Impact of lymphoedema on arm function and health-related quality of life in women following breast cancer surgery

Abstract

To estimate the extent to which the impairments associated with lymphoedema (volume increase, local oedema and sensory alteration) are linked to arm dysfunction and sub-optimal health-related quality of life. A cross-sectional study, embedded within a pilot for an epidemiologic study, was undertaken involving women who had undergone surgery for unilateral stage I or II breast cancer. Two questionnaires (a lymphoedema screening questionnaire and the Disabilities of Arm, Shoulder and Hand questionnaire) were mailed and 72 of 204 responders reported having one or more symptoms of lymphoedema (prevalence 35%). A total of 50 women with symptoms attended for further testing. Women with self-reported symptoms of lymphoedema had a significantly higher score on the Disabilities of Arm, Shoulder and Hand questionnaire (mean difference 23.4, 95% confidence interval 19.3-27.5), indicating activity limitation and participation restriction. Pain was the only impairment directly correlated with activity limitation, participation restriction and sub-optimal health-related quality of life. These findings have implications for treatment, and the outcome measures used for the assessment of lymph?oedema. Treatments focusing on decreasing arm volume without addressing issues of pain may not result in improvements in activity, participation, or health-related quality of life.