Lymphedema and breast cancer: How occupational therapy helps survivors manage symptoms

A breast cancer diagnosis can be overwhelming. On top of all the decisions surrounding treatment, survivors also have to consider long-term side effects.

Lymphedema is one potential side effect of breast cancer surgery and radiation treatment that can occur just a few months after surgery or dozens of years later. 

Lymph is a thin, clear fluid that circulates throughout the body to remove wastes, bacteria and other substances from tissues. Edema is the buildup of excess fluid. Lymphedema occurs when too much lymph collects in any area of the body.

Because lymph nodes are often removed in breast cancer patients during surgery or damaged during radiation, the flow of lymph may get disrupted, leading to swelling. Lymphedema can cause a feeling of heaviness, discomfort, cosmetic deformity and can lead to infections, such as cellulitis.

Symptoms and signs of lymphedema in breast cancer patients include:

• Swelling of the arm on the side where the lymph nodes were removed
• Feeling of heaviness or tightness  in the arm, chest or armpit area
• Clothing, bra or jewelry do not fit as normal
• Aching or pain in the arm
• Trouble bending or moving a joint
• Changes in skin, such as texture or color
• Weakness in the arm

Lymphedema is a chronic condition that can be managed with the right therapy. Treatment right away can lower your risk of infections and complications. Many doctors recommend occupational or physical therapy to help with lymphedema.  

Lymphedema Management Program at St. Joseph's/Candler

St. Joseph’s/Candler and the Nancy N. and J.C. Lewis Cancer & Research Pavilion have a Lymphedema Management Program led by occupational therapists at Candler Hospital’s Outpatient Rehabilitation location.

“Occupational therapy works on improving quality of life,” says Erika Midock, COTA, Occupation Therapy Assistant with Candler Hospital Outpatient Rehabilitation. “Occupational therapy is all about activities of daily living, so what you do during the day to make you, you.

“For our breast care patients, we want to make sure they are able to be functional and independent with their activities of daily living. We want them to be able to drive their car, manage their homes and enjoy life with their kids and grandkids.”

There are four components to the Lymphedema Management Program:

1. Manual lymph drainage, which is a massage process to help move fluid.
2. Exercise, which includes stretching and some resistance training.
3. Skin care to neutralize the skin and includes proper cleaning techniques to avoid dry, cracked skin.
4. Compression, which includes assistance ordering and wearing compression garments.

Lymphedema is diagnosed by a doctor, and a physician’s referral is required for the Lymphedema Management Program. How long therapy lasts depends on each individual case, and the majority of time is spent educating patients to take care of themselves outside of therapy. 

Midock encourages all breast cancer survivors to talk to their surgeon and oncologists about lymphedema. Because it can occur at any time, education is key to early detection.

Midock also recommends any breast cancer survivor wear a compression sleeve during certain activities such as gardening or exercising to prevent infection and injury. Other preventative measures you can take include:

• Ask for injections, blood draw and blood pressure tests on the unaffected arm
• Carry your handbag or heavy packages with the unaffected arm
• Be careful and use a clean razor when shaving underarms
• Prevent sunburns to the affected area
• Clean the skin of the affected area daily
• Exercise regularly but avoid vigorous, repetitive movements
• Eat a healthy, low-sodium diet
• Protect your fingers from needle pricks and sharp objects

Even a mosquito bite can trigger lymphedema, Midock says, and encourages breast cancer patients to always use insect repellent.

“Although there is not a cure for lymphedema, it can be controlled,” Midock says. “We have a variety of conservative treatment options available for our patients. Patients are educated and empowered to take control of their current condition.”

For additional information on the Lymphedema Management Program, please contact us at 912-819-6176.