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. (April 2023)

• Record Type: Journal Article
• Authors: Gandhi, Anusha; Xu, Tianlin; DeSnyder, Sarah M.; Smith, Grace L.; Lin, Ruitao; Barcenas, Carlos H.; Stauder, Michael C.; Hoffman, Karen E.; Strom, Eric A.; Ferguson, Susan; Smith, Benjamin D.; Woodward, Wendy A.; Perkins, George H.; Mitchell, Melissa P.; Garner, Desmond; Goodman, Chelain R.; Aldrich, Melissa; Travis, Marigold; Lilly, Susan; Bedrosian, Isabelle; Shaitelman, Simona F.
• Is Part Of: Breast. Volume 68(2023)
• Page Start: 205
• Page End: 215
• Publication Date: 2023-04
• Subjects: Breast cancer-related lymphedema -- Lymphedema symptom intensity and distress survey-arm -- Work productivity activity and impairment index; Breast -- Diseases -- Periodicals; Breast -- Tumors -- Periodicals; Breast -- Periodicals; Electronic journals; Periodicals; 616
• DOI: 10.1016/j.breast.2023.02.011
• Languages: English
• ISSNs: 0960-9776

Abstract

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. Highlights: Both incidence and fear of BCRL were high after ALND for breast cancer. Fear of BCRL was associated with improved therapeutic compliance. Compliance with preventive/therapeutic interventions decreased over time. Patient-reported BCRL is more strongly associated than objective BCRL with HRQOL. Screening programs must support psychological needs to sustain long-term compliance.