Academic journal article Journal of Cultural Diversity

Nursing Education on Lymphedema Self-Management and Self-Monitoring in a South African Oncology Clinic

Academic journal article Journal of Cultural Diversity

Nursing Education on Lymphedema Self-Management and Self-Monitoring in a South African Oncology Clinic

Article excerpt

Abstract: Breast cancer is the leading cause of cancer in South African women. Without comprehensive national and provincial breast health programs, survivorship issues are in need of being addressed. Lymphedema secondary to breast cancer treatment (BCLE) is one of the most physically and psychologically devastating outcomes of treatment. Nurses at a South African oncology clinic educated survivors with BCLE in cost-effective self-management and self-monitoring techniques. The purpose of this paper is to describe these techniques and their relevance to diverse South African survivors. A case study analysis was performed. The need for cost-effective survivorship programs is discussed.

Key Words: Lymphedema, Self-Management, Self-Monitoring, Nursing Education, South Africa

According to the South African National Cancer Registry (2001a), 1 in 8 South African women is affected by cancer in her lifetime. Breast cancer is now the most common form of cancer affecting South African women (Department of Health, 2002), impacting an estimated 1 in 29 women and accounting for approximately 17% of all cancers among women (National Cancer Registry, 2001b). In South Africa, breast cancer is estimated to account for 30% of all cancers among Asian women; 25% of all cancers among coloured women; 18% of all cancers among white women; and 17% of all cancers among black women (National Cancer Registry, 2001b). However, in the absence of an active cancer registry, incidence and prevalence rates are potentially higher (Mqoqi, Kellett, Sitas, & JuIa, 2004).

Diverse South African women are at particularly high risk for developing breast cancer-related health deficits. Based on statistical information derived from an urban hospital database, breast cancer is believed to be on the rise among urban black South African women (Walker, Adam, & Walker, 2004), a change which has been attributed to urbanization-related lifestyle changes, including alterations in diet and living conditions. In a randomized study of 140 rural (n=70) and urban (n=70) black South African women, a statistically significant difference was found in awareness and knowledge of breast disease, screening, and risk-reduction techniques between urban and rural women (Pillay, 2002). Rural women were significantly less aware and knowledgeable about breast cancer than urban women and were less likely to seek care from a health care provider. These women are at potentially higher risk for developing adverse outcomes of treatment, such as lymphedema secondary to breast cancer treatment (BCLE), due to an advanced stage of disease at the time the diagnosis is made.

Moreover, a paucity in the literature exists in the exploration of the experiences of breast cancer-affected black South African women. This gap in the knowledge suggests the need for continued research concerning the development of comprehensive breast health programs addressing all aspects of breast health, beginning with risk-reduction and lasting throughout survivorship, to promote the health of South African women. According to the Cancer Association of South Africa (2008), South Africa is without a comprehensive breast health program, in part as a consequence of inconsistencies in national and provincial cancer care policy; inconsistencies in health service delivery; and barriers to acquiring health services, such as difficulties in obtaining transportation to health facilities and lack of public knowledge concerning health referrals. Developing cost-effective, self-efficacy-focused programs will play an important role in breast health, not only in minimizing risk but also promoting breast cancer survivorship. Cost-effectiveness is especially salient, as black South Africans have been found to be the most socioeconomically vulnerable of any racial group in South Africa (Bremer, Moore, Bourbon, Hess, & Bremer, 1997). Addressing these disparities is critical to guaranteeing health promotion in all South African populations. …

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