The impact of lymphedema on health-related quality of life up to 10 years after breast cancer treatment

Mads G Jørgensen,Jens A Sørensen,Navid M Toyserkani,Frederik G Hansen,Anette Bygum

doi:10.1038/s41523-021-00276-y

Mads G Jørgensen, Jens A Sørensen + Show 3 more

Open Access

https://doi.org/10.1038/s41523-021-00276-y

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Abstract

The impact of breast cancer-related lymphedema (BCRL) on long-term quality of life is unknown. The aim of this study was to investigate the impact of BCRL on health-related quality of life (HRQoL) up to 10 years after breast cancer treatment. This regional population-based study enrolled patients treated for breast cancer with axillary lymph node dissection between January 1st 2007 and December 31th 2017. Follow up and assessments of the included patients were conducted between January 2019 and May 2020. The study outcome was HRQoL, evaluated with the Lymphedema Functioning, Disability and Health Questionnaire, the Disabilities of the Arm, Shoulder and Hand Questionnaire and the Short Form (36) Health Survey Questionnaire. Multivariate linear logistic regression models adjusted for confounders provided mean score differences (MDs) with 95% confidence intervals in each HRQoL scale and item. This study enrolled 244 patients with BCRL and 823 patients without BCRL. Patients with BCRL had significantly poorer HRQoL than patients without BCRL in 16 out of 18 HRQoL subscales, for example, in physical function (MDs 27, 95%CI: 24; 30), mental health (MDs 24, 95%CI: 21; 27) and social role functioning (MDs 20, 95%CI: 17; 23). Age, BMI, BCRL severity, hand and dominant arm affection had only minor impact on HRQoL (MDs < 5), suggesting a high degree of inter-individual variation in coping with lymphedema. This study showed that BCRL is associated with long-term impairments in HRQoL, especially affecting the physical and psychosocial domains. Surprisingly, BCRL diagnosis rather than clinical severity drove the largest impairments in HRQoL.

Highlights

Breast cancer is one of the most common forms of cancer with a yearly incidence of >1.5 million worldwide[1]
Increased Breast cancer-related arm lymphedema (BCRL) severity was associated with more severe feelings of arm heaviness (MDs pr. 10% increase 4.40, 95% confidence intervals (95%CI): 2.04; 6.77, CS: small), stiffness (MDs pr. 10% increase 4.31, 95%CI: 1.78; 6.83, CS: small), swelling (MDs pr. 10% increase 6.18, 95%CI: 4.14; 8.22, CS: small) and tightness (MDs pr. 10% increase 5.77, 95%CI: 3.14; 8.39, CS: small, Supplementary Fig. 2A)
The residuals between the LYMPH-ICF, DASH, and SF-36 were unbiased with a heteroscedastic pattern along the x-axis (Supplementary Fig. 4D–F). In this regional population-based cross-sectional study of patients treated with axillary lymph node dissection (ALND) for locoregional breast cancer, BCRL was found to be independently associated with impaired health-related quality of life (HRQoL) up to 10 years postoperatively

Summary

Introduction

Breast cancer is one of the most common forms of cancer with a yearly incidence of >1.5 million worldwide[1]. Breast cancer-related arm lymphedema (BCRL) is one of the most frequent and feared side effects to breast cancer treatment affecting >1 in 3 patients treated with axillary lymph node dissection (ALND)[2,3]. BCRL is characterized as a swelling of the arm, patients frequently report a myriad of related symptoms, such as heaviness, tightness and pain in the arm, which can vary in intensity and is often discordant to objective severity[4,5,6]. The primary treatment for BCRL is conservative physiotherapy with complete decongestive therapy and microsurgery in selected cases[7,8,9]. It is paramount to distinguish the arm morbidity and psychosocial impact of BCRL from those sequelae expected to arise following surgical and adjuvant breast cancer treatment itself

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