PURPOSE:The aim of our randomized controlled study is to determine the effect of lymphedema self-management in the prevention of breast cancer-related lymphedema and quality of life. METHOD:Sixty-one breast cancer patients were included in the study. In the intervention group, patients were provided training and given a training booklet describing "exercise, massage and prevention methods" by the researchers, as part of the Self-Management of Lymphedema Program. Patients were followed by telephone for 6 months and through monthly clinical check-ups. Patients in the intervention and control groups were evaluated in both the pre-operative and post-operative periods (at one, three and six months) using the "DASH", "Measurement of Upper Extremity", " EORTC QLQ-30 and BR-23 questionnaire". The Mann Whitney U test, the Kruskal-Wallis H test, the Wilcoxon test, and the Friedman test were used for the statistical analysis of the data. RESULTS:At the end of the study, while lymphedema development was not observed in the intervention group, 61.2% of the control patients developed lymphedema. The difference between the intervention and control groups for the development of lymphedema was found to be statistically significant (χ2 = 25,943; p = 0,000). The quality of life of the intervention group was higher than that of the control group. Moreover, the symptom scores of the intervention group were found to be significantly lower than those of the control group. CONCLUSIONS:As a result of our research, it can be concluded that the Self-Management of Lymphedema Program is effective at preventing lymphedema development following breast cancer treatment.

Lymphedema is a chronic skin disease that has many causes and leads to significant disfigurement and disability worldwide. Recommendations for lymphedema self-care vary by setting and the World Health Organization guidelines for people affected by lymphatic filariasis- and podoconiosis-related lymphedema are centered around a basic daily hygiene regimen. Research on cancer-related lymphedema in developed country settings suggests that deep-breathing exercises and self-massage can improve lymphedema status, but these exercises are not routinely taught to people affected by lymphedema in developing country settings. To determine if the activities proven in cancer-related lymphedema can improve outcomes for people affected by lymphatic filariasis- or podoconiosis-related lymphedema, an enhanced self-care protocol for lower limb lymphedema was developed and trialed in Nilphamari District in Bangladesh and Simada Woreda in Ethiopia. Enhanced self-care activities were chosen on the basis that they would not add financial burden to patients or their families and included recommendations to perform deep-breathing exercises and self-massage, drink clean water, and eat fresh fruits and vegetables. The enhanced-care protocol was developed in collaboration with implementing partners in both countries and may be applicable in other populations affected by lower-limb lymphedema. Trial methods and results will be submitted for peer reviewed publication. Current recommendations for lymphedema self-care may be less effective for people with more advanced disease and new or cross-cutting methods are needed to improve outcomes for these populations.

Lymphedema causes disability and exacerbates poverty in many countries. The management of lymphatic filariasis (LF) and podoconiosis-related lymphedema involves daily hygiene to reduce secondary infections, but self-massage and deep-breathing, which have proven beneficial in cancer-related lymphedema, are not included. A cluster randomized trial in northern Ethiopia investigated the effects of lymphatic stimulation for people affected by moderate to severe lymphedema. Participants were allocated to either standard (control = 59) or enhanced (intervention = 67) self-care groups. Primary outcomes were lymphedema stage, mid-calf circumference, and tissue compressibility. Secondary outcomes were the frequency and duration of acute attacks. After 24 weeks, fewer patients were assessed as severe (control -37.8%, intervention -42.4%, = 0.15) and there were clinically relevant changes in mid-calf tissue compressibility but not circumference. There was a significant between-group difference in patients who reported any acute attacks over the study period (control = 22 (38%), intervention = 7 (12%), = 0.014). Daily lymphedema self-care resulted in meaningful benefits for all participants with a greater reduction in acute episodes among people performing lymphatic stimulation. Observations of a change in lymphedema status support earlier findings in Bangladesh and extend the demonstrated benefits of enhanced self-care to people affected by podoconiosis.