The relationship between delaying physiotherapy intervention commencement and lymphedema among breast cancer survivors in Sri Lanka

Abstract

Introduction: The recent cancer statistics in Sri Lanka evaluated breast cancer as the most common cancer among female population with cancers. Due to the better survival rate, Modified Radical Mastectomy surgery is an ideal surgical management for most of the breast cancer stages. Upper limb lymphedema is a known post-surgical complication which has long-life impact on breast cancer survivors that can be easily managed with early physiotherapy intervention. Objective: This study was aimed to identify the relationship between delaying physiotherapy intervention and lymphedema volume among breast cancer survivors at Apeksha hospital, Maharagama, Sri Lanka. Methods: 74 female breast cancer patients newly referred to the department of physiotherapy were recruited for this study. Patients undergone bilateral surgeries were excluded from the study. An interviewer-administered questionnaire was used to collect information of socio-demographic data and underwent surgical procedures. The severity of upper limb lymphedema was assessed by measuring the lymphedema volume according to the frustum model formula, using multiple circumferential measurements. International Society of Lymphology staging system was used to identify the distribution of lymphedema severity. Results: Within the sample, delayed period to commence physiotherapy after the surgery ranged from < 1 to 17 years. The lymphedema severity stages minimal, moderate and severe among the sample recorded as 37.8%, 50.0% and 12.2% respectively. A significant positive correlation was observed between delayed period to start physiotherapy and lymphedema volume (p=0.05, r= 0.75). Conclusions: The lymphedema volume increases with time of delayed physiotherapy intervention. Hence, the patients are required to participate in early physiotherapy intervention.