Academic journal article Journal of Counseling and Development : JCD

Breast Cancer Survivors Coping with Lymphedema: What All Counselors Need to Know

Academic journal article Journal of Counseling and Development : JCD

Breast Cancer Survivors Coping with Lymphedema: What All Counselors Need to Know

Article excerpt

I tried to talk with my counselor about the problems I was having with my lymphedema after my breast cancer surgery.... Although she knew quite a lot about breast cancer, she knew nothing about lymphedema and the stress I was under, and how ugly l feel.... I know she wanted to help, but I felt like I needed to help her ... I felt even more alone.

The American Cancer Society (2007) has reported that nearly 180,000 women in the United States develop breast cancer each year; it is currently estimated that there are more than 2.4 million breast cancer survivors. It is also reported that approximately a third to a half of these women develop lymphedema (Armer, Fu, Wainstock, Zagar, & Jacobs, 2004; Armer & Stewart, 2005; Mahamaneerat, Shyu, Stewart, & Armer, 2008; Petrek & Heelan, 1998), in which significant and persistent swelling is associated with an abnormal accumulation of protein-rich fluid, most often in the woman's ann, resulting from the removal of numerous lymph nodes in the axilla during the mastectomy and/or radiation treatment effects (Casley-Smith, 1992; Mortimer, 1998). In essence, the occurrence of lymphedema among patients with breast cancer affects millions of American women and represents a major medical and psychosocial problem (see Swirsky & Nannery, 1998).Yet, as the epigraph from the breast cancer survivors who have lymphedema depicts, counselors know little about this common affliction.

The physical impact of lymphedema can be enormous (e.g., Burt & White, 1999; Coster, Poole, & Fallowfield, 2001; Swirsky & Nannery, 1998). The swelling often causes discomfort, pain, and difficulty in using the affected limb; later, cellulitis (inflammation of the subcutaneous tissue) and lymphangitis (acute inflammation of the lymph vessels) often occur, predisposing the women to a systemic infection that can easily become life threatening. Hull (1988) also noted that lymphedema can have a broad impact on the daily lives of women, such as (a) sleeping becomes difficult as women try to elevate or position their arms; (b) carrying items, even cooking kettles or groceries, becomes challenging; (c) many forms of exercise, even walking, can become difficult; and (d) the comfort and fit of clothing can become problematic (e.g., blouses need to be larger, long sleeves are worn even in the summer to cover the swelling, or pressure from the garment). Physical symptoms and restrictions aside, what is less understood is the impact of lymphedema on women's inner lives and the level of stress they experience (Radina & Armer, 2004).

Although the psychological sequelae of breast cancer have been documented (M. B. Tobin, Lacey, Meyer, & Mortimer, 1993), the examination of psychosocial adjustment related to lymphedema is in its infancy (e.g., Passik, Newman, Brennan, & Holland, 1993). Moreover, the research in this area often results in equivocal findings (Coster et al., 2001). For example, uncontrolled case studies provided some anecdotal evidence that lymphedema is associated with psychosocial distress (Passik et al., 1993). M. B. Tobin et al. provided stronger quantitative evidence of a link between lymphedema and psychosocial adjustment, but their findings were inconsistent across measures of psychological distress. Maunsell, Brisson, and Deschenes (1993) also reported an association between lymphedema and psychosocial distress, but implemented outdated assessment instruments not typically used in the current psychological adjustment literature. Passik, Newman, Brennan, and Tunkel (1995) provided additional correlational evidence linking lymphedema and psychological adjustment and particularly highlighted social support deficits and avoidant coping as being significantly related to psychological distress in patients with lymphedema. Using improved assessment inventories, Coster et al. also found patients with lymphedema to have more psychosocial adjustment difficulties than women who have breast cancer without lymphedema. …

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