Article

Self-Reported Comorbid Conditions and Medication Usage in Breast Cancer Survivors With and Without Lymphedema

Sheila H. Ridner

Mary S. Dietrich

self-report, medication adherence, patient compliance
ONF 2008, 35(1), 57-63. DOI: 10.1188/08.ONF.57-63

Purpose/Objectives: To compare the self-reported comorbid conditions and medication usage between breast cancer survivors with and without breast cancer treatment-related lymphedema.

Design: Descriptive, cross-sectional.

Setting: A community-based study conducted in a major metropolitan area and surrounding rural counties in the southeastern United States.

Sample: A convenience sample of 64 breast cancer survivors with lymphedema and 64 breast cancer survivors without lymphedema who were age matched within three years and recruited for a parent study. Twenty-one additional nonage-matched breast cancer survivors with or without lymphedema also were included.

Methods: Self-reported survey instruments and height and weight measurement.

Main Research Variables: Lymphedema, demographic information, self-reported comorbid diseases or medical issues, and medication usage.

Findings: Breast cancer survivors with lymphedema experienced more comorbid conditions. Statistically significant group differences were found in body mass index, orthopedic issues, cardiac medications, hormone blockers, and osteoporosis medication or calcium supplement usage. Co-occurrence of diabetes and carpal tunnel syndrome approached statistical significance. Breast cancer survivors with lymphedema were older and had lower incomes.

Conclusions: Comorbid conditions may influence the development of breast cancer treatment-related lymphedema. Further research, particularly a longitudinal study, is indicated.

Implications for Nursing: Healthcare professionals who care for breast cancer survivors need to routinely assess them for the presence of comorbid conditions and the development of lymphedema. Obese breast cancer survivors may benefit from weight reduction interventions to possibly decrease their risk of developing lymphedema and improve their overall health status. Patients with arthritis and orthopedic and cardiac issues such as hypertension may warrant careful monitoring.

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    References

    Armer, J., Fu, M.R., Wainstock, J.M., Zagar, E., & Jacobs, L.K. (2004). Lymphedema following breast cancer treatment, including sentinel lymph node biopsy. Lymphology, 37(2), 73-91.
    Armer, J., & Porock, C. (2001). Self-reported fatigue in women with lymphedema. Lymphlink, 13(3), 1-4.
    Armer, J., Radina, M.E., Porock, D., & Culbertson, S.D. (2003). Predicting breast cancer-related lymphedema using self-reported symptoms. Nursing Research, 52(6), 370-379.
    Bosompra, K., Ashikaga, T., O'Brien, P.J., Nelson, L., & Skelly, J. (2002). Swelling, numbness, pain, and their relationship to arm function among breast cancer survivors: A disablement process model perspective. Breast Journal, 8(6), 338-348.
    Carpenter, J.S., & Andrykowski, M.A. (1999). Menopausal symptoms in breast cancer survivors. Oncology Nursing Forum, 26, 1311-1317.
    Carpenter, J.S., Johnson, D., Wagner, L., & Andrykowski, M. (2002). Hot flashes and related outcomes in breast cancer survivors and matched comparison women [Online exclusive]. Oncology Nursing Forum, 29(3), E16-E25. Retrieved November 30, 2007, from http://ons.metapress.com/content/6616786818742847/fulltext.pdf http://ons.metapress.com/content/6616786818742847/fulltext.pdf
    Centers for Disease Control and Prevention. (2007). BMI—Body mass index: About BMI for adults. Retrieved November 30, 2007, from http://www.cdc.gov/nccdphp/dnpa/bmi/adult_BMI/about_adult_BMI.htm
    Deutsch, M., & Flickinger, J.C. (2001). Shoulder and arm problems after radiotherapy for primary breast cancer. American Journal of Clinical Oncology, 24(2), 172-176.
    Dodd, M.J., Miaskowski, C., & Paul, S.M. (2001). Symptom clusters and their effect on the functional status of patients with cancer. Oncology Nursing Forum, 28(3), 465-470.
    El Saghir, N.S., Otrock, Z.K., Bizri, A.R., Uwaydah, M.M., & Oghlakian, G.O. (2005). Erysipelas of the upper extremity following locoregional therapy for breast cancer. Breast, 14(5), 347-351.
    Foldi, M., Foldi, E., & Kubik, S. (2003). Textbook of lymphology for physicians and lymphedema therapists. Muchen, Germany: Urban and Fischer.
    Franks, P., Gold, M.R., & Fiscella, K. (2003). Sociodemographics, self-rated health, and mortality in the US. Social Science and Medicine, 56(12), 2505-2514.
    Gold, M., Franks, P., & Erickson, P. (1996). Assessing the health of the nation. The predictive validity of a preference-based measure and self-rated health. Medical Care, 34(2), 163-177.
    Handley, W.S. (1908). Lymphangioplasty: A new method for the relief of the brawny arm of breast cancer and similar conditions of lymphatic oedema. Lancet, 171(441), 783-785.
    Hinrichs, C.S., Watroba, N.L., Rezaishiraz, H., Giese, W., Hurd, T., Fassl, K.A., et al. (2004). Lymphedema secondary to postmastectomy radiation: Incidence and risk factors. Annals of Surgical Oncology, 11(6), 573-580.
    ImpediMed. (2007). ImpediMed US distributor "Lymphedema Products, LLC" launch IMPXCA. Retrieved December 11, 2007, from http://www.impedimed.com/icms_docs/19373_ImpediMed_announces_Lympoedema_Products_US_distribution_launch.pdf
    Johansson, K., Ohlsson, K., Ingvar, C., Albertsson, M., & Ekdahl, C. (2002). Factors associated with the development of arm lymphedema following breast cancer treatment: A match pair case-control study. Lymphology, 35(2), 59-71.
    Langer, I., Kocher, T., Guller, U., Torhorst, J., Oertli, D., Harder, F., et al. (2005). Long-term outcomes of breast cancer patients after endoscopic axillary lymph node dissection: A prospective analysis of 52 patients. Breast Cancer Research and Treatment, 90(1), 85-91.
    Lenz, E.R., Pugh, L.C., Milligan, R.A., Gift, A., & Suppe, F. (1997). The middle-range theory of unpleasant symptoms: An update. Advances in Nursing Science, 19(3), 14-27.
    Lenz, E.R., Suppe, F., Gift, A.G., Pugh, L.C., & Milligan, R.A. (1995). Collaborative development of middle-range nursing theories: Toward a theory of unpleasant symptoms. Advances in Nursing Science, 17(3), 1-13.
    Lewison, E.F. (1955). Breast cancer and its diagnosis and treatment. Baltimore: Williams and Wilkins.
    Lobb, A.W., & Harkins, H.N. (1949). Postmastectomy swelling of the arm; with a note on the effect of segmental resection of the axillary vein at the time of radical mastectomy. Western Journal of Surgery, Obstetrics, and Gynecology, 57(11), 550-557.
    Masmoudi, A., Maaloul, I., Turki, H., Elloumi, Y., Marrekchi, S., Bouassida, S., et al. (2005). Erysipelas after breast cancer treatment (26 cases). Dermatology Online Journal, 11(3), 12.
    Matas, R. (1913). The surgical treatment of elephantiasis and elephantoid states dependent upon the chronic obstruction of the lymphatic and venous channels. American Journal of Tropical Diseases and Preventive Medicine, 1, 60-85.
    McWayne, J., & Heiney, S.P. (2005). Psychologic and social sequelae of secondary lymphedema: A review. Cancer, 104(3), 457-466.
    National Cancer Institute. (n.d.). Cancer of the breast. Retrieved April 26, 2007, from http://seer.cancer.gov/statfacts/html/breast.html
    Newman, M.L., Brennan, M., & Passik, S. (1996). Lymphedema complicated by pain and psychological distress: A case with complex treatment needs. Journal of Pain and Symptom Management, 12(6), 376-379.
    Parshall, M.B., Welsh, J.D., Brockopp, D.Y., Heiser, R.M., Schooler, M.P., & Cassidy, K.B. (2001). Dyspnea duration, distress, and intensity in emergency department visits for heart failure. Heart and Lung: Journal of Critical Care, 30(1), 47-56.
    Passik, S.D., Newman, M.L., Brennan, M., & Tunkel, R. (1995). Predictors of psychological distress, sexual dysfunction, and physical functioning among women with upper extremity lymphedema related to breast cancer. Psycho-Oncology, 4(4), 255-263.
    Petrek, J.A., Pressman, P.I., & Smith, R.A. (2000). Lymphedema: Current issues in research and management. CA: A Cancer Journal for Clinicians, 50(5), 292-307.
    Pugh, L.C., Milligan, R., Parks, P.L., Lenz, E.R., & Kitzman, H. (1999). Clinical approaches in the assessment of childbearing fatigue. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 28(1), 74-80.
    Ridner, S.H. (2004). Symptom clusters occurring with lymphedema after breast cancer. Dissertation Abstracts International, 64(11), AA3113289. (UMI No. 3113289)
    Ridner, S.H. (2005). Quality of life and a symptom cluster associated with breast cancer treatment-related lymphedema. Supportive Care in Cancer, 13(11), 904-911.
    Ridner, S.H. (2006). Pretreatment lymphedema education and identified educational resources in breast cancer patients. Patient Education and Counseling, 61(1), 72-79.
    Ridner, S.H., Montgomery, L.D., Hepworth, J.T., Stewart, B.R., & Armer, J.M. (2007). Comparison of upper limb volume measurement techniques and arm symptoms between healthy volunteers and individuals with known lymphedema. Lymphology, 40(1), 35-46.
    Rockson, S. (2001). Lymphedema. American Journal of Medicine, 110(4), 288-295.
    Say, C.C., & Donegan, W. (1974). A biostatistical evaluation of complications from mastectomy. Surgery Gynecology and Obstetrics, 138(3), 370-376.
    Tabibiazar, R., Cheung, L., Han, J., Swanson, J., Beilhack, A., An, A., et al. (2006). Inflammatory manifestations of experimental lymphatic insufficiency. PLoS Medicine, 3(7), e254.
    U.S. Department of Health and Human Services. (2006). The 2006 HHS poverty guidelines. Retrieved September 14, 2006, from http://aspe.hhs.gov/poverty/06poverty.shtml
    Wilke, L.G., McCall, L.M., Posther, K.E., Whitworth, P.W., Reintgen, D.S., Leitch, A.M., et al. (2006). Surgical complications associated with sentinel lymph node biopsy: Results from a prospective international cooperative group trial. Annals of Surgical Oncology, 13(4), 491-500.