Prospective cohort study assessing limb volume change (LVC) and quality of life in breast cancer survivors

Abstract

9561 Background: The objective of this study was to define the outcomes associated with postoperative limb volume change (LVC) to identify clinically relevant diagnostic criteria for lymphedema following breast cancer treatment and associated findings that could be used to guide risk-reduction practices. Methods: LVC was serially evaluated in 276 women receiving surgical treatment for invasive breast cancer using an optoelectronic volumetry device (perometer). Baseline measures for patients enrolled prior to surgery included ipsilateral limb volume while contralateral limb measurements were used for patients enrolled postoperatively. Symptoms were assessed using the Lymphedema and Breast Cancer Questionnaire (LBCQ). Quality of life (QOL) was assessed at 1 month and 24 months using the Functional Living Index-Cancer (FLIC) and the RAND 36-Item Health Survey (SF-36). Four groups were created based on the maximum LVC: none < 5%, mild 5–9.9%, moderate 10–14.9%, and severe ≥ 15%. Associations between clinical factors, treatment, QOL, and LVC were examined using multivariate regression analyses. Results: With a median follow-up of 29 months, 54 (19.6%) patients did not develop LVC; 120 (43.5%), 50 (18.1%), and 52 (18.8%) developed mild, moderate, and severe LVC, respectively. The frequency of LBCQ-identified symptoms increased and QOL scores decreased as LVC increased. Linear regression analysis demonstrated that increase in body mass index (p = 0.0001) and axillary node dissection (p = 0.046) were associated with increasing LVC, while increasing age had an inverse relationship (p= 0.019). Logistic regression analysis showed that lower QOL scores were significantly associated with a moderate LVC compared to no LVC (odds ratio (OR) =6.7, 95% CI 1.4–32.8, p = 0.018) and postoperative infections (OR = 6.4, 95% CI 2.0–20.1, p = 0.002). Conclusions: LVC at ≥ 5% occurs in up to 80% of breast cancer survivors following treatment and is progressive in most patients. Lymphedema-associated symptoms and decrements in QOL can be detected in patients with even mild LVC (5–9.9%). Risk reduction practices should include post-treatment weight maintenance programs. Cancer surveillance should include postoperative limb monitoring with treatment referral for patients with ≥ 5% LVC. No significant financial relationships to disclose.