Prospective, Early Longitudinal Assessment of Lymphedema-Related Quality of Life Among Patients With Locally Advanced Breast Cancer: The Foundation for Building a Patient-Centered Screening Program

Authors

Anusha Gandhi
Tianlin Xu
Sarah M DeSnyder
Grace L Smith
Ruitao Lin
Carlos H Barcenas
Michael C Stauder
Karen E Hoffman
Eric A Strom
Susan Ferguson
Benjamin D Smith
Wendy A Woodward
George H Perkins
Melissa P Mitchell
Desmond Garner
Chelain R Goodman
Melissa Aldrich
Marigold Travis
Susan Lilly
Isabelle Bedrosian
Simona F Shaitelman

Publication Date

4-1-2023

Journal

Breast

Abstract

BACKGROUND: We examined how breast cancer-related lymphedema (BCRL) affects health-related quality of life (HRQOL), productivity, and compliance with therapeutic interventions to guide structuring BCRL screening programs.

METHODS: We prospectively followed consecutive breast cancer patients who underwent axillary lymph node dissection (ALND) with arm volume screening and measures assessing patient-reported health-related quality of life (HRQOL) and perceptions of BCRL care. Comparisons by BCRL status were made with Mann-Whitney U, Chi-square, Fisher's exact, or t tests. Trends over time from ALND were assessed with linear mixed-effects models.

RESULTS: With a median follow-up of 8 months in 247 patients, 46% self-reported ever having BCRL, a proportion that increased over time. About 73% reported fear of BCRL, which was stable over time. Further in time from ALND, patients were more likely to report that BCRL screening reduced fear. Patient-reported BCRL was associated with higher soft tissue sensation intensity, biobehavioral, and resource concerns, absenteeism, and work/activity impairment. Objectively measured BCRL had fewer associations with outcomes. Most patients reported performing prevention exercises, but compliance decreased over time; patient-reported BCRL was not associated with exercise frequency. Fear of BCRL was positively associated with performing prevention exercises and using compressive garments.

CONCLUSIONS: Both incidence and fear of BCRL were high after ALND for breast cancer. Fear was associated with improved therapeutic compliance, but compliance decreased over time. Patient-reported BCRL was more strongly associated with worse HRQOL and productivity than was objective BCRL. Screening programs must support patients' psychological needs and aim to sustain long-term compliance with recommended interventions.

Keywords

Breast cancer-related lymphedema, Lymphedema symptom intensity and distress survey-arm, Work productivity activity and impairment index

Comments

Supplementary Materials

PMID: 36863241