The Effect Of Supportive-Educative Nursing Intervention On The Lymphedema For People With Breast Cancer Surgery

Background:Lymphoedema after breast cancer surgical treatment is one of the sequelae. It is caused by an acquired interruption or damage to the axillary lymphatic system and it is characterized by an abnormal accumulation of fluids and other substances in the tissue. Psychological distress and pain in these patients adversely affect their quality of life. Lymphedema is usually discovered late, although treatment is numerous, but not lasting curative effect, the condition easily repeatedly, and once edema formed, it is difficult to cure. Currently foreign scholars began to pay more attention to the early diagnosis of lymphedema in order to control the lymphedema early, but there is no any relevant research report found in China. Therefore, it is necessary to explore the effect of nursing intervention on preventing and controlling lymphedema occurred in early stage.Objective:To explore the effect of supportive-educative nursing intervention on the lymphedema after breast cancer surgical treatment. The nursing intervention included postoperative telephone follow-up and guidance of lymphedema self-management behavior.Methods:A historical control trial was used in this study. By convenient sampling,64patients after modified radical mastectomy of breast cancer were recruited from Cancer Institute and Hospital, Chinese Academy of Medical Sciences in October-December2011. The experimental group (n=64) was provided telephone follow-up, and helped establishing self-management of lymphedema. Six months after surgery,the lymphedema incidence and self perceived symptoms were compared with the historical control group (n=60) recruited from Cancer Institute and Hospital, Chinese Academy of Medical Sciences in January-May2008.Results:In the experimental group, there was no statistical significance regarding to postoperative lymphedema incidence among1month,3months and6months after surgery (X2=3.60, P=0.17). Six months after surgery, people in experimental group had significant lower lymphedema incidence than that in the control group (X2=-2.52, P=0.01).In terms of the self perceived symptoms, less people in experimental group who undergone surgery for6months had the following sense than in other two time points,"I felt the sleeves are tighter than before"(X2=14.00, P<0.05), tenderness (X2=6.40,P<0.05), swelling(X2=8.91, P<0.05), firmness(X2=7.40, P<0.05), heaviness (X2=12.17,P<0.05), numbness (X2=10.50, P<0.05). They used affected arm less frequently than in other two time points (X=6.50, P<0.05). Relating to selfperceived symptoms in6months after surgery, more people in control group had the following sense than experimental group,"arms become thicker"(X2=16.50, P<0.05)," sleeves become tighter"(X2=9.17, P<0.05),"limitation of shoulder activities"(X2=5.56, P<0.05), swelling (X2=9.98, P<0.05), firmness (X2=4.46, P<0.05).heaviness (X2=8.39, P<0.05) and numbness (X2=10.86, P<0.05). The control group used affected arm more frequently than experimental group (X2=6.83, P<0.05)Conclusion:Guidance in patients with modified radical mastectomy lymphedema nursing intervention, including lymphedema self-management behavior and support by telephone follow-up after discharge, it can help early finding lymphedema, controlling the occurrence of lymphedema. This study provides the basis and reference for future nursing research in the field of lymphedema control occurred in breast cancer patients at early stage after operation, and also provides basic data for research of breast cancer patients with postoperative lymphedema management.