Critical Appraisal Breast Cancer

Question: Discuss about theCritical Appraisalfor Breast Cancer. Answer: Introduction Around 1.7 million women across the world were reported of breast cancer in the 2012. Around 521,900 women died because of this disease. This disease is affecting women all across the world. (Torre et al., 2015). Breast cancer is one of the most common cancer affecting women. It occurs due to the uncontrolled and abnormal growth of cells in the breast. (Peacock, 2001). It leads to the formation of tumour. Tumour formed in the breast may benign or malignant. Benign tumours are lumps formed in the breast but they are not cancer as they do not spread to the other body organs. Malignant tumours are cancerous as they tend to spread to the other body parts and affect them. (American Cancer Society, 2016). As per the reports from USA, the survival rate of women suffering from breast cancer is 90%. Around 2.9 million women are reported to have survived breast cancer in USA. The major reason for this disease is the bad life style. (American Cancer Society, 2013). The treatment applied to cure the disease involves surgical methods, chemicals interventions, radiotherapy and hormonal therapy. The methods are effective against but may pose adverse health issues. (Heisig et al., 2016). There is a possibility of acquiring Lymphedema which is a severe chronic disease as a result of the side effects. This is observed in around 40% of women who undergo the breast cancer surgery. (McLaughlin et al., 2013). Lymphedema Due to Breast Cancer Lymphedema related to breast cancer occurs due the blockage or disrupted lymph system because the adverse effect of cancer treatment. In this disease the soft tissues get filled with fluid rich in protein mainly due to the disruption in the lymph flow. (Armer Stewart, 2010). This disease mainly targets the limbs but can also affect the genital area, head, neck, lungs and the abdomen. (Gary, 2007). The disease is observed mostly in 2 years after the surgery, although the onset can be different in different women. (Paskett et al., 2007). Disease Pathology Lymphatic system in human body is responsible for maintaining the fluid level in the various tissues and has major role in the removing the pathogens infecting the human body. It is an independent system which has important role in maintaining the immunity of the body. (Wanchai et al., 2016). Due to the accumulation of the larger molecules in the lymphatic vessels, transportation of lymph is obstructed. A high osmotic pressure is generated which increases the fluid level in the interstitial tissues space and leads to the condition known as lymphedema. (Foldi et al, 2006). Symptoms and Risk Associated with Lymphedema The common symptoms reported in the patients after breast cancer surgery are- swelling in limb, stiffness, pain, weakness, muscle fatigue, trouble in moving the limb etc. these symptoms act as sign to the development of lymphedema in the women post breast cancer surgery. The swelling in limb increases with the severity of the disease. As per some of the studies conducted on the breast cancer patients, the diagnosis of change in the volume of limb has increased following the report of pain, swelling and stiffness of the limb by the breast cancer survivors. (Cormier et al., 2009). This disease affect the quality of life of the breast cancer patients and also pose psychological problems. (Fu Kang, 2013). The effect of surgery on the axillary node, exposure to radiation leads to the low lymph flow in axilla and retention of fluid in the tissues. Radiation exposure poses a threat on the functioning of the lymph vessels. Obesity and the cancer development again can also cause lymphedema. (Avraham et al., 2010). Treatment Methods The health care professionals suggest their patients to follow a self care regime after the breast cancer surgery. This can help in the preventing the disease. Some of the common precautions are taking care of skin, using compression undergarments, avoiding muscle damage, obesity control, following a light aerobic exercise regimen every day. Treatment methods will based on the stage of cancer diagnosed, the body mass index of the patient, normal health of the patient. Although this disease has no cure as it is a chronic infection. The preventive method and other suggested method could help in dealing with it and minimising the effect. (Greene et al., 2015). A number of researches conducted on how to control the symptoms. One such study was conducted by Jeff and Wiseman (2012) on the effect of routine exercise along with the self care methods to control the lymphedema in women after breast cancer surgery. The Background of the Study The experiment was designed to observe the effect of exercise on women suffering from the breast cancer related lymphedema. This study was conducted on a smaller level before applying it on a broader level. The duration of the study was about 6 months comparing the effect of standard lymphedema self care to the normal self care alone. The observation was based on the change in volume of the limb after the 6 month following the researchers guideline. Also observation was made on the change in the quality of life, the functioning of the arm and effect on the shoulder movements. Critical Analysis of the Study Introduction- the introduction of the article discusses about the effect of the disease and the number of researches going on to find effective exercises to help the women who are suffering with lymphedema. It mentions to the lack of effective exercise to help in this disease. This is true in case of disease as the proofs are less in case of this disease to justify the role of exercise. (Schmitz et al, 2009). The author justified using several references about the lack of proper research related to the topic. Method-The study was a controlled trial in 6 month, conducted in a cancer centre in England. The study aim on getting not more than 70 women as it was a limited trial but only 23 women participated who were fulfilling the criteria of the research. These women were randomly allocated the group which included A standard self-care alone i.e. the control group (CG) or the standard self- care along with exercise i.e. the intervention group (IG). Previous medical treatment were to be followed during the trial that was related to the skin care, compression undergarment, use of gloves etc. the prescribed exercises were also allowed. The number of participation was less compared to the desired number. This can affect the result as with fewer numbers of participant chances of getting positive result is less. The categorical isolation was well established and all the necessary information was considered. The previous medications and nursing interventions were allowed which was necessary for the response. The exercises included in the trial were mild and gravity resistive (Leduc et al., 1981). The exercises were based on deep breathing, gravity-resistant arm exercises focusing on the flow of the lymph in the limb. The participants were asked question on their regularity with the exercise regimen. The change in the volume of limb, body weight and the shoulder movement were recorded before starting trail and after 4th, 12th, and 26th week. The analysis methodology was well selected with the correct exercises. The exercises chosen are mild which is important as harsh exercise can cause ill effect on the participants health. Instrument selection-The quality of their life was also measured. The technique involved for the measurement included Perometer 350S which measured the change in limb volume. Using this instrument the mean volume was calculated for both arms and relative excess limb volume percent was calculated. Lymphedema specific 28- item was used to analyse the change in quality of life. The functional activity of the patients was measured by the QuickDASH-9 questionnaire. A goinometer was used to measure the shoulders range extension. Analysis was done following the SPSS version guidelines. The value of significance was set at p The researcher has effectively applied the various instruments which are necessary for the research. The guidelines are followed and the limb volume before the trial is measured. They have given the instruments role and used it effectively. The interventions are described. The chart depicts the measures to explain the protocol guidelines. Results- At the end of the study it was observed that all 23 participants followed the trail method. The effect of the different routine was same when observed at baseline. The changes in the limb volume were observed on the 12th week with a reduced limb volume in both the groups whereas no significant change was observed after the 26th week. There were no changes in quality of life and the range of the shoulders extension. The study showed a positive result with the reduction in volume of fluid in the limbs. The reduction in the intervention group was by 6.4 and in the control group was by 2.49. This shows that exercise has a positive impact on management of lymphedema in women. The method followed by the researchers was as per the guidelines mentioned for the analysis and all the points were taken into consideration. The researchers have mentioned all the necessary information and the techniques that were involved. Discussion- The randomisation of the trail is also well established owing to the lesser number of participants. They included all the major effects under the observation criteria. The calculations have been mentioned. The results predict the effect clearly and not vague. The researchers also considered the ethical issue related to the study. They maintained that they were blind to the randomisation. The patients were examined routinely with proper interactions. They were also observed on the basis of changes in the quality of life and what was the impact of the previous medical suggestion that they were following. Both the groups were analysed equally. The participants selected were observed to have a history of at least 3 months suffering with lymphedema. They got the positive results considering the small number of participants. the observed the benefits of the method and ready to continue it to avail the relief from the disease. The only negative point with study is the small number of women. As it is a small cohort of women, the results cannot be applied on the clinical level and also the duration was less. They have mentioned that extending the period was not required. Although considering a small cohort it would be better if they considered the study for a longer duration. The suggestion by the researchers to apply it on clinical level is not correct because the number of women is less. Future research- Although the effect analysed were positive, the implication was on limited women. Thus its effectiveness on the clinical level should be considered only if the results are positive for a large cohort of women. It is necessary to develop effective technique to measure the effect of the disease using proper technique. Development of effective tool is important. The future aspect of the research should be based on the implication of method on more number of women. It should be on applying various techniques and identifying the most effective exercises to manage the disease. Conclusion As there is no possible cure to lymphedema, it is important to discover methods to reduce the effect of the disease. The study was conducted followed the effect of exercise standard for the lymphedema with the self exercise. The researchers have conducted the study considering all the important issues and following all the important guidelines. Considering the interest of the disease on the women, it is sad to observe that not many women turned up for the trial. To formulate effective methods it is important that more number of women take part in the research and cooperate with the method. 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