Lymphedema Affects Quality Of Life
May 10, 2007
Almost one-third of young breast cancer survivors surveyed by researchers at the Ohio State University Comprehensive Cancer said their quality of life suffered because they experienced lymphedema, an often debilitating consequence of breast cancer treatment.
The findings are significant because they point to the need for preventive education, says principal investigator Electra Paskett, associate director of population sciences at Ohio State's Comprehensive Cancer Center.
"This is the first study in the United States to look at the incidence, prevalence and persistence of lymphedema among young breast cancer survivors, and how having lymphedema negatively affects their quality of life," says Paskett. "We found that the women who reported persistent swelling of their arms or hands after surgery or radiation were more likely to report poorer quality of life."
The research involved 622 breast cancer survivors who were 45 years or younger at diagnosis. They were monitored with semiannual questionnaires for 36 months after breast cancer surgery to determine the incidence of lymphedema, prevalence of swelling, factors associated with each and quality of life.
The study is published in the April issue of the Journal of Cancer Epidemiology Biomarkers & Prevention.
Lymphedema is a common complication of cancer therapy and is characterized by an accumulation of lymphatic fluid, which causes swelling, most often in the arms or legs. Lymphedema can occur anywhere lymph nodes have been surgically removed or lymph flow has been disturbed.
The study found that 54 percent of participants reported at least one incidence of swelling of the arm or hand within 36 months after surgery, with 32 percent reporting persistent swelling. Swelling was reported to in the upper arm by 43 percent of the women; in the hand only by 34 percent; and in both arm and hand in 22 percent of participants.
Factors associated with an increased risk of developing swelling included having a greater number of lymph nodes removed, receiving chemotherapy and being obese. Factors associated with persistent swelling included having more lymph nodes removed and being obese. Weight management may be a potential intervention for those at greatest risk of lymphedema to maintain optimal health-related quality of life among survivors, Paskett says.
Women who reported swelling had significantly lower quality of life compared to women without swelling, Paskett says.
"These are the women we are most concerned about," says Paskett, a two- time breast cancer survivor who struggles with a mild case of lymphedema. She does daily exercises and occasionally wears a pressure sleeve and glove to control her swelling.
"If we can identify women who are at greatest risk of developing lymphedema, then we can educate them about the problem, so they can watch for symptoms and seek early treatment," Paskett says.
The majority of women in the study reported mild swelling. But even that can interfere with daily activities and negatively affect quality of life, she says.
"Some women must buy larger clothing because of the swelling, while others can't wear rings or button their blouses because their fingers are swollen," Paskett says. "For many, lymphedema is a constant reminder that they had cancer."
Paskett also is the principal investigator of a major, multicenter clinical trial that will enroll 500 women nationwide in the Lymphedema and Education Awareness Program. The ongoing study will test a program to prevent lymphedema in women who have been treated for breast cancer.
There is always a risk of developing lymphedema after the removal of lymph nodes during breast cancer surgery, and the condition can develop immediately, in months or even years later, Paskett says.
"It is important for women to recognize the signs and symptoms of lymphedema and seek treatment immediately to lessen the severity," Paskett says.