Lymphedema and quality of life in survivors of early-stage breast cancer

Abstract

Background: The standard of care for early-stage breast cancer includes surgical removal of the tumor and axillary lymph node dissection (ALND). Despite increased use of breast-conserving surgery, lymphedema rates are similar to those with more radical surgery.

Hypothesis: Women who experience breast cancer-related lymphedema have a measurable reduction in quality of life compared with women without lymphedema.

Design: In a retrospective cohort study, we explored the association between lymphedema and quality of life, controlling for patient demographics, surgical factors, and treatment types.

Settings: An urban academic medical center and a community hospital.

Participants: A total of 151 women surgically treated for early-stage breast cancer (stages 0-II) were assessed at least 1 year after their ALND. The women had been treated with either conservative surgery and radiation or mastectomy without radiation.

Main outcome measures: Arm volume was measured by water displacement. Grip strength and range-of-motion measurements assessed arm function. The Functional Assessment of Cancer Therapy-Breast (FACT-B) quality-of-life instrument assessed breast, emotional, functional, physical, and social well-being.

Results: Lymphedema (an arm volume difference > or =200 cm(3)) was measured in 42 women (27.8%). Mastectomy or conservative surgery patients had similar lymphedema rates. Women with lymphedema in both surgical groups scored significantly lower on 4 of the 5 subsections than women without lymphedema, even after adjusting for other factors influencing quality of life.

Conclusions: Lymphedema occurs at appreciable rates, and its impact on long-term quality of life in survivors of early-stage breast cancer should not be underestimated.