My first preceptor was a nursing assistant who had been treated for breast cancer several years prior to my orientation. While I didn’t know the extent of her disease or treatment, I can still remember the tight wrap that she wore on her left arm and the arm exercises that she would do whenever we had a little “down time” on the unit.
I couldn’t help but think of this woman, who helped me get started on my path into nursing, when I read Self-Management of Lymphedema: A Systematic Review of the Literature From 2004 to 2011, published in the August issue of Nursing Research. Self-management has long been recommended for the treatment of lymphedema as this chronic condition cannot be cured medically or surgically; lifetime self-management is necessary to control swelling exacerbations, prevent infections, and manage other lymphedema-associated symptoms, including reduced activity and fatigue.
Sixteen articles met the inclusion criteria for this systematic review and based on the review, the authors identified ten categories of self-management:
* Advanced pneumatic compression devices
* Compression garments
* Full-body exercise
* Infection management
* Phase 2 complete decongestive therapy (includes self-administered manual lymphatic drainage [MLD], compression garments, bandaging, exercise, and skin care)
* Simple MLD
* Skin care
* Weight reduction
This review found that full-body exercise and Phase 2 CDT are likely to be effective self-management techniques for lymphedema, however, randomized control trials supporting Phase 2 CDT are lacking. Effectiveness was not established for advanced pneumatic compression, compression garments, full-body exercise, self-monitoring, skin care, simple MLD, and weight reduction as stand-alone therapies. Also, based on the evidence, aromatherapy was deemed effectiveness unlikely and should not be recommended as a self-care technique.
Unfortunately the evidence does not provide much guidance for self-management recommendations for lymphedema. Further research is indicated, yet in the meantime, a thorough assessment of each individual patient’s symptoms and the availability of resources should be used to guide the plan of care.
Armer, J. M., Cormier, J.N., Fu, M.R., Ridner, S.H., Stewart, B.R., Wanchai, A. (2012). Self-Management of Lymphedema: A Systematic Review of the Literature From 2004 to 2011. Nursing Research, 61 (4).