Intervention program to promote self-management for prevention of lymphedema after gynecological cancer surgery ― Evaluation of the effectiveness at 12 months after the intervention –

Abstract

In Japan cancer has been the most common cause of deaths since 1981, and effort has been made to provide countermeasure for cancers. The key to countermeasures is for the general population including cancer patients to know about and overcome cancer. Because the development of cancer is related to lifestyle, it is necessary to work at preventing cancer with attention to the conduct of daily life. The five-year relative survival rate registered in the community from 2006 to 2008 was 62.1%, and this illustrates that there are many cancer survivors leading daily lives after contracting cancer. Uterine cancer was the fifth most common in cancer in 2013. However, it is an important object of the treatment to prevent postoperative complications in gynecologic cancer patients, such as development of lymphedema, because it is reported that the survival rate of uterine cancer is high. The incidence of lymphedema is reported to be between 27.2% and 42% in Japan. Once lymphedema develops, it is difficult to cure, making prevention of the onset an important issue.

As a result of the multiple logistic regression analysis performed here using patients where the right femoral circumference increased 2 cm or more as an objective variable, there were differences between the groups analyzed (intervention and control). Compared to the intervention group, 4.46 times more patients in the control group had increases in the right femoral circumference by 2 cm or more. We conducted a randomized controlled trial of an intervention program to promote self-management to prevent lymphedema development after gynecological cancer surgery, and examined the effectiveness at 12 months after the surgery. From the results it can be inferred that observing the lymphedema symptoms including measuring and recording of femoral circumferences and body weight by patients themselves influenced the promotion of self-management. Six months after the surgery, there were significantly more patients who developed lymphedema in the control group, but there were no differences between the groups at 12 months after the surgery. Lymphedema development after gynecological cancer surgery appears about 2.6 months after surgery and chronic lymphedema often appears around 9.7 months after surgery. It can be inferred that this difference is due to the temporary improvement of lymphatic reflux after the improvement of edema. The difference in femoral circumferences
is sometimes used as one diagnostic tool for the determination of lymphedema. In this study, we compared the right femoral circumferences before discharge and 12 months after the surgery. Mild lymphedema is defined as larger than 10 mm but smaller than 20 mm in any dimension. In severe cases, a dimension may be larger than 20 mm]. In this study, we performed a multiple logistic regression analysis by defining the patients with lymphedema as patients whose right femoral circumference is increased more than 2 cm. The analysis showed the following as factors influencing the increase in the right femoral circumference by more than 2 cm: group (intervention and control), aerobic exercise, and self-efficacy. Compared to the intervention group, 4.46 times more patients in the control group had increases in the right femoral circumference of more than 2 cm, and this suggests that the intervention program to promote self-management to prevent lymphedema after gynecological cancer surgery is effective at 12 months after the surgery.