TY - JOUR
T1 - Prospective, early longitudinal assessment of lymphedema-related quality of life among patients with locally advanced breast cancer
T2 - The foundation for building a patient-centered screening program
AU - Gandhi, Anusha
AU - Xu, Tianlin
AU - DeSnyder, Sarah M.
AU - Smith, Grace L.
AU - Lin, Ruitao
AU - Barcenas, Carlos H.
AU - Stauder, Michael C.
AU - Hoffman, Karen E.
AU - Strom, Eric A.
AU - Ferguson, Susan
AU - Smith, Benjamin D.
AU - Woodward, Wendy A.
AU - Perkins, George H.
AU - Mitchell, Melissa P.
AU - Garner, Desmond
AU - Goodman, Chelain R.
AU - Aldrich, Melissa
AU - Travis, Marigold
AU - Lilly, Susan
AU - Bedrosian, Isabelle
AU - Shaitelman, Simona F.
N1 - Publisher Copyright:
© 2023
PY - 2023/4
Y1 - 2023/4
N2 - 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.
AB - 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.
KW - Breast cancer-related lymphedema
KW - Lymphedema symptom intensity and distress survey-arm
KW - Work productivity activity and impairment index
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U2 - 10.1016/j.breast.2023.02.011
DO - 10.1016/j.breast.2023.02.011
M3 - Article
C2 - 36863241
AN - SCOPUS:85149771836
SN - 0960-9776
VL - 68
SP - 205
EP - 215
JO - Breast
JF - Breast
ER -