Factors influencing lymphedema onset of gynecologic cancer patients-Evaluation of the effectiveness of an intervention program to promote self-management of lymphedema prevention.

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    • Abstract:
      In Japan diagnostic criteria for lymphedema after gynecological cancer surgery have not been established, and it is difficult to accurately determine the rate of incidence of its occurrence [1]. As the length of hospitalizations has been shortened, there are many patients who are discharged from the hospital without having sufficient knowledge and skills to prevent the onset of lymphedema [2]. This study aims to determine factors influencing the lymphedema onset of gynecologic cancer patients who have undergone surgery, to conduct intervention programs to promote self-management of lymphedema prevention, and to establish the effect of the interventions. The study participants were gynecologic cancer patients who had undergone lymph node dissection in the participating hospitals. Inclusion criteria are patients aged between 20 and 74, and who are able to perform the self-management, participate in all the programs with physically and mentally stable conditions. We provided instruction about the self-management to prevent lymphedema for the intervention group. After discharge from the hospital, patients were given health instruction once a month by phone. The femoral circumference and body weight were measured and recorded weekly from 3 to 5 days after surgery (before discharge). For the control group, the femoral circumference and weight were measured and recorded before discharge and 6 months after surgery. Surveys were conducted twice, before discharge and 6 months after the surgery. Surveyed items were the right and left femoral circumferences and body weight, and any presence of lymphedema. We also administered a self-rating questionnaire survey, with questions of demographic characteristics, health conditions, self-efficacy with health problems, and ability to conduct self-management activities. The questionnaire was collected by mail, and the significance level of the statistical measures was set as below 0.05. This study was conducted in accordance with commonly accepted ethical considerations. We explained the outline of the study to 130 patients, and 108 expressed consent. We randomly divided the patients into two groups: 56 as an intervention group, and 52 as a control group. Before the discharge, 55 valid responses (98%) to the questionnaire were collected from the intervention group and 51 (98%) from the control group, and 6 months after surgery, from 51 (92.7%) of the intervention group, and from 45 (88.2%) of the control group. At discharge there were no significant differences in femoral circumference and body weight, or in presence of lymphedema in the groups. Six months after the surgery, the body weight and incidence of lymphedema were significantly lower in the intervention group. The intervention group reported some mild symptoms of health problems, and this group scored significantly better in the meaningfulness of sense of coherence (SOC), overall quality of life (QOL), physical area of QOL, and self-efficacy with health problems in the questionnaire. For the self-management behavior, the intervention group showed significantly higher scores in the interactions with medical personnel and in coping with symptoms. As a result of the multiple logistic regression analysis using the presence of lymphedema as an objective variable, there were differences between the groups and in the coping with symptoms as factors influencing the onset of lymphedema. The possibility of not developing lymphedema was 4.1 times higher in the intervention group, and 1.9 times higher in patients who are able to cope with symptoms. Traditionally, emphasis has been placed on physical self-management to prevent the onset of lymphedema after gynecological cancer surgery. The program here was developed by further assuming that it is important to make physical, mental and social adjustments, and we developed a program paying close attention to these aspects of recovery. As the differences between the groups and the coping with symptoms have been shown to be factors influencing lymphedema onset, it is suggested that providing interventions addressing physical, mental, and social aspects concurrently will enable patients to acquire the skills necessary to cope with symptoms by themselves. [ABSTRACT FROM AUTHOR]
    • Abstract:
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