Lymphedema after gynecological cancer treatment

[patoco]

Original Article

Lymphedema after gynecological cancer treatment

May 2007

Prevalence, correlates, and supportive care needs
Vanessa Beesley, PhD 1 *, Monika Janda, PhD 1, Elizabeth Eakin, PhD 2,
Andreas Obermair, MD 3 4, Diana Battistutta, PhD 1
1Queensland University of Technology, School of Public Health,
Institute of Health and Biomedical Innovation, Brisbane, Australia
2University of Queensland, School of Population Health, Cancer
Prevention Research Centre, Brisbane, Australia
3Royal Brisbane & Women's Hospital, Queensland Centre for
Gynecological Cancer, Brisbane, Australia
4University of Queensland, School of Medicine, Brisbane, Australia

email: Vanessa Beesley (vanessa.bees...@qimr.edu.au)

*Correspondence to Vanessa Beesley, Cancer and Population Health
Group, Queensland Institute of Medical Research, P.O. Box Royal
Brisbane Hospital, Herston, QLD, 4029, Australia

This study was made possible by funding support from the Queensland
Cancer Fund and access to participants through the Queensland
Gynaecological Cancer Registry at Royal Brisbane and Women's Hospital.
Fax: +61-7 3845 3503

Keywords
lymphedema · morbidity · supportive care · gynecologic carcinoma ·
perceived needs · continuity of patient care

Abstract

BACKGROUND.
Few studies have evaluated lymphedema after gynecological cancer
treatment. The aim of this research was to establish prevalence,
correlates, and supportive care needs of gynecological cancer
survivors who develop lymphedema.

METHODS.
In 2004, a population-based cross-sectional mail survey (56% response
rate) was completed by 802 gynecological cancer survivors. The
questionnaire included demographic questions, a validated, generic
supportive care needs measure, and a supplementary, newly developed,
lymphedema needs module.

RESULTS.
Ten percent (95% confidence interval [CI], 8%-12%) of participants
reported being diagnosed with lymphedema, and a further 15% (95% CI,
13%-17%) reported undiagnosed symptomatic lower limb swelling.
Diagnosed lymphedema was more prevalent (36%) amongst vulvar cancer survivors. For cervical cancer survivors, those who had radiotherapy or who had lymph nodes removed had higher odds of developing swelling.

For uterine and ovarian cancer survivors, those who had lymph nodes
removed or who were overweight or obese had higher odds of developing
swelling. Gynecological cancer survivors with lymphedema had higher
supportive care needs in the information and symptom management
domains compared with those who had no swelling.

CONCLUSIONS.
This population-based study provided evidence that lymphedema is a
morbidity experienced by a significant proportion of gynecological
cancer survivors and that there are considerable levels of associated
unmet needs. Women at risk of lymphedema would benefit from
instructions about early signs and symptoms and provision of referral
information. Cancer 2007. © 2007 American Cancer Society.

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Received: 5 December 2006; Revised: 24 January 2007; Accepted: 6
February 2007
Digital Object Identifier (DOI)

http://www3.interscience.wiley.com/cgi- ... /ABSTRAC...

****************

Pat O'Connor
Lymphedema People
http://www.lymphedemapeople.com

[patoco]

Lymphedema in gynecologic cancer survivors: an area for exploration?

Cancer Nurs. 2007 Jul-Aug

Lockwood-Rayermann S.
From Harris College of Nursing and Health Sciences, Texas Christian
University, Fort Worth, Tex.

There is a paucity of research on the incidence and impact of lower
body lymphedema in the gynecologic cancer population. The cornerstone
of management for gynecologic cancer is cytoreductive surgery.

Depending on the site of the cancer, surgery traditionally involves
removal of the ovaries, fallopian tubes, uterus and cervix,
accompanied with extensive node dissection throughout the pelvic
cavity, and, in the case of ovarian cancer, removal of the omentum.
Resection of pelvic lymph nodes and vessels, compounded by
gravitational influences on lymphatic flow, can lead to lymphatic
congestion that impairs mobility, raises intra-abdominal pressure,
and increases abdominal and extremity girth. Lymphedema can be an
indicator of recurrence and is frequently associated with toxicities
such as skin breakdown, pain, neuropathy, and myopathy.

Physical changes, role changes, and psychosocial issues are common symptoms reported by breast cancer survivors with lymphedema. Assessment and management strategies for upper extremity lymphedema following treatment of breast cancer cannot be directly transferred to lower extremity lymphedema affecting women with cancer of the ovary, cervix, uterus, and vulva because of limb size, volume, and location.

Clinicians have anecdotally reported the presence of lower body
lymphedema in many gynecologic cancer patients. Survivors have
described tightness, swelling, and heaviness. Despite these clinical
findings, no systematic study of lower body lymphedema in women with
gynecologic cancer has been conducted. Whether lower body lymphedema
is as debilitating and long-term as post-mastectomy lymphedema is not
empirically known.

PMID: 17666969 [PubMed - in process]

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Unmet needs of gynaecological cancer survivors: implications for developing community support services.

Psychooncology. 2007 Aug 6

Vanessa Beesley 1 *, Elizabeth Eakin 2, Suzanne Steginga 3, Joanne
Aitken 3, Jeff Dunn 3, Diana Battistutta 1
1Institute of Health and Biomedical Innovation, School of Public
Health, Queensland University of Technology, Brisbane, Australia
2Cancer Prevention Research Centre, School of Population Health,
University of Queensland, Brisbane, Australia
3Viertel Centre for Research in Cancer Control, The Cancer Council
Queensland, Brisbane, Australia

email: Vanessa Beesley (vanessa.beesley@qimr.edu.au)

*Correspondence to Vanessa Beesley, Cancer and Population Studies
Group, Queensland Institute of Medical Research, PO Box Royal
Brisbane Hospital, Herston, Qld 4029, Australia

Funded by:
Cancer Council Queensland

Keywords
supportive care • cancer • perceived needs • continuity of patient
care • oncology

Abstract
After treatment completion, gynaecological cancer survivors may face
long-term challenges and late effects, specific to this disease.
Available research on supportive care needs of women with
gynaecological cancer is limited. This study aimed to determine the
prevalence and correlates of unmet needs within a population of
gynaecological cancer survivors. Eight hundred and two women
participated in a population-based mail survey in 2004 (56% response
rate).

The questionnaire included a validated instrument to assess 45 need
items across multiple supportive care domains, and a range of
measures to evaluate related correlates consistent with a social-
ecological perspective. Forty-three per cent of respondents reported
having at least one moderate- or high-level unmet need.

The five highest included needing help with fear about the cancer
spreading (17%), concerns about the worries of those close to them
(15%), uncertainty about the future (14%), lack of energy/tiredness
(14%), and not being able to do things they used to do (14%).
Subgroups of women with higher odds of reporting some unmet needs
across multiple supportive care domains include those who, are not in
remission, live with lymphoedema or are unable to work due to
illness. Odds were also higher for women who had undergone more
recent treatment, and who lived in rural or remote locations. Further
assistance with the top specific concerns of gynaecological cancer
survivors is recommended. Identified subgroups with higher needs are
important targets for support.

http://www3.interscience.wiley.com/cgi-
bin/abstract/114298371/ABSTRACT?CRETRY=1&SRETRY=0