Meme kanseri ilişkili lenfödem: Egzersiz yapmak için bir engel midir?

Meme kanseri tedavisinin en yaygın komplikasyonlarından biri olan lenfödem; ağrı, etkilenen ekstremitenin hareket yeteneğinde azalma veya kayıplara neden olarak bireyleri fiziksel, fonksiyonel ve psikososyal açıdan olumsuz yönde etkilemektedir. Meme kanseri ilişkili lenfödem yönetimi uzun yıllardır tartışma konusu olmuştur ve bu tartışma halen güncelliğini korumaktadır. Fiziksel aktivite ve egzersizin meme kanseri ilişkili lenfödem yönetiminde terapötik etkisi ile ilgili çok az kanıt olmakla birlikte lenfödem tedavisinin önemli bir komponenti olduğu kabul edilmektedir. Geçmişte meme kanseri ilişkili lenfödem gelişimini azaltmak veya tetiklememek adına etkilenen ekstremiteye yönelik tekrarlı ve yorucu üst ekstremite egzersizlerinden kaçınılması gerektiği düşünülürdü. Çünkü sağlık profesyonelleri arasında da üst ekstremiteye yönelik yapılacak egzersizlerin lenfödem gelişimini tetikleyebileceği veya var olan lenfödemin şiddetini olumsuz yönde etkileyebileceğine dair görüşler mevcuttu. Ancak yapılan araştırmalar sonucunda bu görüşlerin kanıta dayalı olmadığı ortaya çıkmıştır. Sağlık profesyonellerinin sahip olduğu bu düşünceler ve hastalara yapmış oldukları tür önerileri egzersiz türü, sıklığı, şiddeti vb. gibi konularda korku, gerginlik ve endişe yaşamalarına neden olarak egzersiz yapmalarını engelleyebilmekteydi. Günümüzde ise kanıt gücü yüksek randomize kontrollü çalışmalar ile egzersiz tedavisinin lenfödem gelişimine veya mevcut lenfödem tablosunun ilerlemesine neden olmadığı kanıtlanmıştır. Meme kanseri hastalarında özellikle tedaviye bağlı olarak gelişen lenfödemin önlenmesi ve yönetimine yönelik girişimler ile hastaları fiziksel ve psikolojik olarak olumlu yönde etkileyerek bireylerin yaşam kalitelerine önemli bir destek sağlanabilir. Bu doğrultuda farmakolojik olmayan yaklaşımlardan biri olan egzersiz programları ile bireylerin kendini fiziksel ve psikolojik yönden daha rahat hissetmelerine katkı verilebilir.

Anahtar Kelimeler:

Meme kanseri, lenfödem, egzersiz, lenfödem yöntemi

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