Impact of breast cancer–related lymphedema on working women
The professional impact of upper limb lymphedema, which affects 15–20% of women after breast cancer treatment, has been poorly evaluated.
To analyze lymphedema characteristics and global lymphedema- and/or sleeve-attributed impact (mildly inconvenient to severely debilitating) on professional activities, workplace relationships, and workstation ergonomics.
Patients received a standardized, anonymous, self-administered questionnaire at consultation/hospitalization for treatment in a specialized lymphedema management center.
All 134 consecutive women (March/2015–March/2017; median age 54), with 53-month median lymphedema duration and 34% median excess volume, were included; 35% considered global impact (arm-use impairment) high. For high vs. low global impact during occupational activities, univariate analyses identified global impairment as being associated with the low (23.8%), intermediate (60%), or high (63.2%) (p < 0.01) arm-use level, while multivariate analyses retained intermediate (OR 6.9 [95% CI 1.1–118.1], p < 0.01) and high (OR 4.5 [95% CI 1.5–37.3], p < 0.05) vs. low arm-use level. Lymphedema affected the careers of 70 (52.2%) patients, mostly those with severely impaired arm movement (53.8% vs. 10.2, p < 0.001), without modifying their relationships with colleagues and superiors for 84 (62.7%). Highly impaired women reported changed relationships with colleagues (45% vs. 20%, p < 0.01) and superiors (43.6% vs. 16.9%, p < 0.01). Only 10 women’s (7.5%) job changes reflected lymphedema or its treatment. Workplace adaptations (53% ergonomic) were made for 36 (26.9%) patients, mostly those with greater arm-movement impairment (43.6% vs. 25.3%, p < 0.05), who were highly satisfied (86%).
Upper limb lymphedema can significantly impact work, sometimes upending careers. The rare workstation adaptations were beneficial. Occupational physicians should assess lymphedema-attributed difficulties to improve working conditions.
KeywordsBreast cancer Lymphedema Occupational activity
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 4.Pyszel A, Malyszczak K, Pyszel K, Andrzejak R, Szuba A (2006) Disability, psychological distress and quality of life in breast cancer survivors with arm lymphedema. Lymphology 39(4):185–192Google Scholar
- 9.Lasinski BB, McKillip Thrift K, Squire D, Austin MK, Smith KM, Wanchai A, Green JM, Stewart BR, Cormier JN, Armer JM (2012) A systematic review of the evidence for complete decongestive therapy in the treatment of lymphedema from 2004 to 2011. PM R 4(8):580–601. https://doi.org/10.1016/j.pmrj.2012.05.00 CrossRefGoogle Scholar
- 11.International Society of Lymphology (2013) The diagnosis and treatment of peripheral lymphedema: 2013 consensus document of the International Society of Lymphology. Lymphology 46(4):1–11Google Scholar
- 18.Wang L, Hong BY, Kennedy SA, Chang Y, Hong CJ, Craigie S, Kwon HY, Romerosa B, Couban RJ, Reid S, Khan JS, McGillion M, Blinder V, Busse JW (2018) Predictors of unemployment after breast cancer surgery: a systematic review and meta-analysis of observational studies. J Clin Oncol 36(18):1868–1879. https://doi.org/10.1200/JCO.2017.77.3663 CrossRefGoogle Scholar
- 19.O’Toole JA, Ferguson CM, Swaroop MN, Horick N, Skolny MN, Brunelle CL, Miller CL, Jammallo LS, Specht MC, Taghian AG (2015) The impact of breast cancer-related lymphedema on the ability to perform upper extremity activities of daily living. Breast Cancer Res Treat 150(2):381–388. https://doi.org/10.1007/s10549-015-3325-3 CrossRefGoogle Scholar
- 22.Belmonte R, Messaggi-Sartor M, Ferrer M, Pont A, Escalada F (2018) Prospective study of shoulder strength, shoulder range of motion, and lymphedema in breast cancer patients from pre-surgery to 5 years after ALND or SLNB. Support Care Cancer 26(9):3277–3287. https://doi.org/10.1007/s00520-018-4186-1 CrossRefGoogle Scholar
- 28.Maxeiner S, Downer A (2009) Comparing the psychosocial issues experienced by individuals with primary vs secondary lymphedema. Rehab Oncol 27(2):9–15Google Scholar
- 30.Kalfa S, Koelmeyer L, Taksa L, Winch C, Viveros H, Gollan PJ, Mackie H, Boyages J (2019) Work experiences of Australian cancer survivors with lymphoedema: a qualitative study. Health Soc Care Community. https://doi.org/10.1111/hsc.12698
- 34.Crevenna R (2019) Aspects of cancer rehabilitation: an Austrian perspective. Disabil Rehabil:1. https://doi.org/10.1080/09638288.2018.1522554