Medicine and Health Sciences Commons^™

Implementation Of Lymphedema Education Toolkit For Nurse Coordinators, Heather Gee

Master's Projects and Capstones

Problem: Lymphedema is a chronic condition that develops secondary to cancer treatments such as chemotherapy, radiation, and surgical removal of affected lymph nodes. This swelling in patient’s limbs can cause discomfort and limit mobility, however lymphedema is often not detected until later stages, delaying treatment and patient education.

Context: This quality improvement project was conducted at Hospital S Women’s Cancer Center, an outpatient center specializing in advanced treatments for breast and gynecological cancers. This center has a multidisciplinary team focusing on both the medical and surgical aspects of oncology treatment.

Interventions: An evidence-based lymphedema education toolkit was created for nurse …

Application Of Lymphedema Education Toolkit For Nurse Coordinators, Julian K. Miranda

Master's Projects and Capstones

Problem: There is approximately one in five breast cancer survivors affected by breast cancer-related lymphedema (BCRL), a potentially debilitating condition affecting the physical, emotional, social, and financial well-being of individuals. Context: This Quality Improvement (QI) project was conducted at an outpatient facility of Hospital X’s Women’s Cancer Center. Within this microsystem, there are 24 permanent clinical nurse coordinators and advanced practice providers, with 15 nurse coordinators dedicated to care for patients with breast cancer or gynecological conditions. Intervention: The intervention aims to evaluate if a standardized educational tool improves early interventions for patients with lymphedema and knowledge among healthcare providers …

Getting Off On The Right Foot: Addressing Severe Lymphedema Through A Novel Shoe Design, Carl R. Russell Iii, Anjollie M. Ramakrishna, Christopher H. Johns Iii, Alana V. Van Wijnen

Purdue Journal of Service-Learning and International Engagement

Engineering Projects in Community Service (EPICS) is a service-learning design program run by the College of Engineering at Purdue University. EPICS teaches students design skills by providing solutions for individuals, communities, and organizations in the surrounding area while mirroring engineering industry standards. Biomedical Engineering is a team within EPICS that strives to serve community partners through biomedical applications. HR is a patient who suffers from severe lymphedema. This condition results in her foot swelling three times its original size and requires her to utilize weekly leg compression therapy. Prescription shoes are slightly adequate. However, they lead to sores and pain …

Expanding The Occupational Therapy Oncology Rehabilitation Program At James A. Haley Veterans' Hospital, Annalisa M. Rodriguez

Department of Occupational Therapy Entry-Level Capstone Projects

No abstract provided.

Coping Mechanisms For Lymphedema: An Analysis Of Patient Experiences., Claudia Admoun, Harvey N. Mayrovitz

HPD Articles

Background and objective Lymphedema is a condition caused by impaired lymphatic function. Acquired lymphedema is often due to neoplasia, infection, trauma, or radiation damage. Most patients rely on advice from fellow patients and personal research to manage their symptoms. We believe coping mechanisms for lymphedema can be more streamlined and made easily accessible if the most common effective strategies are determined and collected in a single repository for reference. To that end, we aimed to assess the experiences of lymphedema patients and the coping mechanisms they employed. Methods Feedback from lymphedema patients was obtained using a 19-item questionnaire-based survey distributed …

Early Manual Lymphatic Drainage With Secondary Edema, Tiana Bridges Mot/S, Carly Fallin Mot/S, Emma Hilliard Mot/S, Olivia Holmes Mot/S, Kathryn Mullins Mot/S, Jonathan Richardson Mot/S, Cassie Warlick Mot/S

Master of Occupational Therapy Student Critically Appraised Topics

Implementation of an early manual lymphatic drainage program on post-op head/neck patients to decrease secondary edema.

Lymphatic Dysfunction And Associated Systemic Inflammation In Lymphedema, Assessed By Nirf-Li Imaging And Plasma Cytokine/Chemokine Analysis, Anna Vang

Dissertations & Theses (Open Access)

Breast cancer-related lymphedema (BCRL) manifests as swelling of the upper extremities and trunk as a result of lymphatic fluid buildup due to radiation therapy (RT), surgical lymph node removal, or chemotherapy. As there is currently no cure, BCRL treatment aims to improve quality of life (QOL). First-line treatment involves specialized massage therapy and the use of compression garments. Second-line treatments include reparative lymphatic microsurgeries such as lymphovenous bypass (LVB) and/or vascularized lymph node transplant (VLNT). There is a need for better understanding of the etiology of BCRL and lymphatic microsurgery outcomes. Blood specimens and near-infrared fluorescent lymphatic imaging (NIRF- LI)data …

Variation In Leg Tissue Dielectric Constant Values Of Healthy Young Adult Females With And Without Compression Bandaging., Suzie Ehmann, Harvey N. Mayrovitz

HPD Articles

Background The clinical efficacy of a compression application has been often limited to the assessment of the change in limb volume, change in clinical symptoms (i.e., wound size, pain, range of motion, incidence of cellulitis), or vascular hemodynamics of the whole limb. Assessing compression-related biophysical changes of a localized area, such as around a wound, or in an area outside of an extremity cannot be objectively assessed by these measurements. Tissue dielectric constant (TDC) values, which provide a measure of the local tissue water (LTW) content, offer an alternative method to document variation in the LTW content of the skin …

Does The Osteopathic Pedal Pump Reduce Lower Limb Volume In Healthy Subjects?, Jill S. Adams, Sahil H. Parikh, Brandon J. Goodwin, Donald R. Noll

Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship

CONTEXT: Lymphatic treatments are gentle and passive techniques believed to enhance movement of lymph back into the central circulatory system. Animal studies provide supportive evidence, yet there are few studies in humans.

OBJECTIVES: The aim of this study is to investigate whether the osteopathic pedal pump protocol reduces volume in the lower limbs of healthy subjects.

METHODS: A total of 30 first- and second-year medical students were recruited. Subjects were excluded from participating if they had acute asthma, chronic obstructive pulmonary disease (COPD), congestive heart failure, active infections, fractures of the lower extremities, or metastatic cancer. A within-subjects study design …

Plasma Cytokines/Chemokines As Predictive Biomarkers For Lymphedema In Breast Cancer Patients, Anna R Vang, Simona F Shaitelman, John C Rasmussen, Wenyaw Chan, Eva M Sevick-Muraca, Melissa B Aldrich

Journal Articles

Breast cancer-related lymphedema (BCRL) occurs in ~ 40% of patients after axillary lymph node dissection (ALND), radiation therapy (RT), or chemotherapy. First-line palliative treatment utilizes compression garments and specialized massage. Reparative microsurgeries have emerged as a second-line treatment, yet both compression and surgical therapy are most effective at early stages of LE development. Identifying patients at the highest risk for BCRL would allow earlier, more effective treatment. Perometric arm volume measurements, near-infrared fluorescent lymphatic imaging (NIRF-LI) data, and blood were collected between 2016 and 2021 for 40 study subjects undergoing treatment for breast cancer. Plasma samples were evaluated using MILLIPLEX …

Patient-Reported Outcome Measures Of Function And Quality Of Life In Individuals With Lower Extremity Lymphedema: A Scoping Review, Rachel A. Dratnol, Laura H. Vanpuymbrouck

The Open Journal of Occupational Therapy

Background: Lower extremity lymphedema (LEL) is more prevalent than lymphedema in other body parts. Assessing lymphedema severity and impact on occupational functioning and quality of life (QOL) is essential to client-centered care in occupational therapy. The purpose of this study was to identify and compare the patient-reported outcome measures (PROMs) available to assess QOL and/or level of functioning in individuals with LEL and studies using such assessments.

Method: A search of two online databases (PubMed and CINAHL) yielded 15 studies. A scoping review was completed.

Results: Numerous PROMs were identified in the development and/or validation studies or …

Conducting A Supportive Oncology Clinical Trial During The Covid-19 Pandemic: Challenges And Strategies, Jie Deng, John N. Lukens, Joy C. Cohn, Erin Mcmenamin, Barbara Murphy, Bryan A. Spinelli, Niya Murphy, Alicia K. Steinmetz, Megan A. Landriau, Alexander Lin

Department of Physical Therapy Faculty Papers

The coronavirus disease 2019 (COVID-19) pandemic resulted in severe interruptions to clinical research worldwide. This global public health crisis required investigators and researchers to rapidly develop and implement new strategies and solutions to mitigate its negative impact on the progress of clinical trials. In this paper, we describe the challenges, strategies, and lessons learned regarding the continuation of a supportive oncology clinical trial during the pandemic. We hope to provide insight into the implementation of clinical trials during a public health emergency to be better prepared for future instances.

Trial registration: ClinicalTrials.gov, a service of the US National Institute of …

Promoting Self-Management Of Breast Cancer-Related Lymphedema Through The Remotivation Process, Kaye Rubio, Patricia Bowyer, Sherry Hite, Vidya Pingale, Wyona Freysteinson, Gayle Hersch, Christine Raber Phd, Otr/L

The Open Journal of Occupational Therapy

Background. Lymphedema affects a significant number of women with breast cancer. Self-Management Programs (SMP) are important in the long-term management of chronic conditions such as lymphedema. Motivation is crucial in the daily performance of the SMP. The study explored the effect of the Remotivation Process on the motivation of women with breast cancer-related lymphedema to incorporate an SMP into their daily routine.

Methodology. The study was a within-subjects quasi-experimental design that used the Volitional Questionnaire, frequency count of the SMP, and circumferential measurement as outcome measures. Eleven participants (n = 11) with breast cancer-related lymphedema completed the study …

Prediction Of Breast Cancer-Related Lymphedema By Dermal Backflow Detected With Near-Infrared Fluorescence Lymphatic Imaging, Melissa B Aldrich, John C Rasmussen, Sarah M Desnyder, Wendy A Woodward, Wenyaw Chan, Eva M Sevick-Muraca, Elizabeth A Mittendorf, Benjamin D Smith, Michael C Stauder, Eric A Strom, George H Perkins, Karen E Hoffman, Melissa P Mitchell, Carlos H Barcenas, Lynn E Isales, Simona F Shaitelman

Journal Articles

PURPOSE: Mild breast cancer-related lymphedema (BCRL) is clinically diagnosed as a 5%-10% increase in arm volume, typically measured no earlier than 3-6 months after locoregional treatment. Early BCRL treatment is associated with better outcomes, yet amid increasing evidence that lymphedema exists in a latent form, treatment is typically delayed until arm swelling is obvious. In this study, we investigated whether near-infrared fluorescence lymphatic imaging (NIRF-LI) surveillance could characterize early onset of peripheral lymphatic dysfunction as a predictor of BCRL.

METHODS: In a prospective, longitudinal cohort/observational study (NCT02949726), subjects with locally advanced breast cancer who received axillary lymph node dissection and …

Feasibility And Effectiveness Of A Prehabilitation Program Prior To Breast Cancer Surgery: A Critically Appraised Topic, Emma Choi, Alissa Lee, Kayla Woods, Morgan Mills, Carol Houston

Master of Occupational Therapy Student Critically Appraised Topics

The purpose of our project is to determine the feasibility and effectiveness of a prehabilitation (prehab) program for patients undergoing breast cancer surgery as compared to only receiving post-surgical rehabilitation. Our clinical mentor has recently obtained certification as a lymphedema specialist and is assisting with the opening of an outpatient mastectomy clinic through the Methodist University systems. Through our research process, we critically appraised two Level II articles, two Level III articles, and one Level IV article. Positive outcomes related to the feasibility were identified, however there is limited significant evidence supporting the effectiveness of the intervention. We recommend using …

The Relationship Between Head And Neck Lymphedema And Dysphagia For Individuals With Oropharyngeal Cancer: A Retrospective Study, Madison A. Cherry

OT Student Capstones

The American Cancer Society (2022) estimates about 54,000 new cases of oropharyngeal cancer in 2022. Oropharyngeal cancer, a type of head and neck cancer (HNC), typically refers to cancer in the base of tongue, oropharynx, tonsils, or mouth. The American Cancer Society (as cited by Cohen et al., 2016) recommends that physicians assess HNC survivors for lymphedema and refer them to a lymphedema therapist if necessary. Lymphedema presents as soft-tissue swelling and localized accumulation of high-protein fluid that can cause an inflammatory response resulting in disfigurement, tissue fibrosis, functional limitation, pain, and infections (Gutiérrez et al., 2020). There are two …

The Effects Of A Teletherapy Follow-Up Education Program On The Quality Of Life And Self-Care Management Of Lymphedema Among Breast Cancer Patients: A Doctoral Capstone Experience, Victoria Tanyag

OT Student Capstones

Background and Purpose. The primary purpose of this doctoral capstone research project was to evaluate the effect of a teletherapy follow-up education program on the participants’ quality of life in lymphedema management. A secondary objective was to determine whether an increase occurred in compliance and independence in the following recommended lymphedema management protocols within the home setting. Methods. A 14-week prospective study design was conducted at Banner Gateway Medical Center (BGMC). Eight female subjects (mean age of 61.88 years) were recruited and randomized into two treatment groups. The control group resumed care as usual. The intervention group participated in a …

Pilot Study For Use Of The Spurgeon Methodtm Of Breast Massage After Mastectomy, Cynthia L. Veazey

OT Student Capstones

Importance: Reduced range of motion of the shoulder and chronic pain negatively affect the ability to complete daily activities and the mental and physical quality of life for women after breast cancer surgery. Objective: To assess the results over time of the Spurgeon MethodTM of breast massage after breast cancer surgery in improving shoulder range of motion and performance of activities of daily living. Design: Mixed methods pilot study performing the Spurgeon MethodTM protocol with participants once a week for six weeks. Setting and Participants: The setting was The Caring Place, a nonprofit program managed by the Nevada Childhood Cancer …

The Effect Of Apical Axillary Lymph Node Dissection On The Incidence Of Upper Arm Lymphedema, Ahmed S. Elgammal, Ahmed A. Fawzy, Mohammed N. S. Nassar

Menoufia Medical Journal

Objectives The aim of this study is to determine the relation between apical axillary lymph node dissection (ALND) and upper arm lymphedema in patients with breast cancer. Background Lymphedema is a swelling that occurs when protein-rich lymph fluid accumulates in the interstitial tissue, and it is the most common complication following axillary dissection. This lymph fluid may contain plasma proteins, extravascular blood cells, excess water, and parenchymal products. Few studies have discussed ALND levels as a possible risk factor of upper arm lymphedema. Patients and methods This is a prospective clinical study that included 70 women with well-established diagnosis of …

Surgical Techniques For Lymphedema Management, Matthew Kayal, Shelley Dicecco

Research Day

Introduction: Lymphedema is known as a debilitating disease where the management plan can require a combination of surgical and conservative treatments. Worldwide, greater than 300 million people suffer from lymphedema. The lymphatic system is responsible for the drainage of fluid from the interstitial tissues and organ systems and is the body’s primary way of managing edema. The aim of this review was to investigate the efficacy of the procedures and the multiple surgical options that exist for the treatment of lymphedema, including the Charles procedure, liposuction or suction-assisted protein lipectomy (SAPL), lymphovenous anastomosis (LVA), and vascularized lymph node transfer (VLNT). …

Clinical Relevance Of Quantifying Pelvic Lymph Nodes For Predicting And Treating Genital Lymphedema, Shelley Dicecco

Research Day

Anatomical research on the pelvic lymph nodes (LN) is inadequate. According to previous research there are between 41-154 LNs in the pelvic region (Inguinals-Lumbar) based on reported mean values across several studies. This range should be considered too large for a surgeon to decide how many LN to remove for diagnosing cancer without causing unnecessary harm or for a lymphedema therapist to explain expectations of involvement or improvement to a person with lymphedema. A more precise understanding of numbers and LN removed can help guide a therapist’s treatment with genital lymphedema. Muscles can assist in pumping fluid from an involved …

Quantitative Analysis Of Cadaveric Pelvic Lymph Nodes, Brandon Y. Boeur, Matthew P. Kayal, Jade Johnson, Yuhyun Kang, Kelsey Rice, Alicia Schmidt, Shelley Dicecco

Research Day

Introduction: Lymphedema commonly develops as a result of cancer treatments, including surgical removal of lymph nodes (LN). Research suggests there are 500-800 (LN) throughout the body. Deciding how many LN to remove and predicting possible severity of damage can become problematic when the range of LN in one area can vary by 30 LN.

Objective: The purpose of this study was to investigate more precise ranges of pelvic LN within cadaver samples.

Methods: Quantification of LN for number occurred on cadavers simultaneous with DO, PT, and PA students’ dissections. Demographics of the cadavers were 27 female, 16 male, 39 Caucasian, …

Evaluation Of Clinical Morbidities And Their Influence On Quality Of Life In Patients With Oral Cavity Cancer After Radiotherapy, Hao-Wei Tang, Tung-Hao Chang, Kuan-Lin Chen, Kuo-Yang Tsai, Su-Fen Liao, Wei-Te Wang

Rehabilitation Practice and Science

Background: Oral cavity cancer is the most common cancer in middle-aged men in Taiwan. Radiation fibrosis syndrome and lymphedema are the leading side effects in patients with oral cavity cancer, and can deteriorate their quality of life (QOL). The aim of this study was to prospectively evaluate common morbidities and their influences on QOL in patients with oral cavity cancer. Methods: 27 patients with oral cavity cancer who received surgery and radiotherapy (RT) were recruited. Clinical evaluations of each patient included the VAS pain scale, the lymphedema scale, facial distance measurement for lymphedema, maximal interincisal distance (MID), range of motion …

The Influence Of Breast Cancer Related Lymphedema On Women’S Return-To-Work, Yuanlu (April) Sun, Cheryl Shigaki, Jane Armer

Nursing Faculty Works

Background: Lymphedema is one of the major treatment complications following breast cancer surgery and radiation. As the majority of women who develop breast cancer are at the age of employment, occupational functioning and employment are issues of concern. This study is novel in exploring the ways that lymphedema affects their work experience. Methods: A multiple-case study methodology drawn from Yin’s definition was employed. A total of 13 female survivors who developed breast cancer–related lymphedema participated by completing a survey and a 60-min semi-structured interview. Results: Four main themes emerged: (1) breast cancer–related lymphedema affects physical and emotional functioning associated with …

Effectiveness Of Therapeutic Exercise To Improve Arm And Breast Symptoms In The Post-Operative Breast Cancer Patients, Jui-Hsiang Sung, Chao-Chun Huang, Kai-Jie Yang, Kuan-Cheng Chen

Rehabilitation Practice and Science

Background: Breast cancer is one of the most common cancers in women worldwide. Current options for breast cancer therapy include surgical excision, radiotherapy, and chemotherapy. Many studies have indicated that multifactorial exercise and complete decongestive therapy have positive effects on post-operative/post-radiotherapy lymphedema and shoulder dysfunction (i.e., range of motion). Quality of life after cancer therapy has been a great concern. Many cancer-specific evaluation tools, such as EORTC QLQ - BR23 for breast cancer, have been established in recent years to evaluate quality of life. Objectives: To confirm the effectiveness of therapeutic exercise and complete decongestive therapy on arm and breast …

Efficacy Of Evidence-Based Exercise As A Treatment For Breast Cancer Related Lymphedema, Eric Kartevold, Katrina Maañao Perez, Malcolm Reed

School of Occupational Therapy Master's Capstone Projects (2016-2021)

Breast cancer related lymphedema (BCRL) of the upper extremity is a frequent sequela following axillary node dissection (AND). A recent meta-analysis by Gillespie et al. (2018), suggested a 21.4% incidence of chronic arm edema post breast cancer intervention. Gillespie et al. (2018) explained that because of a lack of diagnostic criteria for BCRL, incidence reports varied widely from less than 5% to over 50%.

The purpose of this review was to determine the efficacy of exercise in the self-management of BCRL, including the types and frequency of exercise. Protocols from 24 articles on the self-management of BCRL, including exercise as …

Comparison Of Quantitative Analysis To Qualitative Analysis For Interpretation Of Lower‑Limb Lymphoscintigraphy, Edward Nganga, Khalid Makhdomi

Imaging & Diagnostic Radiology, East Africa

Qualitative analysis of lymphoscintigrams is subject to wide variability and may miss subtle differences in ilioinguinal uptake between normal and abnormal limbs. This study compared quantitative analysis to qualitative analysis of lower‑limb lymphoscintigraphy in diagnosing lymphedema. Fifty‑two lymphoscintigrams performed using standardized protocol, 99‑metastable technetium nanocolloid intradermal injection at the first interdigital space, were analyzed quantitatively. Fifty‑three normal and 51 abnormal limbs were analyzed. For each limb, a region of interest (ROI) was drawn around the injection site, and ilioinguinal nodes on the 1.5 h static images and the counts in these ROIs were recorded. Percentage ilioinguinal nodes uptake was then …

Lymphedema Techniques To Manage Edema After Sci: A Retrospective Analysis, Rebecca Hammad, Catherine Furbish, W. Mark Sweatman, Edelle Field-Fote

Rebecca Hammad

Lymphatouch As A Tool For Manual Lymph Drainage: A Therapist's Perspective, Karlie D. Kimball

Occupational Therapy: Student Scholarship & Creative Works

Lymphedema, swelling due to impaired flow of lymph fluid, is a result of interrupted lymph circulation of the lymphatic system (McLafferty, Hendry, & Farley, 2012). This project aims to review and synthesize literature regarding the physiology of the lymphatic system, treatment of lymphedema involving the use of manual lymph drainage (MLD), and technology advances in the use of negative pressure in treatment and intervention in lymph flow. In addition to the literature review and synthesis, one Certified Lymphedema Therapist and physical therapist will be interviewed and asked to provide commentary on her experience using an advanced technology, the LymphaTouch®.

National Survey Of Lymphedema Therapists’ Dosing Of Complete Decongestive Therapy In Breast Cancer Survivors With Lymphedema, Katie M. Polo, Peter J. Rundquist, Nathaniel D. Krumdick, Gail L. Gamble

Internet Journal of Allied Health Sciences and Practice

Purpose: The purpose of this study was to identify dosing levels of complete decongestive therapy (CDT) with survivors with Breast Cancer-Related Lymphedema (BCRL) and describe factors related to how occupational therapists, occupational therapy assistants, physical therapists, and physical therapists assistants with advanced lymphedema training determine dosing.

Methods: An electronic survey was sent to 598 occupational therapists, occupational therapy assistants, physical therapists, and physical therapists assistants with training in lymphedema. Respondents completed questions regarding demographics, dosing practices, and factors related to dose determination in complete decongestive therapy of survivors with Breast Cancer-Related Lymphedema.

Results: 107 surveys were returned (18% response rate). …