Correlates of Lymphedema in Women with Breast Cancer: a Case Control Study in Shiraz, Southern Iran.

Eghbal Sekhavati,Sara Rostami,Zeinab Zakeri,Sedigheh Tahmasebi,Negin Sayar,Sahar Khademi,Behnam Honarvar,Amene Sabzi Sarvestani,Asra Talei

doi:10.7314/apjcp.2016.17.s3.81

Abstract

Globally, the burden of breast cancer (BC) continues to increase. BC related lymphedema (BCRL) is currently non curable and as a life time risk it affects at least 25% of BC patients. Knowing more about BCRL and appropriate control of its modifiable risk factors can improve quality of life (QOL) of the affected patients. In this case control study to detect factors, 400 women with BCRL (as the case group) and 283 patients with BC without lymphedema (as the control group) that were referred to Shiraz University of Medical Sciences affiliated BC clinic center were assessed. The data were analyzed in SPSS. The mean age of the case group was 52.3±11.0 years and of the control group was 50.1±10.9 years. In patients with BCRL, 203(50.7%) had left (Lt) side BC and in non- lymphedema group 151 (53.3%) had Lt side BC. Out of all BCRL patients, 204 (51%) had lymphedema in all parts of their affected upper extremities, 100 (25%) had swelling in the arm and forearm and 23 (5.7%) had edema in both the upper extremity and trunk. Edema, heaviness, concern about changing body image, pain and paresthesia were the most common signs/symptoms among patients with BCRL. In BCRL patients, the difference of circumference between the affected upper limb and non-affected limb was 4.4±2.5 cm and the difference in volume displacement was 528.7±374.4 milliliters. Multiple variable analysis showed that moderate to severe activity (OR; odds ratio =14, 95% CI: 2.6-73.3 ), invasiveness of BC (OR =13.7, 95% CI: 7.3-25.6), modified radical mastectomy (OR=4.3, 95% CI: 2.3-7.9), BMI =>25 (OR=4.2, 95% CI: 2-8.7), radiotherapy (OR=3.9, 95% CI: 1.8-8.2 ), past history of limb damage (OR=1.7, 95% CI: 0.9-3.1) and the number of excised lymph nodes (OR=1.06, 95% CI: 1.02-1.09) were the significant predictors of lymphedema in women with BC. Modifiable risk factors of BCRL such as non-guided moderate to severe physical activity, high BMI and trauma to the limb should be controlled as early as possible in BC patients to prevent development of BCRL and improve QOL of these patients.

Highlights

Burden of breast cancer (BC) continues to increase
Mortality among BC patients is decreasing, there are many issues such as BC related lymphedema (BCRL), changed body image, depression, anxiety, stress, changes in relationships with husband and children, dealing with any ongoing side effects and the fear of BC recurrence that these women are chronically challenging (Fu MR., 2014; Jassim et al.,2015)
Our study revealed that edema, heaviness, concern about body image, pain and paresthesia are the most common signs/symptoms among patients with BCRL

Summary

Introduction

BC is the second most common cancer among all cancers and the most frequent cancer among women worldwide including 140 of 184 countries and Eastern Mediterranean Region countries (EMRO). It caused 1 in 4 of all cancers in women with 1.7 million new diagnosed patients in 2012. In Iran, with an age-standardized death rate from cancer of 69.8 per 100,000 for females (Lankarani et al.,2013), BC is the most frequent cancer in women, the 1st cause (14.2%) of death due to cancer among women and the 5th common cause of death in Iranian women while women of 41-50 years of age group are more affected by it (Afsharfard et al, 2013).

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