Heidi Shaffer, OTR/L, MSM, CLT-LANA at MultiCare-Gig Harbor was interested in how early intervention, namely intervening at Stage 0, related to better outcomes for oncology patients at risk of lymphedema. This question was developed from a desire to follow-up prior student research relating to the usefulness of the LDEX in lymphedema management, however current literature did not indicate the LDEX as an early intervention method. Although the authors did not exclude other types of cancer, the research only reflected breast cancer outcomes. Overall, strong evidence was found that exercise is not contraindicated for clients at risk of breast cancer related lymphedema (BCRL). There was strong evidence endorsing implementation of surveillance models to increase early detection and early intervention of BCRL. There was strong evidence that compression sleeves and decongestive therapy were effective in treating BCRL. There was moderate evidence to suggest that exercise and early intervention helped prevent the progression of BCRL. There was no evidence to the authors’ knowledge that surveillance methods were contraindicated for clients at risk of lymphedema. Additionally, there was some evidence that treating lymphedema at a subclinical stage reduces treatment time and inhibits the progression of lymphedema. In conclusion, surveillance methods coupled with early intervention could be recommended by the authors to help prevent the progression of lymphedema. These recommendations, if followed, may lead to reduced overall healthcare costs and maintain a high quality of life for oncology patients.

Knowledge translation was conducted to support the dissemination of our findings. Our knowledge translation included submitting an abstract to the International Lymphoedema Framework Conference in the Netherlands. The authors created and proposed a template to track outcomes of current and upcoming lymphedema clients. A PowerPoint was created and provided to Shaffer’s supervisor, Sherri Olsen OTD, MBA synthesizing our findings. The authors then had an informed conversation with Olsen about their findings and the realistic application and implementation of the findings into practice. The authors’ hope was that Olsen would disseminate the information to a wider audience, specifically, providers who are responsible for referring clients at risk of lymphedema to a lymphedema specialist, and other lymphedema specialists who may benefit from this research. Future recommendations include synthesizing outcome data collected by lymphedema specialists at MultiCare and further investigation of the support systems for clients at risk of lymphedema.

Publication Place

Tacoma, Washington


University of Puget Sound

Project Chairperson

Jennifer Pitonyak, PhD, OTR/L, SCFES

Publication Date



Capstone Project





Degree Program

Occupational Therapy

Degree Level

Master of Science


Occupational Therapy


University of Puget Sound