Discovery To Cure Happenings
February 2022

Reminder to Save the Date, May 1, 2022, for the
Beverly Levy Walk and Festival
New Social Worker in Gynecologic Oncology

Rebecca Halbert, LCSW
Gynecologic Oncology

My name is Rebecca Halbert and I am the new social worker for Gynecologic Oncology! I have been with the Yale New Haven Health System for a little over two years and previously worked at the Saint Raphael Campus in adult inpatient medicine. Gynecologic Oncology social work is close to my heart following my experience with a close family member’s diagnosis with ovarian cancer and I am beyond happy to have made this transition to Smilow. I hope to bring my passion and dedication to as many Smilow patients and their families as I can!

Oncology Social Work here at Smilow Cancer Hospital is unique in that we have a chance to support patients in processing challenges throughout their cancer journey and assist them in identifying ways to cope with the demands of their illness. In addition, we are also able to connect patients with many community resources. As social workers, we believe addressing psychosocial needs is essential to the patient’s treatment and enhancing their care. If you are interested in setting up a time to connect, please ask your Smilow provider to submit a social work referral.

Lymphedema Q&A

Wendy Farnen Price, PT, DPT, MS, WCS, DipACLM, CHWC, NPT
Founder, Healthcore Lifestyle Medicine
Exercise Therapist, Yale University
wendy.price@ynhh.org
wendy@myhealthcore.com
203.772.8820
Women with gynecologic cancer are at risk for lymphedema. A 2018 research article published in Cancer stated, "Because the surgical treatment of ovarian cancers often involves removal of the lymph beds in the pelvic sidewalls and para-aortic area, the risk of lower limb lymphedema (LLL) is high. However, women are mostly unaware of the risk, and few gynecologic oncologists discuss this potential side effect with patients when they are reviewing the treatment for their cancer." 1

What is Lymphedema?
Lymphedema is abnormal swelling in the body, usually the arms or legs, but can also happen in the face, neck, trunk, abdomen (belly), or genitals when the lymph system is damaged or blocked. In women with ovarian cancer, this fluid is most likely to collect in your legs or possibly your pelvic area. The lymphatic system is a network of lymph vessels, tissues, and organs that carry lymph throughout the body— think of it as your body’s plumbing system responsible for removing waste material from the body. Lymphedema occurs when lymph is not able to flow through the body the way that it should. 2

What are the common causes of lymphedema?
Lymphedema can be caused by cancer treatments that remove or damage your lymph nodes or vessels such as during surgery to remove lymph nodes or radiation therapy. Cancers that block lymph vessels can also cause lymphedema 2

What are the signs and symptoms of lymphedema?
  • Swelling in part of the body (such as your breast, chest, shoulder, arm, leg, pelvis, or genitals)
  • Skin feeling tight or hard, changing in texture, looking red, or feeling hot
  • New aching, feeling full or heavy, tingling, numbness
  • Less movement or flexibility in nearby joints (such as your hand, wrist, shoulder, hip, knee, ankle)
  • Trouble fitting your arm into a jacket or sleeve, or trouble fitting into or buttoning your pants
  • Collars, rings, watches, and/or bracelets feeling tight even though you haven’t gained weight 2
 
Red Flags: receive immediate medical attention:
  • Redness on the body area that was not present before and seems to be worsening
  • Redness with skin tissue that is warm to touch
  • A new lump or thickening on the limb or in the region of the body affected with swelling
  • New, rapid onset of swelling
  • New onset of pain in the limb or area
  • Fever, chills, and body aches
  • Areas of the limb or body area that seep or weep fluid with an apparent injury to the tissue 3

What is the treatment for lymphedema?
Prevention and early treatment of lymphedema are key! Each patient should be evaluated for lymphedema pre-and post-cancer treatment by a physical or occupational therapist that is a certified lymphedema specialist. An evaluation can include a complete medical history, physical evaluation, and measurements including limb circumference measurements taken at specified anatomical landmarks or regular intervals along the length of the limb, volume measurements with a perometer, and at Smilow Cancer Hospital, the rehabilitation department is equipped with SOZO, a noninvasive bioimpedance spectroscopy (BIS) device that incorporates L-Dex technology to deliver a precise reading of fluid status and tissue composition in less than 30 seconds to provide individualized and proactive care. 

Complete Decongestive Therapy (CDT) is widely accepted and most effective as the standard of care for the conservative management of lymphedema. Treatment by the certified lymphedema therapist may consist of manual therapy techniques including manual lymph drainage, compression bandages and garments, pneumatic pumps, activity and exercise, and skin and nail care. It is important for both the patient and family members to learn the techniques. A 2022 study on the prophylactic use of compression sleeves showed that it reduces the incidence of arm swelling in women at high risk of breast cancer-related lymphedema. Future research may indicate the prophylactic use of compression to reduce limb/pelvic lymphedema in women with ovarian cancer. 

Education about lymphedema is very important to understand why it can happen and when to get help and support. Risk factors include extreme temperatures, getting sunburn, needle sticks or cuts in that extremity or area, wearing tight clothing that causes redness, and having blood pressure taken on the limb where lymph nodes are removed. Obesity or being overweight is also a major risk factor for lymphedema, therefore, working with both a physical therapist and dietitian may be helpful. 4

Please talk with your healthcare team about lymphedema because there is support and treatment. Stopping lymphedema starts with preventing it!
Webinar for Newly Diagnosed Patients: Recording

Speakers:
Heather Glazer, Discovery To Cure
Dr. Erin Stevens, Prevea Health Green Bay Wisconsin
Emily Szafara, LMSW Mount Sinai Hospital
If you missed our Webinar last week Click Here to Watch
This newsletter is published monthly for patients and survivors of women's reproductive cancers. If you have suggestions for any specific content you would like to see featured,
or if you have feedback to share, please email Ruth Ann Ornstein.
Become an Advisory Group Member: Research Study on Uterine Cancer
 
For uterine cancer, non-Hispanic Black women are less likely than non-Hispanic White women to be diagnosed at early stage. Researchers at Yale University and Columbia University are conducting a study to understand the reasons for this disparity in early diagnosis. The study is titled “Racial Disparity in Diagnostic Evaluation of Uterine Cancer,” and it is funded by the National Institutes of Health/National Institute on Minority Health and Health Disparities.
 
The research team hopes to work with uterine cancer patients and community stakeholders in the form of an Advisory Group on this project. Members of the Advisory Group will help provide feedback on research design and interpretation of research findings. If you are committed to reducing disparities in uterine cancer care and are interested in becoming a member of this Advisory Group, please contact the study’s Principal Investigator, Xiao Xu, PhD, at xiao.xu@yale.edu or 203-737-6254.
Staff Spotlight: Rebecca Spivack Bartomeli, RN
Rebecca Spivack Bartomeli, RN
Women's Infusion, Gynecologic Oncology
Rebecca is the “go to” person for clinical oncology nursing questions and on the unit she has oriented newly hired nurses to the department and is extremely efficient – she has often carried her assignment plus additional unit duties. She is competent, capable, no-nonsense, and confident, and is the person who gets the work completed. Rebecca does not shy away from giving a straight answer. She has received the Nightingale Award and the Great Catch Award for ensuring patient safety. In her free time, Rebecca reads and watches television to relax.
Survivor Spotlight: Keron Martin
My name is Keron Martin and I was diagnosed with uterine cancer in March of 2021. "Shellshocked" is the only word that comes to mind when I received my diagnosis.

After caring for my father who passed away in June 2020, I was ready to start the next chapter in my life. A new career and even a geographical change was my carpe diem mantra. Life happens even as you are making the best of plans. As Dr. Gulden Menderes gave me the diagnosis, which held the word aggressive in it, life completely rearranged in a matter of seconds.

The clouds came and poured down hard on my life parade. Surgery followed by radiation, chemo and then more radiation. But as quickly as those clouds came in, the sunshine came back! A village from the North, South, East, and West showed up to care for me. I'm now 4 scans clear and the village is still here for me!

"In The Living" a poem by Keron Martin
As I gaze upon the future,
Reaching for my dreams,
From the very distant past
Unearth layers to unmuddy the scream

Buried within all masts and all shoalds
Are dark gray clouds hiding a sunlit sky,
Awareness in my being comes through,
Bursting of passions and purpose of why I'm alive.

Mercy! I'm through digging in all of that dirt,
Love in creation is nothing like work.
Live in a moment of sunlit sky
Completely presents in panorama wider
Getting what you need from a grand mysterious force.
Just pay attention, straight from the heart,
Wonder I keep seeing, just stay the course.
Discovery To Cure
475-202-3838
ruthann.ornstein@yale.edu
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