Lymphedema in Breast Cancer Patients

A focus on successful cancer treatment can mean that side effects, even if they are disfiguring and debilitating, can be given lower priority. This was the case for many years with the effects of breast cancer surgery, which now can be addressed for many women with the options of breast-conserving surgery or breast reconstruction following mastectomy. However, a side effect of breast cancer treatment that may be overlooked is lymphedema, a chronic inflammation of lymph vessels of the arm, hand, and torso on the treated side. As a result of damage due to surgery, radiation, and lymph node removal, the lymphatic system is compromised, leading to swelling, numbness, pain, loss of mobility, hardening of the skin, and susceptibility to infection. The incidence of lymphedema, ranging from mild to severe, has been documented to be as high as 42 percent.¹

Understandably, this side effect, which can occur immediately or even years after treatment, can diminish the quality of life and increase depression.² It can be hard to conceal, creates problems with the functioning of the arm and hand, and the discomfort associated with it can interfere with social and sexual functioning.³ Reduction and control of lymphedema involve lymphatic draining by a trained therapist, skin cleansing, exercise, and wearing a compression garment. Such a program is time-consuming and can interfere with other areas of functioning.

Taking steps to avoid the onset of lymphedema is important because the condition is chronic once it has developed, managing the condition requires a great deal of time and effort, and resources for treatment, such as lymphedema therapists, are limited or unavailable in some areas. The suggested precautionary measures for women treated surgically for breast cancer include: avoiding infection, injury, pressure, or heat to the involved arm, using caution when shaving the underarm area, keeping one’s skin in good condition, maintaining an ideal weight, and wearing a support garments.⁴ Contrary to previous notions, exercise and even supervised weightlifting is considered safe.⁵

Education efforts have increased the likelihood that women are aware of lymphedema and its negative outcomes and the importance of preventive strategies. However, some psychological factors have been shown to be important over and above knowledge of preventive strategies. One study showed that perceptions the controllability of lymphedema and one’s abilities to engage in risk reduction strategies predicted the likelihood that patients would engage in them. The authors concluded, “this study has highlighted the importance of underlying beliefs as determinants of whether a woman who is informed about lymphedema will undertake the recommended risk management actions.”⁶