoring processing style and pre-surgical distress predict reported neuropathic pain in women with breast cancer

Background: Pain is a commonly-reported symptom following surgery that is more likely to occur in individuals distressed prior to surgery. Moreover, monitoring processing style has been associated with reporting of somatic symptoms, but not specifically pain. The aim of this clinical study was to investigate whether pre-surgical distress and monitoring processing style predicted post-surgical pain in women undergoing breast surgery. Methods: Women scheduled to undergo breast cancer surgery (N=104) completed pre-surgical assessments of cancer-specific and generalised-distress, and monitoring style. Self-reported neuropathic pain was assessed at 3-months post-surgery. Findings: Post-surgical mean neuropathic pain was 19.33 (low to moderate pain). Backwards linear regression indicated that greater cancer-specific distress (p=.01) and higher monitoring scores (p=.02), as well as younger age (p<.0001) were predictive of post-surgical pain. Discussion: Since the reduction of post-surgical pain is a key goal of healthcare, attention should be given to alleviating pre-surgical cancer-specific distress, particularly for high monitoring individuals.1 page(s

Body positional effects on bioimpedance spectroscopy measurements for lymphedema assessment of the arm

Background: Bioimpedance spectroscopy (BIS) measurements have conventionally been performed using a device that uses gel-backed electrodes with the patient in a supine position. More recently, impedance devices that use stainless steel electrodes with the patient in a standing position have become available. The aim of this study was to assess and compare BIS measurements made in three different body positions using two different impedance devices (lead device and stand-on device) in women with and without arm lymphedema.Methods: A cross-sectional study design was used to recruit two cohorts of women, healthy controls (n = 47) and those who had been diagnosed with breast cancer (n = 53) and were either at risk of (n = 14) or with unilateral arm lymphedema (n = 39). BIS measurements were taken three times in each position for each device.Results: Impedance measurements were reliably made using either a lead or stand-on device with a coefficient of variation being 0.6% or lower. Absolute impedance measurements for the stand-on device were larger than the comparable lead device values due to the difference in electrode position, but were highly correlated (r = 0.92, p < 0.0001). Interarm impedance ratios and L-Dex scores were slightly (3.1% equivalence), but significantly different.Conclusion: The findings support impedance measurements being made reliably using either the lead or stand-on device, representing supine and upright measurement positions, respectively. Data between devices were, however, not directly interchangeable

Perceived barriers to adherence to breast cancer-related lymphoedema self-management

Background: Self-management is critical for the effective maintenance of breast-cancer related lymphoedema (BCRL), but levels of adherence are suboptimal. Aims: To compare the perceptions of lymphoedema therapists with those of women affected with BCRL regarding barriers to self-management. Methods: One-hundred-and-sixty-two women with breast cancer-related lymphoedema and 98 lymphoedema therapists were recruited. Participants completed an online survey assessing perceived barriers to adherence to lymphoedema self-management. Results: Multivariate analysis of variance indicated a significant difference between the extent to which therapists and affected women agreed that each of the seven perceived barriers negatively impact adherence. For each perceived barrier, therapists were more likely to agree that it negatively impacts adherence, while affected women were more likely to disagree that it negatively impacts adherence. Conclusion: The results suggest a need for improvements in communication between patients and care providers.7 page(s

Psychosocial factors associated with adherence for self-management behaviors in women with breast cancer-related lymphedema

Purpose Cognitive and affective psychosocial factors have been found to underlie adherence to preventive behaviors in women at risk of developing lymphedema following treatment for breast cancer. The aim of this study was to determine if these factors are associated with adherence to self-management behaviors for women diagnosed with breast cancer-related lymphedema (BCRL). Methods Women with BCRL were recruited through a community-based breast cancer organization and three Australian lymphedema treatment clinics. Participants completed an online questionnaire assessing demographics, medical history, adherence to self-management behaviors, psychosocial variables (personal control, treatment control, consequences, distress, and self-regulation of affect), and knowledge about lymphedema self-management. Results A total of 166 women participated in the study. Participants reported adhering to a mean of five out of seven behaviors, with 19.5 % of participants adhering to all seven behaviors. Adherence to individual behaviors ranged from 65 % (self-lymphatic drainage) to 98.2 % (skin care). Greater knowledge about lymphedema was significantly correlated with higher adherence. Hierarchical multiple linear regression analysis indicated that only medical history factors (time since diagnosis and having undergone hormone replacement therapy) predicted a significant amount of the variance in adherence. Conclusion These findings highlight the importance of patient knowledge for optimal adherence to a self-management regimen. In addition, medical history factors may identify if a patient is at risk of nonadherence. The lack of association of adherence with other psychosocial factors considered in this study indicates that factors underlying adherence in affected women differ considerably from those factors prompting preventive behavior adherence in the at-risk population.8 page(s