My first preceptor was a nursing assistant who had been treated for breast cancer several years prior to my orientation. While I didn’t know the extent of her disease or treatment, I can still remember the tight wrap that she wore on her left arm and the arm exercises that she would do whenever we had a little “down time” on the unit. 

I couldn’t help but think of this woman, who helped me get started on my path into nursing, when I read Self-Management of Lymphedema: A Systematic Review of the Literature From 2004 to 2011, published in the August issue of Nursing Research. Self-management has long been recommended for the treatment of lymphedema as this chronic condition cannot be cured medically or surgically; lifetime self-management is necessary to control swelling exacerbations, prevent infections, and manage other lymphedema-associated symptoms, including reduced activity and fatigue.

Sixteen articles met the inclusion criteria for this systematic review and based on the review, the authors identified ten categories of self-management:
* Advanced pneumatic compression devices
* Aromatherapy
* Compression garments
* Full-body exercise
* Infection management
* Phase 2 complete decongestive therapy (includes self-administered manual lymphatic drainage [MLD], compression garments, bandaging, exercise, and skin care)
* Simple MLD
* Skin care
* Self-monitoring
* Weight reduction

This review found that full-body exercise and Phase 2 CDT are likely to be effective self-management techniques for lymphedema, however, randomized control trials supporting Phase 2 CDT are lacking. Effectiveness was not established for advanced pneumatic compression, compression garments, full-body exercise, self-monitoring, skin care, simple MLD, and weight reduction as stand-alone therapies. Also, based on the evidence, aromatherapy was deemed effectiveness unlikely and should not be recommended as a self-care technique. 

Unfortunately the evidence does not provide much guidance for self-management recommendations for lymphedema. Further research is indicated, yet in the meantime, a thorough assessment of each individual patient’s symptoms and the availability of resources should be used to guide the plan of care.

Reference: 
Armer, J. M., Cormier, J.N., Fu, M.R., Ridner, S.H., Stewart, B.R., Wanchai, A. (2012). Self-Management of Lymphedema: A Systematic Review of the Literature From 2004 to 2011. Nursing Research, 61 (4).