Managing lymphedema and shoulder morbidity can be a major concern for breast cancer survivors in LMICs. Patients should be
encouraged to self-report upper extremity limb changes. Monitoring for lymphedema can be done using basic circumferential measurements of limb girth, andbioelectric impedance devices . More advanced monitoring strategies, such as perometers, can add sensitivity to limb girth measurement and promote early identification of limb asymmetry. Patient and family education should include teaching simple
shoulder movement exercises, and how to incorporate these exercises into daily activities. Limb compression supplies, such as non-custom sleeves or stretch tubing, are often available and may be helpful in controlling lymphedema, whereas physical therapy (PT) or occupational therapy (OT), including the more intense lymphedema treatment of complex-decongestive therapy (CDT), will require significant expertise to provide. Early introduction of lymphedema therapy, including arm exercises and
lymphatic massage, has been associated with a lower incidence of lymphedema, compared to controls . Resistance exercise may reduce symptom exacerbations in survivors with lymphedema. A study in Australia found that women who are informed and knowledgeable about lymphedema risk and management were more likely to adhere to recommended patient-directed lymphedema prevention and management strategies . Patient education should also include self-management for other late-effects of treatment, including fatigue, insomnia and pain. (See the BHGI companion consensus statement, Supportive Care during Treatment , which covers fatigue, insomnia and pain complications during