Download A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE OF

A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE OF PREOPERATIVE
ARM EXERCISE ON PREVENTION OF COMPLICATIONS AMONG BREAST CANCER
PATIENT'S WHO UNDERGOING MASTECTOMY SURGERY IN SELECTED HOSPITALS
AT BANGALORE
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
BY
Mrs.John Sophia
MSc NURSING 1ST YEAR 2011 TO 2013
Under the Gudiance of
HOD, DEPARTMENT OF MEDICAL SURGICAL NURSING
NIGHTINAGLE COLLEGE OF NURSING
Guruvanna Devara Mutt
Magadi road
Bangalore-23
1
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
MRS.JOHN SOFIA
1.
NAME OF THE CANDIDATE
(IN BLOCK LETTERS)
MSc NURSING 1ST YEAR
2.
NAME OF THE INSTITUTION
NIGHTINAGLE COLLEGE OF
NURSING
GURUVANNA DEVARA MUTT
MAGADI ROAD
BANGALORE-23
3.
COURSE OF THE STUDY AND M.SC., NURSING IN MEDICAL
SURGICAL NURSING
SUBJECT
4.
DATE
OF
COURSE
5.
TITLE OF THE STUDY
ADMISSION 04/05/2011
A DESCRIPTIVE STUDY TO ASSESS
THE KNOWLEDGE OF
PREOPERATIVE ARM EXERCISE ON
PREVENTION OF COMPLICATIONS
AMONG BREAST CANCER
PATIENT'S WHO UNDERGOING
MASTECTOMY SURGERY
IN SELECTED HOSPITALS
AT BANGALORE.
2
6.
BRIEF RESUME OF INTENDED WORK:
6.1: INTRODUCTION
Cancer as a disease process reminds us often unexpectedly of our mortality. It
frequently compromises our patient's vitality. It is also a burden emotionally and
physically on family, friends, significant others, community, and other social resources.1
Physical medicine and rehabilitation is the medical specialty principally
concerned with impairments, disabilities, and handicaps that arise after acute or chronic
illness. According to the 1980 classification of the World Health Organization (WHO),
impairment is physiologic dysfunction or loss of anatomic integrity. Disability refers to
functional consequences in relation to self-care and mobility imposed by underlying
impairments. Handicap may be defined as a physical condition that interferes with a
patient's ability to engage in social, educational, recreational, and vocational pursuits. In
essence, handicap compromises patient's full integration into personal relationships and
family and societal roles.2
Cancer is a group of diseases characterized by uncontrolled growth and spread of
abnormal cells, which can result in death. Cancer is caused by both external factors (eg,
chemicals, radiation, viruses) and internal factors (eg, hormones, immune conditions,
inherited mutations). Causal factors may act together or in sequence to initiate or
promote carcinogenesis. Ten or more years may pass between carcinogenic exposure or
inheritance of a mutation and detectable cancer. Today, cancer is treated with surgery,
radiation, chemotherapy, hormones, and/or immunotherapy.3
Each year, the American Cancer Society estimates the number of new cancer
cases and deaths expected in the United States in the current year and compiles the most
recent data on cancer incidence, mortality, and survival using data from the National
Cancer Institute (NCI) and using mortality data from the National Center for Health
Statistics. Incidence and death rates are age standardized to the 2000 standard million
population in the United States. In 2005, 1,372,910 new cases of cancer and 570,280
3
cancer-related deaths were expected in the United States. When deaths are aggregated
by age, cancer has surpassed heart disease as the leading cause of death for persons
younger than 85 since 1999.4
Complications after any operation can be minimized with thorough preoperative
evaluation, meticulous technique, hemostasis, and wound closure. In addition to the
standard oncologic evaluation, preoperative evaluation includes assessment of the
patient's overall physiologic condition, with particular emphasis on tolerability of
anesthesia, uncontrolled diabetes, hypertension, anemia, coagulopathy, or steroid
dependency. Lymphedema is a dreaded complication of breast cancer surgery. Patients
with severe lymphedema have chronic, often debilitating arm swelling with resultant
pain, decreased function, decreased quality of life, and cosmetic deformity. Because of
its chronic nature, as well as a lack of proven long-term treatment methods,
development of lymphedema is perhaps the most feared complication of breast cancer
surgery for both patients and surgeons. Effective treatment for lymphedema is available.
Early diagnosis is important since treatment is most effective when lymphedema is
diagnosed at the earliest stage. Every patient with lymphedema should have access to
established effective treatment for this condition. Lymphedema has no cure but can be
successfully managed when properly diagnosed and treated.5
Cancer rehabilitation can be defined as a process that assists the cancer patient to
obtain maximal physical, social, psychological, and vocational functioning within the
limits created by the disease and its resulting treatment.
6.2. NEED FOR THE STUDY:
When adjusted to delayed reporting, incidences of cancer stabilized in men from
1995 through 2001 but continued to increase by 0.3% per year from 1987 through 2001
in women. The death rate from all cancers combined has decreased by 1.5% per year
since 1993 among men and by 0.8% per year since 1992 among women. Mortality rates
4
have also continued to decrease for 3 most common cancers in men (lung and bronchus,
colon and rectum, and prostate) and for breast and colorectal cancers in women.
Application of existing knowledge about cancer control across all segments of the
population has accelerated these declines. 7
Rehabilitation of the post-mastectomy patients produces problems of varying
complexity. Pathophysiology, prevention, and management of lymphedema are also
discussed. Mastectomy is a safe operation with low morbidity and mortality. Although
the incidence of postoperative complications is low, physicians should be aware of the
morbidity unique to mastectomy and axillary node dissection. The risk of developing
lymphedema does not diminish over time but is a lifelong risk. Progressive lymphedema
is complicated by recurrent infections, non-healing wounds, discomfort or pain,
difficulty with daily tasks, emotional and social distress.
After modified radical mastectomy the rates of wound infections range from
2.8% to 15% .5Infection of the mastectomy wound or ipsilateral arm may represent
serious morbidity in the postoperative patient and produces disability that may
progress to late postoperative lymphedema of the arm. Cellulitis seen in the early postoperative period, responds to antibiotic treatment in most cases. When abscess
formation does occur, attempts should be made to culture the wound for aerobic and
anaerobic organisms with immediate Gram-stain of identifiable strains to document the
bacterial contaminant. The predominant organisms are S aureus and S epidermidis.
Factors that may increase the risk for infection include open biopsy before
mastectomy, increasing age, prolonged suction catheter drainage, and alterations of
host defense mechanisms.8
A commonly recognized complication of breast surgery is necrosis of the
developed skin flaps or skin margins. Bland and colleagues observed an incidence of
21% for minor and major necrosis of mastectomy skin flaps with associated wound
infection .9 Local debridement is usually not necessary in minor areas of necrosis (<2
cm area). Larger areas of partial or full-thickness skin loss require debridement and on
occasion the application of split-thickness skin grafts. Rotational composite skin flaps
and subcutaneous skin tissue can be used from the lateral chest wall or the contralateral
5
breast to cover the defect.
Hemorrhage: It is reported as a post-operative complication in 1% to 4% of
patients and is manifested by undue swelling of flaps of the operative site.10 Early
recognition of this complication is imperative. Aspirating the liquefied hematoma and
establishing patency of the suction catheters can treat hemorrhage. The application of a
light compression dressing reinforced with Elastoplast-tape should diminish the
recurrence of this adverse event. Early severe hemorrhage is most often related to
arterial perforators of the thoracoacromial vessels or internal mammary arteries. Direct
suture ligation is advisable. Miller and associates concluded that use of the
electrocautery for the development of skin flaps in the performance of a mastectomy
reduces blood loss without incurring a greater incidence of wound complications.11
Neuro-Vascular Structures Injuries: Injury to the brachial plexus is a rare
complication of mastectomy and avoided by meticulous (cold scalpel) sharp dissection
in and about the neuro-vascular bundle and through the development of tissue planes
that parallel the neurilemma and the wall of the axillary vein to allow en bloc resection
of lymphatic structures and fatty tissue. The sensory innervation of the breast is derived
from the lateral and anterior cutaneous branches of the second through the sixth
intercostals nerves. The patient usually experiences moderate pain in the operative site,
shoulder, and arm in the immediate postoperative period. Because of the necessity of
extensive flap development, the patient may note hyperesthesia and paraesthesia, as well
as occasional "phantom" hyperesthesia in the mastectomy site. Phantom breast
syndrome is a continued sensory presence of the breast after it has been removed. It is a
phantom pain in 17.4% of cases, and in 11.8% of cases, and it presents as a non-painful
phantom sensation such as itching, nipple sensation, and premenstrual-type breast
discomfort.12
A number of promising treatments have been reported, but they have not yet
been subjected to sufficient rigorous research to recommend as the standard of care.
These treatments include cold laser, electrical stimulation, vibratory therapy, oscillation
therapy, endermologie and aqua-lymphatic therapy .13 All of these techniques are done
6
in combination with components of CDT. Acupuncture has shown benefit for some
symptoms of cancer and cancer treatment, including fatigue, hot flashes, muscular or
joint pain, neuropathy and nausea. There are no rigorous studies on using acupuncture
for treating lymphedema or using acupuncture on lymphedema extremities. Rebounder
trampolines have been advocated by some for treating lymphedema, but there are no
published studies on this treatment. Rebounding is good exercise, it but is not known to
be superior to other forms of aerobic exercise in individuals with lymphedema. Due to
potential interactions of natural supplements with prescription drugs and other negative
side effects, patients should check with their physician or healthcare provider before
taking any natural supplements.14
Rehabilitation specialists have proposed several general principles regarding
rehabilitation interventions for patients with cancer. Rehabilitation requires an
interdisciplinary team approach because of the variety of potential problems patients
may face during the course of illness. The availability of professionals from major
disciplines is essential to offering comprehensive care.15
From all these findings, the researcher interested to conducted the study
knowledge of preoperative arm exercise on prevention of complications among breast
cancer patient's who undergoing mastectomy surgery in selected hospitals at Bangalore.
6.3. REVIEW OF LITERATURE
A study evidenced that cancer survivors are at increased risk for secondary
cancers and other diseases. Healthy dietary practices may improve cancer survivors'
health and well-being. Data were collected at baseline and 1- and 2-year follow-ups.
Breast and prostate cancer survivors (n=543) were recruited from 39 states and two
provinces within North America. A total of 489 participants completed the 2-year
follow-up assessment (10% attrition).Participants were randomly assigned to either a
10-month program of tailored mailed print materials promoting fruit and vegetable
consumption, reduced total and saturated fat intake, and/or increased exercise or to a 10month program of publicly available mailed materials on diet and exercise. Telephone
surveys (supported with blood biomarkers) assessed dietary habits at baseline and 1- and
7
2-year follow-ups. Paired-samples t tests were conducted to examine the durability of
the intervention's effects on dietary outcomes within each study arm. Arm differences in
follow-up outcomes were then tested with the general linear model, controlling for the
baseline value of the outcomes.Both arms reported decreased saturated fat intake,
increased servings of fruits and vegetables, and better overall diet quality at year 2
relative to baseline. However, Results suggest that mailed material interventions,
especially those that are tailored, can produce long-term dietary improvement
among cancer survivors.16
A study on randomised, controlled trial with concealed allocation and blinded
outcome assessment.A multidisciplinary breast centre of a tertiary hospital in
Belgium.Patients were eligible to be included if they received unilateral surgery with
axillary node dissection forbreast cancer, and agreed to participate. Randomisation of
160 participants allocated 79 to the intervention group and 81 to a control group. Both
groups received guidelines about the prevention of lymphoedema in the form of a
brochure, and exercise therapy involving supervised individualised 30 minute sessions initially twice a week, reducing to once fortnightly as patients progressed. Participants in
both groups were also asked to perform exercises at home twice/day. 154 participants
(96%) completed the study at 12 months. At 12 months the incidence of lymphoedema
in the intervention group (n=18, 24%) was similar to the incidence of lymphoedema in
the control group (n = 15, 19%, OR 1.3, 95% CI 0.6 to 2.4); also there was no difference
in incidence at 3 or 6 months. There was no difference between the groups in the time
taken to develop lymphoedema, and no difference between the groups in any secondary
outcome measure.The application of manual lymph drainage after axillary node
dissection for breast cancer in addition to providing guidelines and exercise therapy did
not prevent lymphoedema in the first year after surgery.17
A study was conducted to compare the effects of dance/movement therapy and
standard care with standard care alone or standard care and other interventions in
patients with cancer.It included all randomized and quasi-randomized controlled trials of
dance/movement therapy interventions for improving psychological and physical
8
outcomes in patients with cancer. Two review authors independently extracted the data
and assessed the methodological quality. Results were presented using standardized
mean differences. It included two studies with a total of 68 participants. The second trial
reported a large beneficial effect on fatigue. However, this trial was at high risk of bias.
The individual studies did not find support for an effect of dance/movement therapy on
mood, distress, and mental health. It is unclear whether this was due to ineffectiveness
of the treatment or limited power of the trials. Finally, the results of one study did not
find evidence for an effect of dance/movement therapy on shoulder range of motion
(ROM)
or arm circumference
in
women
who
underwent
a
lumpectomy
or breast surgery. However, this was likely due to large within-group variability for
shoulder ROM and a limited number of participants with lymphedema. It did not find
support for an effect of dance/movement therapy on body image. The findings of one
study suggest that dance/movement therapy may have a beneficial effect on QoL.
However, the limited number of studies prevents us from drawing conclusions
concerning the effects of dance/movement therapy on psychological and physical
outcomes in cancer patients.18
Despite advances in the treatment of breast cancer, there is little research
examining the prevention of lymphedema after breast and/or axillary surgery. Currently,
there are no national guidelines for activity restrictions; however, many medical
providers recommend restricting activity of the surgically affected arm, which can create
quality-of-life issues as well as future medical issues for patients with breast cancer. A
literature review of several current research articles was performed. This report reviews
four studies evaluating the effects of restricted activity versus progressive exercise and
stretching activities on development of lymphedema.The results show that there is no
difference in the risk of developing lymphedema when following activity guidelines. All
four of the studies reviewed report results of either a decrease in the development of
lymphedema
or
no
increased
risk
of
development
of
lymphedema
when
early exercise regimens are incorporated into postoperative care. The four research
articles show promising results that support future change in practice guidelines.
However, none of the studies report follow-up results beyond 2 years. Additionl
evaluation to monitor long-term effects is warranted.19
9
A study evidenced that exercise for Health was a pragmatic, randomised,
controlled trial comparing the effect of an eight-month exercise intervention on function,
treatment-related side effects and quality of life following breast cancer, compared with
usual care. The intervention commenced six weeks post-surgery, and two modes of
delivering the same intervention was compared with usual care. Consenting women
were randomised to a face-to-face-delivered exercise group (FtF,n=67), telephonedelivered exercise group (Tel, n = 67) or usual care group (UC, n = 60) and were
assessed pre-intervention (5-weeks post-surgery), mid-intervention (6 months postsurgery)
and
10
weeks
post-intervention
(12
months
post-surgery).
Each
intervention arm entailed 16 sessions with an Exercise Physiologist. Of 318 potentially
eligible women, 63% (n = 200) agreed to participate, with a 12-month retention rate of
93%. Participants were similar to the Queensland breast cancer population with respect
to disease characteristics, and the randomisation procedure was mostly successful at
attaining group balance, with the few minor imbalances observed unlikely to influence
intervention effects given balance in other related characteristics. Median participation
was 14 (min and max: 0 and 16) and 13 (min and max: 3 and 16) intervention sessions
for the FtF and Tel, respectively, with 68% of those in Tel and 82% in FtF participating
in at least 75% of sessions. Participation in both intervention arms during and following
treatment for breast cancer was feasible and acceptable to women. Future work,
designed to inform translation into practice, will evaluate the quality of life, clinical,
psychosocial and behavioural outcomes associated with each mode of delivery.20
The purpose of the a study was to evaluate the influence of a
mixed exercise program, including Greek traditional dances and upper body training, in
physical function, strength and psychological condition of breast cancer survivors.
Twenty-seven women (N = 27), who had been diagnosed and surgically treated
for breast cancer, volunteered to participate in this study. The experimental group
consisted of 14 women with mean age 56.6 (4.2) years. They attended supervised Greek
traditional dance courses and upper body training (1 h, 3 sessions/week) for 24 weeks.
The control group consisted of 13 sedentary women with mean age 57.1 (4.1) years.
Blood pressure, heart rate, physical function (6-min walking test), handgrip
strength, arm volume and psychological condition (Life Satisfaction Inventory and Beck
10
Depression Inventory) were evaluated before and after the exercise program. The results
showed significant increases of 19.9% for physical function, 24.3% for right handgrip
strength, 26.1% for left handgrip strength, 36.3% for life satisfaction and also a decrease
of 35% for depressive symptoms in the experimental group after the training program.
Significant reductions of 9% for left hand and 13.7% for right hand arm volume were
also found in the experimental group. Consequently, aerobic exercise with Greek
traditional dances and upper body training could be an alternative choice of physical
activity for breast cancer survivors, thus promoting benefits in physical function,
strength and psychological condition.21
A study evidenced that Lymphoedema is a common and troublesome condition
that develops following breast cancer treatment. The aim of this study is to analyze the
effectiveness of Manual Lymphatic A randomized, controlled clinical trial in 58 women
with post-mastectomy lymphoedema. The control group includes 29 patients with
standard treatment (skin care, exercise and compression measures, bandages for one
month and, subsequently, compression garments). The experimental group includes 29
patients with standard treatment plus Manual Lymphatic Drainage. The therapy will be
administered daily for four weeks and the patient's condition will be assessed one, three
and six months after treatment. The results of this study will provide information on the
effectiveness of Manual Lymphatic Drainage and its impact on the quality of life and
physical limitations of these patients.22
6.4. STATEMENT OF PROBLEM :
“A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE OF PREOPERATIVE
ARM EXERCISE ON PREVENTION OF COMPLICATIONS AMONG BREAST
CANCER PATIENT'S WHO UNDERGOING MASTECTOMY SURGERY
IN SELECTED HOSPITALS AT BANGALORE.”.
11
6.5. OBJECTIVES :
1. To assess the knowledge of preoperative ARM exercise on prevention of
complications among breast cancer patents undergoing mastectomy surgery
in selected hospitals.
2. To determine the association between the knowledge regarding of
preoperative ARM exercise on prevention of complications among breast
cancer patents undergoing mastectomy surgery with their demographic
variables.
6.6. HYPOTHESIS :
i.
H1: There will be significant association between the knowledge regarding
preoperative ARM exercise on prevention of complications among breast
cancer patents undergoing mastectomy surgery with their selected
demographic variables.
6.7. OPERATIONAL DEFINITIONS :
i.
Assess :It refers to examine the knowledge on preoperative ARM exercise on
prevention of complications among
breast cancer patents
undergoing
mastectomy surgery in selected hospitals.
ii.
Knowledge: It refers to the amount of information or awareness on preoperative
ARM exercise on prevention of complications among breast cancer patents
undergoing mastectomy surgery in selected hospitals in which is explored by the
score of knowledge questionnaires.
iii.
Prevention : It refers measures are strategies that stops the occurrence of the
illness and complications among breast cancer patents undergoing mastectomy
12
surgery in selected hospitals..
iv.
Breast cancer: It refers cancer is a malignant (cancerous) growth that begins in
the tissues of the breast. Cancer is a disease in which abnormal cells grow in an
uncontrolled way. Breast cancer is the most common cancer in women, but it can
also appear in men. In the U.S., it affects one in eight women.
v.
Mastectomy : It refers to Surgical removal of all or part of a breast, performed
as a treatment for cancer. A radical mastectomy includes excision of the
underlying pectoral muscles and regional lymph nodes.
vi.
Preoperative arm exercise: It refers a special course of manual exercise like
massage planned to administer before mastectomy to prevent complication.
6.8. ASSUMPTION:

Breast cancer patients will have some knowledge regarding preoperative
arm exercise in prevention of complication of mastectomy.

Breast cancer patients would willingly express their true knowledge
regarding arm exercise in prevention complication of mastectomy..
6.9. DELIMITATION OF THE STUDY:

Breast cancer patients undergoing mastectomy surgery patients who are
from selected maternity hospitals only.
7.

Only a sample of 60 breast cancer patients.

Duration of this study is 1 month.
MATERIALS AND METHODS:
7.1. SOURCE OF DATA
The data will be collected from breast cancer patients undergoing mastectomy
surgery in selected maternity hospitals in Bangalore.
13
7.2. METHOD OF COLLECTION OF DATA
Data will be collected by the investigator herself using structured closed ended
questionnaire.
7.2.1 RESEARCH APPROACH AND DESIGN :
Non -experimental design descriptive study approach will be used for this study.
7.2.2 SETTING OF THE STUDY:
The study will be conducted in the selected hospitals, Bangalore.
7.2.3 POPULATION :
The population of the present study will be all the breast cancer patients
undergoing mastectomy in the selected hospitals..
7.2.4 SAMPLE SIZE :
The sample size consisted of 60 breast cancer patients undergoing mastectomy
in the selected hospitals..
7.2.5 SAMPLE TECHNIQUE :
Convenience sampling technique is used for this study.
7.2.6 SAMPLING CRITERIA :
1. Inclusive criteria :

Who were present during the period of data collection.

Who were willing to participate in this study.

Who are able to read & speak in Kannada & English.
14
2. Exclusive criteria :
 Who were not present during the period of data collection.
 Who were not willing to participate in this study.
 Who are not able to read & speak in Kannada & English.
7.2.7 DATA COLLECTION TOOLS & TECHNIQUES :
Structured closed ended questionnaire scheduled will be prepared for data
collection. The questionnaire consists of:
Part A : Questions related to demographic variables like age, educational status,
marital status, type of family, occupation, income, type of diet, immunization, type of
gravid & other background information.
Part B: Questionnaire related to knowledge on preoperative arm exercise in
prevention of complications.
7.2.8 DATA ANALYSIS METHOD :
1. Appropriate descriptive and inferential statistics will be used for
data analysis & present in the form of tables, graphs & figures.
2. Mean, SD and range will be used to
assess the knowledge
regarding preoperative arm exercise among breast cancer patients.
3. The significance of relationship between the selected demographics
variables & knowledge scores will be analyzed by using chi-square
test.
7.3
Does the study require any investigation or interventions to be
conducted on patients
or other human & animals? If so please
15
describe briefly.
-No7.4
Has ethical clearance been obtained from your institution in case of
above?
Permission obtained from research committee, head of the hospital and sample.
8.
LIST OF REFERENCES
1. O'Hea BJ, Ho MN, Petrek JA. External compression dressing versus standard
dressing after axillary lymphadenectomy. Am J Surg 1999;177:450-455
2. Elder EE, Brandber Y, Bjorklund T, et al. Quality of life and patient satisfaction
in breast cancer patients after immediate breast cancer reconstruction: a
prospective study. Breast 2005;14:201-208
3. McCarty CM, Pusic AL, Sclafani L, et al. Breast cancer recurrence following
prosthetic,
postmastectomy
reconstruction:
incidence,
detection,
and
treatment. Plast Reconstr Surg 2008;121:381-388
4. Howard MA, Polo K, Pusic AL, et al. Breast cancer local recurrence after
mastectomy and TRAM flap reconstruction: incidence and treatment
options. Plast Reconstr Surg2006;117:1381-1386
5. Vinton AL, Traverso LW, Jolly PC. Wound complications after modified radical
mastectomy compared with tylectomy with axillary lymph node dissection. Am J
Surg 1991;161:584-589
6. Banerjee D, et al. Obesity predisposes to increased drainage following axillary
node clearance: a prospective audit.Ann R Coll Surg Engl 2001;83:268-272
7. Miller PJ, et al. Scalpel versus electrocautery in modified radical
mastectomy. Am Surg 1988;54:284-293
8. Kroner K, et al. Long-term phantom breast syndrome after mastectomy. Clin J
Pain 1992;8:346-354
9. Petrek JA, Senie RT, Peters M, et al. Lymphedema in a cohort of breast
16
carcinoma survivors 20 years after diagnosis. Cancer 2001;92:1368-1377
10. Foldi E, et al. The science of lymphedema bandaging in Caine, S. Editor.
European Wound Management Association (EWMA). Focus Document:
Lymphedema Bandaging in Practice. London: MEP Ltd, 2-4, 2005
11. Lawenda B, et al. Lymphedema: A primer on the identification and management
of
chronic
condition
in
oncologic
treatment. Cancer
Journal
for
Clinicians 2009:59:8-24
12. Pillar N. Phlebolymphoedema/chronic venous lymphatic insufficiency: an
introduction
to
strategies
for
detection,
differentiation
and
treatment. Phlebology 2009;24:51-55
13. Armer JM, Stewart BR. A comparison of four diagnostic criteria for
lymphedema in a post-breast cancer population.Lymphat Res Biol 2005:3:208217.
14. Mclaughlin SA, Wright MJ, Morris KT, et al. Prevalence of lymphedema in
women with breast cancer 5 years after sentinel lymph node biopsy or
axillary dissection: patient perceptions and precautionary behaviors. J Clin
Oncol2008;26:5220-5226
15. Christy SM, Mosher CE. Long-Term Dietary Outcomes of the FRESH START
Intervention for Breast and prostate cancer Survivors. J Am Diet Assoc. 2011
Dec;111(12):1844-51.
16. Reul-Hirche H. Manual lymph drainage when added to advice and exercise may
not be effective in preventing lymphoedema after surgery for breast cancer. J
Physiother. 2011;57(4):258.
17. Bradt J, Goodill SW, Dileo C.Dance/movement therapy for improving
psychological and physical outcomes incancer patients. Cochrane Database Syst
Rev. 2011 Oct 5;(10):CD007103.
18. Cavanaugh KM. Effects of early exercise on the development of lymphedema in
patients withbreast cancer treated with axillary lymph node dissection. J Oncol
Pract. 2011 Mar;7(2):89-93.
19. Hayes S, Rye S, Battistutta D, Yates P, Pyke C, Bashford J, Eakin E. Design and
implementation of the Exercise for Health trial -- a pragmatic exercise
17
intervention for women with breast cancer. Contemp Clin Trials. 2011
Jul;32(4):577-85. Epub 2011 Apr 2.
20. Kaltsatou A, Mameletzi D, Douka S. Physical and psychological benefits of a
24-week traditional dance program in breast cancer survivors. J Bodyw Mov
Ther. 2011 Apr;15(2):162-7. Epub 2010 Apr 13.
21. Martín ML, Hernández MA, Avendaño C, Rodríguez F, Martínez H. Manual
lymphatic drainage therapy in patients with breast cancer related lymphoedema.
BMC Cancer. 2011 Mar 9;11:94.
22. Sprod
LK, Palesh
OG, Janelsins
MC, Peppone
LJ, Heckler
CE, Adams
MJ, Morrow GR, Mustian KM .Exercise, sleep quality, and mediators of sleep
in breast and prostate cancer patients receiving radiation therapy. Community
Oncol. 2010 Oct;7(10):463-471.
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9
SIGNATURE OF CANDIDATE
10
REMARK OF GUIDE
11
NAME AND DESIGNATION
11.1 GUIDE
11.2 SIGNATURE
11.3 CO-GUDE
11.4 SIGNATURE
11.5 HEAD OF DEPARTMENT
11.6 SIGNATURE
12
12.1 REMARK OF PRINCIPAL
12.2 SIGNATURE
19