Self-reported symptoms of arm lymphedema and health-related quality of life among female breast cancer survivors

Abstract

We examined cross-sectional associations between arm lymphedema symptoms and health-related quality of life (HRQoL) in the Health, Eating, Activity and Lifestyle (HEAL) Study. 499 women diagnosed with localized or regional breast cancer at ages 35-64 years completed a survey, on average 40 months after diagnosis, querying presence of lymphedema, nine lymphedema-related symptoms, e.g., tension, burning pain, mobility loss, and warmth/redness, and HRQoL. Analysis of covariance models were used to assess HRQoL scores in relation to presence of lymphedema and lymphedema-related symptoms. Lymphedema was self-reported by 137 women, of whom 98 were experiencing lymphedema at the time of the assessment. The most common symptoms were heaviness (52%), numbness (47%), and tightness (45%). Perceived physical health was worse for women reporting past or current lymphedema than those reporting no lymphedema (P-value < 0.0001). No difference was observed for perceived mental health (P-value = 0.31). Perceived physical health, stress, and lymphedema-specific HRQoL scores worsened as number of symptoms increased (P-values ≤ 0.01). Women reporting tension in the arm had lower physical health (P-value = 0.01), and those experiencing burning pain, tension, heaviness, or warmth/redness in the arm had lower lymphedema-specific HRQoL (P-values < 0.05). Treatment targeting specific lymphedema-related symptoms in addition to size/volume reduction may improve some aspects of HRQoL among affected women.

Figure 1

Flowchart describing recruitment flow and data collection. Out of 1183 participants who completed the baseline assessment, 499 were included in this study after exclusions.

Figure 2

Lymphedema and health-related quality of life measures. Adjusted means are presented for the SF-36 physical and mental component summary scores and perceived stress scale. Medians are presented for the other health-related quality of life measures. The vertical lines represent the 95% confidence intervals for the means and the interquartile ranges for the medians. A higher score indicates better health-related quality of life in Medical outcomes study 36-item short form health survey scales and Wesley Clinical Lymphedema Scale and worse health-related quality of life in perceived sterss, fear of recurrence, and sexual health scales. P values are based on F statistics from the analysis of covariance in 499 women (for the analysis of sexual health, only 288 women who reported being sexually active during the 6 months prior to 40-month assessment were included). Asterisk(s) indicate a statistically significant difference observed in Scheffé's pair-wise multiple comparison test (*0.01 ≤ P value < 0.05, **P value < 0.01). LE lymphedema.