Clinical Management Strategies for Lymphedema Secondary to Breast Cancer Treatment in Selected Hospitals in Western Region,Kenya

Abstract

Background: Globally breast cancer remains the most diagnosed cancer with approximately 2.3 million cases in both sexes, about, 28% to 38% develop lymphedema following breast cancer treatment affecting one in five patients, when severe, Lymphedema significantly impact the person’s ability to perform tasks and without treatment the condition progresses to serious complications. In Sub-Saharan Africa reported comorbidities associated with lymphedema showed it is on the increase. Kenya has no data on the prevalence of lymphedema, although reports exist on different types of lymphedema treatment. In western Kenya, no studies have examined lymphedema. This study evaluated clinical management strategies for lymphedema secondary to breast cancer treatment in selected hospitals in the Western Region of Kenya.

Material and Methods: This was a cross sectional analytic study. Simple random sampling was used to select health care facilities offering cancer screening and treatment. HealthCare providers were randomly selected from five health facilities depending on the number required at each health facility. 192 health care providers were selected to participate in the study. Data collection was by structured questionnaires, observation checklist and focus group discussion, analysed by SPSS version 23.1 and Qualitative data thematically analysed guided by questions on knowledge, skills and management strategies.

Results: The results showed healthcare providers knowledge ranging from low to average with deficit in important areas of practice such as skincare
(OR=0.56, p=0.01). stocking pressure (OR=1.841, P=0.004, positive stemmer’s sign test (OR=2.217, p=0.001) with over 50% getting incorrect answers. Good history and assessment Skills were demonstrated (0R=1.6;CI;1.0-24;P=0.037) but patient education was poorly done. Findings from focus group discussion showed deficit in knowledge by failure to clearly define lymphedema.

Conclusion: Structured education of lymphedema is needed to increase the knowledge of healthcare providers and improving knowledge may fill the gaps in knowledge and demonstrate good practical skills in patient management.