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

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

doi:10.1016/j.breast.2023.02.011

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

Breast. 2023 Apr:68:205-215. doi: 10.1016/j.breast.2023.02.011. Epub 2023 Feb 24.

Authors

Anusha Gandhi¹, Tianlin Xu², Sarah M DeSnyder³, Grace L Smith⁴, Ruitao Lin², Carlos H Barcenas⁵, Michael C Stauder⁶, Karen E Hoffman⁶, Eric A Strom⁶, Susan Ferguson⁵, Benjamin D Smith⁶, Wendy A Woodward⁶, George H Perkins⁶, Melissa P Mitchell⁶, Desmond Garner⁶, Chelain R Goodman⁶, Melissa Aldrich⁷, Marigold Travis⁸, Susan Lilly⁸, Isabelle Bedrosian², Simona F Shaitelman⁹

Affiliations

¹ Baylor College of Medicine, USA; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA.
² Department of Biostatistics, The University of Texas MD Anderson Cancer Center, USA.
³ Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, USA.
⁴ Department of GI Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA.
⁵ Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, USA.
⁶ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA.
⁷ Center for Molecular Imaging, UT Health Science Center at Houston, USA.
⁸ Department of Rehabilitative Therapy, The University of Texas MD Anderson Cancer Center, USA.
⁹ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA. Electronic address: sfshaitelman@mdanderson.org.

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.

MeSH terms

Breast Cancer Lymphedema* / etiology
Breast Neoplasms* / pathology
Early Detection of Cancer
Female
Humans
Lymph Node Excision / adverse effects
Lymphedema* / etiology
Patient-Centered Care
Prospective Studies
Quality of Life

Abstract

MeSH terms

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