Quality of life and a symptom cluster associated with breast cancer treatment-related lymphedema
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The aim of this study was to compare quality of life and symptoms between breast cancer survivors who have developed and undergone treatment for chronic lymphedema with those who have not developed lymphedema.
Patients and methods
The cross-sectional, mixed-methods design included 64 breast cancer survivors with lymphedema and 64 breast cancer survivors without lymphedema. Variables assessed quantitatively included sociodemographic information, medical data, body mass index (BMI), arm extracellular fluid volume, quality of life (QOL), and physical and emotional symptoms. For the qualitative component, individuals with lymphedema responded in writing to the question: During the past week what other difficulties have you experienced because of your lymphedema?
Compared with those without lymphedema, breast cancer survivors with lymphedema reported poorer QOL. A symptom cluster that included alteration in limb sensation, loss of confidence in body, decreased physical activity, fatigue, and psychological distress was identified. Perception of limb size influenced the cumulative symptom experience more than objective arm volume. Qualitative data revealed multiple QOL, physical health, and psychological concerns. BMI correlated with multiple outcomes.
Findings suggest that current lymphedema treatments, although beneficial, may not provide complete relief of symptoms associated with lymphedema and complementary interventions are needed. The poorer QOL in breast cancer survivors with lymphedema may relate to the presence of an untreated symptom cluster.
KeywordsBreast cancer Body mass index Lymphedema Quality of life Symptom cluster
This research was funded by National Research Service Award 1 F31 NR07854-02, Sigma Theta Tau Iota Chapter grant, and Vanderbilt University Dissertation Enhancement Award.
This paper was presented in part at the 29th Oncology Nursing Society Congress, 29 April 2004, Anaheim, CA.
- 1.Armer J, Porock C (2001) Self reported fatigue in women with lymphedema. Lymph Link 13:1–4Google Scholar
- 2.Carpenter JS, Andrykowski MA, Wilson J et al (1998) Psychometrics for two short forms of the center for epidemiologic studies depression scale. Issues Ment Health Nurs 19:481–494Google Scholar
- 3.Casley-Smith JR, Morgan RG, Piller NB (1993) Treatment of lymphedema of the arms and legs with 5, 6-benzo-[alpha]-pyrone. N Engl J Med 329:1158–1163Google Scholar
- 4.Cella D (1997) FACIT manual: manual of the functional assessment of chronic illness therapy (FACIT) measurement system, version 4. Evanston Northwestern Healthcare & Northwestern University, ChicagoGoogle Scholar
- 5.Cornish BH, Bunce IH, Ward LC et al (1996) Bioelectric impedance for monitoring the effect of lymphoedema treatment programs. Breast Cancer Res Treat 38:169–176Google Scholar
- 6.Coster S, Poole K, Fallowfield LJ (2001) The validation of a quality of life scale to assess the impact of arm morbidity in breast cancer patients post-operatively. Breast Cancer Res Treat 68:73–282Google Scholar
- 7.Curran SL, Androykowski MA, Studts JL (1995) Short form of the Profiles of Mood State (POMS-SF): psychometric information. Psychol Assess 7:80–83Google Scholar
- 8.Dodd MJ, Miaskowski C, Paul SM (2001) Symptom clusters and their effect on the functional status of patients with cancer. Oncol Nurs Forum 28:465–470Google Scholar
- 9.Foldi E, Foldi M, Clodius L (1989) The lymphedema chaos: a lancet. Ann Plast Surg 22:505–515Google Scholar
- 10.Foldi M, Foldi E (2003) Physiology and pathophysiology of the lymphatic system. In: Foldi M, Foldi E, Kubik S (eds) Textbook of lymphology for physicians and lymphedema therapists. Urban & Fischer, Munich, pp 195–230Google Scholar
- 11.Impedimed (2002) Lymphometer: the new tool in monitoring lymphedema. Mansfield, AustraliaGoogle Scholar
- 12.International Society of Lymphology (2003) The diagnosis and treatment of peripheral lymphedema: consensus document of the International Society of Lymphology. Lymphology 36:84–91Google Scholar
- 13.Johansson K, Albertsson M, Ingvar C et al (1999) Effects of compression bandaging with or without manual lymph drainage treatment in patients with postoperative arm lymphedema. Lymphology 32:103–110Google Scholar
- 14.Johansson K, Lie E, Ekdahl C (1998) A randomized study comparing manual lymph drainage with sequential pneumatic compression for treatment of postoperative arm lymphedema. Lymphology 31:56–64Google Scholar
- 15.Johansson K, Ohlsson K, Ingvar C et al (2002) Factors associated with the development of arm lymphedema following breast cancer treatment: a match pair case-control study. Lymphology 35:59–71Google Scholar
- 17.Launois L, Alliot F (2000) Quality of life scale in upper limb lymphedema: a validation study. Lymphology 33(Suppl):266–274Google Scholar
- 18.Logan VB (1995) Incidence and prevalence of lymphoedema: a literature review. J Clin Nurs 4:213–219Google Scholar
- 19.Mirolo BR, Bunce IH, Chapman M et al (1995) Psychosocial benefits of postmastectomy therapy. Cancer Nurs 18:197–205Google Scholar
- 20.Passik SD, Newman M, Brennan M et al (1993) Psychiatric consultation for women undergoing rehabilitation for upper-extremity lymphedema following breast cancer treatment. J Pain Symptom Manage 8:226–233Google Scholar
- 21.Petrek JA, Heelan MC (1998) Incidence of breast carcinoma-related lymphedema. Cancer 83:2776–2780Google Scholar
- 22.Ridner SH (2002) Breast cancer lymphedema: pathophysiology and risk reduction guidelines. Oncol Nurs Forum 29:1285–1291Google Scholar
- 23.Say CC, Donegan W (1974) A biostatistical evaluation of complications from mastectomy. Surg Gynecol Obstet 138:370–376Google Scholar
- 24.Shacham S (1983) A shortened version of the profile of mood states. J Pers Assess 47:305–306Google Scholar
- 25.Ward LC, Bunce IH, Cornish BH et al (1992) Multi-frequency bioelectrical impedance augments the diagnosis and management of lymphoedema in post-mastectomy patients. Eur J Clin Investig 22:751–754Google Scholar
- 27.Woods M, Tobin M, Mortimer P (1995) The psychosocial morbidity of breast cancer patients with lymphoedema. Cancer Nurs 18:467–471Google Scholar