title: Proactive approach to lymphedema risk reduction: a prospective study.
abstract: BACKGROUND
  Advances in cancer treatments continue to reduce the incidence of lymphedema. Yet, many breast cancer survivors still face long-term postoperative challenges as a result of developing lymphedema. The purpose of this study was to preliminarily evaluate The Optimal Lymph Flow program, a patient-centered education and behavioral program focusing on self-care strategies to enhance lymphedema risk reduction by promoting lymph flow and optimize body mass index (BMI).
  
  
  METHODS
  A prospective, longitudinal, quasi-experimental design with repeated-measures was used. The study outcomes included lymph volume changes by infrared perometer, and BMI by a bioimpedance device at pre-surgery baseline, 2-4 weeks after surgery, 6-month and 12-month follow-up. A total of 140 patients were recruited and participated in The Optimal Lymph Flow program; 134 patients completed the study with 4 % attrition rate.
  
  
  RESULTS
  Fifty-eight percent of patients had axillary node dissection and 42 % had sentinel lymph node biopsy (SLNB). The majority (97 %) of patients maintained and improved their preoperative limb volume (LV) and BMI at the study endpoint of 12 months following cancer surgery. Cumulatively, two patients with SLNB and two patients with axillary lymph node dissection had measurable lymphedema (>10 % LV change). At the 12-month follow-up, among the four patients with measurable lymphedema, two patients' LV returned to preoperative level without compression therapy but by maintaining The Optimal Lymph Flow exercises to promote daily lymph flow.
  
  
  CONCLUSIONS
  This educational and behavioral program is effective in enhancing lymphedema risk reduction. The study provided initial evidence for emerging change in lymphedema care from treatment-focus to proactive risk reduction.
authors.affiliation: College of Nursing, New York University, New York, NY, USA, mf67@nyu.edu.
authors.forename: Mei R
authors.initials: MR
authors.lastname: Fu
authors.forename: Deborah
authors.initials: D
authors.lastname: Axelrod
authors.forename: Amber A
authors.initials: AA
authors.lastname: Guth
authors.forename: Francis
authors.initials: F
authors.lastname: Cartwright
authors.forename: Zeyuan
authors.initials: Z
authors.lastname: Qiu
authors.forename: Judith D
authors.initials: JD
authors.lastname: Goldberg
authors.forename: June
authors.initials: J
authors.lastname: Kim
authors.forename: Joan
authors.initials: J
authors.lastname: Scagliola
authors.forename: Robin
authors.initials: R
authors.lastname: Kleinman
authors.forename: Judith
authors.initials: J
authors.lastname: Haber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008197:Lymph Node Excision / Q000009:adverse effects*; D008209:Lymphedema / Q000209:etiology / Q000517:prevention & control*; D008875:Middle Aged; D009367:Neoplasm Staging; D010865:Pilot Projects; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011379:Prognosis; D011446:Prospective Studies; D040242:Risk Reduction Behavior; D012648:Self Care; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects*; D011795:Surveys and Questionnaires