| dc.description.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. | en_US |
