LYMPHEDEMA MANAGEMENT OUTCOMES AND THEIR DETERMINANTS AMONG PATIENTS TREATED FOR BREAST CANCER AT SELECTED HOSPITALS IN WESTERN REGION OF KENYA

Abstract

Globally, 28% to 38% of breast cancer survivors develop lymphedema following breast treatment affecting one in five patients, Symptoms vary but include swelling, heaviness and pain, when severe, significantly impact the person’s ability to perform tasks. Without treatment the condition progresses to serious complications such as necrosis and infection. 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 related to breast. This study evaluated clinical management strategies for lymphedema secondary to breast cancer treatment in selected hospitals in western region of Kenya. Specific objectives were to assess healthcare providers competence in clinical management of lymphedema secondary to breast cancer treatment, to examine the effectiveness of strategies used in clinical management of lymphedema and determine lymphedema patient management outcome. Study design was cross sectional analytic. included were health care providers and patients in the selected oncology centers. A pretest was carried out at Vihiga county referral hospital. Data collection was by a self-administered questionnaire, observation check list and focus group discussion. Qualitative data was analyzed thematically. Quantitative data was analyzed using descriptive statistics, frequencies and percentages and inferential statistics were used to test the association of variables. The results showed knowledge ranging from with deficit in important areas of practice such as skin care (OR = 0.56, p = 0.01). Stocking class, A pressure (OR = 1.841, p = 0.004). With over 50% getting incorrect answers. Better skills demonstrated in history taking and assessment (OR;1.6:CI:1.0-2.4; p value =0.037). Bivariate analysis showed statistically significant results of patients developing lymphedema after single agent surgery (OR;0.1 CI 0.0-0.8 P Value =0.004) or combined treatment Chemotherapy and Hormonal therapy, (OR:0.5;CI;0.1-0.8,P Value =0.003). Borderline statistically significant results were also obtained from those on the combination of Surgery, Chemotherapy, Radiotherapy and Hormonal therapy OR;0.5; CI: 0.1-0.4 P Value = 0.065. The asymmetrical distributions showed some patients took several months to development lymphedema symptoms and used more than one treatment strategies, the highest proportion used prescribed exercise (58.8%) and medical treatment (59.4%) and Management strategies varied with a significant difference in response to each treatment and not all treatment strategies were effective. there was statistically significant difference in outcome to treatment strategies. When using medical treatment as patients were likely to report improvement (OR:3.3; 95%CI: 1.6-6.5: P =0.005, physical exercises (OR:1.6; 95% CI: 1.1-3.2: P =0.032), In conclusion, healthcare providers were not knowledgeable and strategies were effective when the diagnosis was made early. The study recommended training opportunities and continuing education for healthcare providers.