The incidence and effects of lower limb lymphoedema in women treated with radiotherapy for gynaecological cancer in an academic hospital in Johannesburg

Abstract

Even though cancer treatment has improved survivorship, women who receive radiotherapy as part of treatment for gynaecological cancer have a lifetime risk of developing lower limb lymphoedema. Little is known about cancer related lower limb lymphoedema in South Africa as there is a dearth of South African literature focusing on the subject. It might be argued that international literature can inform South African nurses; however, South Africa faces unique challenges in terms of cancer control such as poor health care seeking behavior among women and a poor referral system. The purpose of the study was to describe the incidence of lower limb lymphoedema and its effects on women treated with radiotherapy for gynaecological cancer at an academic hospital in Johannesburg. The study was conducted at the chosen academic hospital’s department of radiation oncology. A quantitative survey design and convenience sampling for a calculated sample size of 155 were used. Data was collected through structured interviews using the Gynaecological Cancer Lymphoedema Questionnaire (GCLQ) and limb circumference measurements from which limb volumes were calculated. Lower limb lymphoedema was defined by an inter limb volume difference of 200ml and graded according to the percentage volume difference; >20% for mild, 20% to 40% for moderate and >40% for severe lymphoedema. Data was analysed using descriptive statistics and quantitative content analysis. Statistical level of significance was set at 0.05 (p<0.05). Lower limb lymphoedema was detected in 29.7% of the respondents; 93.5% with Stage I and 6.5% with Stage II lymphoedema. External beam radiotherapy, age and body mass index were not associated with lymphoedema. On the contrary, brachytherapy and the type of gynaecological cancer had a statistically significant association with the development of lower limb lymphoedema; p=0.030 and p=0.017 respectively. Respondents reported experiencing changes such as taking long to finish tasks, increased hospital charges and feeling unattractive due to the lymphoedema. Outpatient gynaecological clinics may consider regular assessment of patients for lower limb lymphoedema during follow up care through history taking and leg measurements, to detect lymphoedema early.