Abstract
Lower extremity lymphedema (LEL) is associated with decreased physical functioning (PF) and activities of daily living (ADLs) limitations. However, the prevalence of LEL in older survivors of cancer is unknown. To examine LEL among older female survivors of colorectal, endometrial, or ovarian cancer and investigate the association of LEL with PF and ADLs. This secondary analysis of the Women's Health Initiative (WHI) Life and Longevity After Cancer (LILAC) study was conducted using data from postmenopausal women enrolled at 40 US centers. Participants were women who had a prior diagnosis of endometrial, colorectal, or ovarian cancer and who had completed the WHI LILAC baseline and year 1 follow-up questionnaires as of September 2017. The 13-item Lower Extremity Lymphedema Screening Questionnaire in Women was used to determine LEL (ie, score ≥5). Validated surveys were used to assess PF and ADLs. Among 900 older women diagnosed with endometrial, colorectal, or ovarian cancer, the mean (SD) age was 78.5 (5.9) years and the mean (range) time since cancer diagnosis was 8.75 (1.42-20.23) years. Overall, 292 women (32.4%) reported LEL, with the highest LEL prevalence among survivors of ovarian cancer (38 of 104 women [36.5%]), followed by survivors of endometrial cancer (122 of 375 women [32.5%]) and colorectal cancer (132 of 421 women [31.4%]). Compared with women without LEL, women with LEL had a PF score that was lower by a mean (SE) 16.8 (1.7) points (P < .001) and higher odds of needing help with ADLs (odds ratio [OR], 2.45; 95% CI, 1.64-3.67). In the association of LEL with PF, the mean (SE) decrease in PF score was greatest among survivors of colorectal cancer (-21.8 [2.6]) compared with survivors of endometrial cancer (-13.3 [2.7]) and ovarian cancer (-12.8 [5.2]). Additionally, among survivors of colorectal cancer, LEL was associated with increased odds of needing help with ADLs (OR, 3.59; 95% CI, 1.94-6.66), while there was no such association among survivors of endometrial cancer or ovarian cancer. However, there were no interaction associations between LEL and cancer type for either outcome. Additionally, the overall mean (SE) difference in PF between women with and without LEL was greater among those aged 80 years and older (-19.4 [2.6] points) vs those aged 65 to 79 years (-14.9 [2.2] points). However, among survivors of colorectal cancer, the mean (SE) difference in PF score was greater among women aged 65 to 79 years (-22.9 [3.7] points) vs those aged 80 years or older (-20.8 [3.7] points) (P for 3-way interaction = .03). This study found that nearly one-third of older female survivors of colorectal, endometrial, or ovarian cancer experienced LEL and that LEL was associated with decreased PF and increased odds of needing help with ADLs. These findings suggest that clinicians may need to regularly assess LEL among older survivors of cancer and provide effective interventions to reduce LEL symptoms and improve PF for this population.
Highlights
Each year, approximately 158 000 women are diagnosed with endometrial, ovarian, or colorectal cancer.[1]
Among survivors of colorectal cancer, lower extremity lymphedema (LEL) was associated with increased odds of needing help with activities of daily living (ADLs) (OR, 3.59; 95% CI, 1.94-6.66), while there was no such association among survivors of endometrial cancer or ovarian cancer
This study found that nearly one-third of older female survivors of colorectal, endometrial, or ovarian cancer experienced LEL and that LEL was associated with decreased physical functioning (PF) and increased odds of needing help with ADLs
Summary
Approximately 158 000 women are diagnosed with endometrial, ovarian, or colorectal cancer.[1]. One common sequela for survivors of gynecologic and colorectal cancer after surgeries involving lymph node dissection or pelvic radiotherapy is lower extremity lymphedema (LEL).[2-11]. This outcome is characterized by abnormal accumulation of protein-rich interstitial fluid, often due to obstruction or scarring of the lymphatic system.[12-14]. It is commonly estimated that 20% to 60% of survivors of gynecologic cancer have LEL,[5,21-24] whereas the reported prevalence ranges from 2.4% to 78%.2,4,19,25-28. The prevalence of LEL varies by cancer site, ranging from 1% to 47% in endometrial cancer,5,29,30 0% to 81% in cervical cancer,[5,31,32] and 5% to 41% in ovarian cancer.[4,5,33,34]. It is commonly estimated that 20% to 60% of survivors of gynecologic cancer have LEL,[5,21-24] whereas the reported prevalence ranges from 2.4% to 78%.2,4,19,25-28 The prevalence of LEL varies by cancer site, ranging from 1% to 47% in endometrial cancer,5,29,30 0% to 81% in cervical cancer,[5,31,32] and 5% to 41% in ovarian cancer.[4,5,33,34] Notably, the prevalence of LEL in colorectal cancer is unknown because of the lack of published studies
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