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BACKGROUND Early intervention with self-management strategies can potentially reduce the risk of progression of breast cancer-related lymphedema (BCRL). OBJECTIVE To determine if The-Optimal-Lymph-Flow (TOLF) program focused on self-management strategies applied to patients with a subclinical or mild stage of BCRL can improve lymphedema-related behaviors, symptom experience, and limb circumference changes. METHODS A total of 41 women with subclinical or mild lymphedema were enrolled in TOLF program. Lymphedema-related behaviors and lymphedema-related symptom experiences were measured by the Breast Cancer and Lymphedema Symptom Experience Index, and limb circumference changes were measured by sequential circumferential limb measurements at baseline and 1, 3, 6, and 12 months after the intervention. Generalized estimating equations were used to estimate the effects of the intervention on outcomes. RESULTS Generalized estimating equations revealed that lymphedema-related behaviors and the number and severity of lymphedema-related symptoms were significantly improved at 4 postintervention test points compared with baseline (all P < .001). Reduced lymphedema-related symptom distress in functional, social, emotional, and psychological and self-perception (all P < .01) also resulted. The majority (77.5%) of patients maintained their preintervention lymphedema status; 17.5% of them reversed from mild lymphedema to subclinical lymphedema; 5.0% of them had lymphedema status progression. CONCLUSION Positive outcomes in terms of lymphedema-related behaviors, relieving lymphedema-related symptom experience, and halting the progression of lymphedema status were documented following TOLF. IMPLICATIONS FOR PRACTICE Nurses could educate patients to incorporate the self-management strategies of TOLF program into daily life to help patients prevent or reverse subclinical or mild stage of BCRL.

Background Fear of cancer recurrence (FCR) is the most prevalent need among breast cancer survivors. Age is the most consistent predictor of higher FCR, with prevalence rates as high as 70% among young adults. Although the association between age and higher FCR is well established, a more comprehensive understanding of the factors contributing to higher FCR among young adult breast cancer survivors is needed. Objective The purpose of this integrative review was to explore the factors associated with higher FCR among young adult breast cancer survivors (≤ 45 years old). Methods A literature search was conducted using PubMed, CINAHL, PsycINFO, and EMBASE databases with specific Medical Subject Headings terms delimited to FCR, diagnosis, sex, and age range. The initial search yielded 378 studies, 13 of which met the eligibility criteria. Results Themes include motherhood status, health behaviors and decision making (eg, surveillance behaviors and surgical decision making), psychological morbidity, and social support. Cognitive behavioral factors include cognitive processing, metacognition, illness intrusiveness, and self-efficacy. Conclusion Fear of cancer recurrence among young adult breast cancer survivors is a unique construct requiring further exploration and tailored interventions to improve the health-related quality of life for this population. Implications for practice Oncology nurses should screen all cancer survivors for FCR, with particular attention to the unique needs of young adults. Future research should address the role of age-appropriate support and increased levels of FCR during surveillance periods.

Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide, causing about 1 million deaths annually. Patients with HCC usually reported multiple concurrent symptoms. The purpose of this multivariate study was to explore whether multiple concurrent symptoms are clustered into groups of symptoms and to explore the effect of symptom clusters on the quality of life (QOL) in patients with HCC. A sample of 180 patients with HCC at a medical center in Korea was recruited. Patients completed a demographic questionnaire, a Symptom Checklist, the Hospital Anxiety and Depression Scale, and the Functional Assessment of Cancer Therapy-Hepatobiliary. Factor analysis was used to identify symptom clusters based on the severity of patients' symptom experiences. Four symptom clusters were identified: pain-appetite, fatigue related, gastrointestinal, and itching-constipation. Two patient subgroups were identified through cluster analysis: high- and low-symptom group. Patients in the high-symptom group had significantly poorer functional status and poorer QOL in all the domains, with the exception of social well-being. The differences between the 2 patient subgroups were not only statistically but also clinically significant. Patients in the high-symptom group were also statistically and clinically anxious and depressed. Further research is needed to explore whether compositions of symptom cluster phenotypes vary over time and whether the associations of symptom clusters with QOL and mood are changing along the disease and treatment trajectory as well as symptom status.

This descriptive, cross-sectional, correlational study with a convenience sample of 96 women treated for breast cancer at an outpatient service in Brazil was designed to investigate post-lymphadenectomy complications after axillary lymph node dissection (ALND) and sentinel lymph node biopsy and explore the associative relationships between the complications and quality of life. Clinical evaluations using perimetry, goniometry, and muscle strength test were used to evaluate the complications. Pain and quality of life were assessed by the Short-Form McGill Pain Questionnaire and the Functional Assessment of Cancer Therapy-Breast. All participants had at least one complication. Incidence was higher for pain (57%), impaired shoulder strength (57%), and fibrosis (54%), followed by impaired shoulder range of motion (46%) and lymphedema (17%). The incidence of impaired shoulder flexion (P = .01) and lymphedema (P = .002) was higher in ALND group. Winged scapula (8.4%) only occurred in the ALND group. Quality of life was significantly correlated with pain (r = -0.53, P = .000) and impaired shoulder strength in flexion (r = 0.4; P = .000) and abduction (r = -0.5, P = .000). Future studies are needed to prospectively investigate the onset of the complications and identify appropriate interventions to promote quality of life in women treated for breast cancer.

The purpose of this study was to determine reliability and validity of the Chinese version of the Index of Nausea, Vomiting, and Retching (INVR) and the Index of Nausea and Vomiting Form 2 (INV-2) to provide a reliable and valid measure of nausea, vomiting, and retching for Chinese nurses and other healthcare providers. An integrative translation method was used in the study. The reliability and validity of the Chinese versions of the INVR and the INV-2 was evaluated using test-retest, parallel forms, and crossover design. A convenience sample of 177 Chinese-speaking participants was accrued from a large teaching cancer institute and a teaching obstetric hospital in Beijing, Peoples Republic of China. The integrative translation method was proven to be an effective method for translating instruments from the source to the target language. The Chinese versions of both the INV-2 and INVR were found to have high Cronbach's alpha scores and high agreement rates. The responses to the Chinese version of INVR were more frequently consistent than the responses to the INV-2. The majority of the patients voiced preference for the INVR. The findings suggest the significance of the Chinese versions of INVR and INV-2 in terms of nursing practice. The findings also support the cross-cultural method for future study at international level.

The purpose of this study was to describe the experience of managing lymphedema in breast cancer survivors. A descriptive phenomenological method was used as a guide for developing a bracket, gathering data, and analyzing data. A cross-sectional design with a purposive sampling technique was employed. During the 3 private, semi-structured, audio-recorded interviews with each woman, 12 breast cancer survivors described how they managed lymphedema in their daily lives. A taxonomy of 3 levels was created to describe the essential structures of the experience from general, to mediating, to specific: revelatory intention, cluster intention, and unit intention. The study revealed that the women's major intentions of managing lymphedema were to keep in mind the consequences, prevent lymphedema from getting worse, get ready to live with lymphedema, and integrate the care of lymphedema into daily life. Findings of the study provided an insightful alternative to the compliance approach to lymphedema management. Instead of merely evaluating breast cancer survivors' degree of compliance with treatment, it is suggested that researchers and practitioners should also assess the impact of the presence or absence of the women's intentions on lymphedema management.

This secondary data analysis was designed to explore the age differences in lymphedema (LE) occurrence and self-reported symptoms in post-breast cancer LE. A descriptive-exploratory cross-sectional design was used with a convenience sample composed of 102 women treated and followed for breast cancer at a midwestern cancer center. Sequential circumferential arm measurement was used to estimate limb volume differences. Self-reported symptoms were assessed by the Lymphedema and Breast Cancer Questionnaire (LBCQ) designed and tested by the research team. Lymphedema occurrence was relatively higher (41.2%) in breast cancer survivors younger than 60 than in those older than 60 (30.6%). Six subjectively reported symptoms were found to occur more often (P