title: Prescription and adherence to lymphedema self-care modalities among women with breast cancer-related lymphedema.
abstract: OBJECTIVE
  To profile the prescription for and adherence to breast cancer-related lymphedema (BCRL) self-care modalities among breast cancer (BrCa) survivors with BCRL in a 12-month randomized weightlifting trial.
  
  
  METHODS
  We developed a questionnaire that assessed prescription for and adherence to 10 BCRL self-care modalities that included physical therapy exercise, pneumatic compression pump, medication, lymphedema bandaging, arm elevation, self-administered lymphatic drainage, therapist-administered lymphatic drainage, compression garments, skin care, and taping. We measured prescription for and adherence to BCRL self-care modalities at baseline, 3, 6, and 12 months. Longitudinal logistic regression was used to estimate the odds ratio (OR) and 95 % confidence interval (95 % CI) associated with prescription for and adherence to BCRL modalities over time.
  
  
  RESULTS
  This study included 141 BrCa survivors with BCRL. Women were prescribed an average of 3.6 ± 2.1 BCRL self-care modalities during the study. The prescription for therapist-administered lymphatic drainage (OR = 0.92, 95 % CI 0.88-0.96), pneumatic compression pump use (OR = 0.94, 95 % CI 0.89-0.98), and bandaging (OR = 0.96, 95 % CI 0.93-0.99) decreased over 12 months of follow-up. No other prescribed BCRL self-care modalities changed during the study. Over 12 months, the average adherence to all BCRL self-care modalities varied with 13, 24, 32, and 31 % of women reporting <25, 25-49, 50-74, and ≥75 % adherence, respectively. Over 12 months, there was a noticeable change from high to low adherence in self-administered lymphatic drainage, such that there was a 15 % increased likelihood of adherence <25 % compared to ≥75 % (OR = 1.15 (95 % CI 1.05-1.26); p = 0.002). The adherence patterns of all other modalities did not change over follow-up.
  
  
  CONCLUSIONS
  Our findings suggest the prescription for BCRL self-care modalities is variable. The average adherence to BCRL self-care was non-optimal. Future research is necessary to prepare BrCa survivors with the knowledge, skills, abilities, and resources necessary to care for this lifelong condition.
authors.affiliation: University of Pennsylvania School of Medicine, 423 Guardian Drive, 8th Floor, Blockley Hall, Philadelphia, PA, 19104, USA.
authors.forename: Justin C
authors.initials: JC
authors.lastname: Brown
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Cheville
authors.forename: Julia C
authors.initials: JC
authors.lastname: Tchou
authors.forename: Susan R
authors.initials: SR
authors.lastname: Harris
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Schmitz
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000150:complications / Q000628:therapy*; D005081:Exercise Therapy / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008209:Lymphedema / Q000209:etiology / Q000628:therapy*; D008875:Middle Aged; D010349:Patient Compliance; D012648:Self Care / Q000379:methods / Q000592:standards*; D017592:Skin Care / Q000379:methods / Q000592:standards; D011795:Surveys and Questionnaires; D014891:Weight Lifting