Lower extremity lymphedema in patients with gynecologic cancer: Validation of the Gynecologic Cancer Lymphedema Questionnaire (GCLQ) in German language and investigation of lymphedema real-world treatment

Abstract

Purpose: The Gynecologic Cancer Lymphedema Questionnaire (GCLQ) is an established patient-reported outcome measure for lower extremity lymphedema (LEL) in gynecologic oncology. We aimed to validate the GCLQ in German language (GCLQ-GER) for lymphedema detection in German-speaking patients and also investigated real-world patterns of lymphedema treatment.

Methods: The GCLQ was translated from English into German in accordance with the standards of a professional translation process. Subsequently, the questionnaire was administered in a prospective observational study including 102 patients who had undergone lymph node dissection (LND) within gynecologic cancer surgery. Various test quality criteria were calculated for the GCLQ-GER. As gold standard of testing methods, patients were clinically evaluated for LEL, and limb volume measurements were taken. Further data for lymphedema treatment were collected in patients with lymphedema diagnosis.

Results: Patients with LEL had increased GCLQ-GER total scores (mean 7.27) compared to patients without LEL (mean 1.81), p < 0.001. High diagnostic accuracy was indicated by the large area under the receiver operating characteristics curve (AUC) of 0.874 (95% CI 0.802-0.946). Based on sensitivity and specificity values ≥ 79.0%, the GCLQ total score ≥ 4 was determined as the optimal cut-off value to identify LEL. Excellent internal consistency was demonstrated by Cronbach's alpha of 0.876. The clinical examination revealed a LEL prevalence of 48.0% (n = 49), and 85.7% (n = 42) of these patients received treatment.

Conclusion: The GCLQ-GER is a valid and feasible patient-reported outcome measure for lymphedema detection in German-speaking gynecologic cancer survivors. Its clinical introduction could improve secondary prevention of lymphedema and real-world treatment.

Keywords: Clinical screening tool; GCLQ-GER; Patient-reported outcome measures (PROMs); Quality of life; Secondary prevention of lymphedema.

Fig. 1

Correlation of clinically diagnosed lymphedema with (a) number of dissected lymph nodes, b GCLQ-GER total score, c limb volume difference of the lower extremities in liters and d correlation of limb volume difference of the lower extremities in liters with the GCLQ-GER total score. LEL, lower extremity lymphedema; No LEL, no presence of lower extremity lymphedema. p values for (a), (b) and (c) were determined by using Mann–Whitney-U-Test. Correlation analysis (d) was performed by using Spearman´s correlation coefficient r_s

Fig. 2

Frequency of patient-reported lymphedema symptoms on the GCLQ-GER in patients with clinically diagnosed lymphedema

Fig. 3

Receiver Operating Characteristic (ROC) curve for the patient-reported GCLQ-GER total score against the gold standard of clinically diagnosed lymphedema

Fig. 4

Lymphedema treatment in patients with clinically diagnosed lymphedema (n = 49)