Lymphedema and Quality of Life in Survivors of Early-Stage Breast Cancer | Breast Cancer | JAMA Surgery | JAMA Network
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1.
Ries  LAGedKosary  CLedHankey  BFedMiller  BAedEdwards  BKed SEER Cancer Statistics Review, 1973-1996..  Bethesda, Md National Cancer Institute1999;
2.
Brady  MJCella  DFMo  F  et al.  Reliability and validity of the Functional Assessment of Cancer Therapy–Breast quality-of-life instrument.  J Clin Oncol. 1997;15974- 986Google Scholar
3.
Cella  D Manual of the Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System.  Evanston, Ill Evanston Northwestern Healthcare and Northwestern University1997;
4.
Kissin  MWQuerci della Roveret  GEaston  DWestbury  G Risk of lymphoedema following the treatment of breast cancer.  Br J Surg. 1986;73580- 584Google ScholarCrossref
5.
Coster  SPoole  KFallowfield  LJ 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. 2001;68273- 282Google ScholarCrossref
6.
Wapnir  ILCody  RPGreco  RS Subtle differences in quality of life after breast cancer surgery.  Ann Surg Oncol. 1999;6359- 366Google ScholarCrossref
7.
Poulsen  BGraversen  HPBeckmann  JBlichert-Toft  M A comparative study of post-operative psychosocial function in women with primary operable breast cancer randomized to breast conservation therapy or mastectomy.  Eur J Surg Oncol. 1997;23327- 334Google ScholarCrossref
8.
Velanovich  VSzymanski  W Quality of life of breast cancer patients with lymphedema.  Am J Surg. 1999;177184- 187Google ScholarCrossref
9.
Maunsell  EBrisson  JDeschenes  L Arm problems and psychological distress after surgery for breast cancer.  Can J Surg. 1993;36315- 320Google Scholar
10.
Ilfeld  FW  Jr Psychologic status of community residents along major demographic dimensions.  Arch Gen Psychiatry. 1978;35716- 724Google ScholarCrossref
11.
Ilfeld  FW  Jr Further validation of a psychiatric symptom index in a normal population.  Psychol Rep. 1976;391215- 1228Google ScholarCrossref
12.
Tasmuth  Tvon Smitten  KKalso  E Pain and other symptoms during the first year after radical and conservative surgery for breast cancer.  Br J Cancer. 1996;742024- 2031Google ScholarCrossref
13.
Newman  MLBrennan  MPassik  S Lymphedema completed by pain and psychological distress: a case with complex treatment needs.  J Pain Symptom Manage. 1996;12376- 379Google ScholarCrossref
14.
Sneeuw  KCAaronson  NKYarnold  JR  et al.  Cosmetic and functional outcomes of breast conserving treatment for early stage breast cancer 2: relationship with psychosocial functioning.  Radiother Oncol. 1992;25160- 166Google ScholarCrossref
15.
Tobin  MBLacey  HJMeyer  LMortimer  PS The psychological morbidity of breast cancer related arm swelling: psychological morbidity of lymphoedema.  Cancer. 1993;723248- 3252Google ScholarCrossref
16.
Segerstrom  KBjerle  PNystrom  A Importance of time in assessing arm and hand function after treatment of breast cancer.  Scand J Plast Reconstr Surg Hand Surg. 1991;25241- 244Google ScholarCrossref
17.
Sneeuw  KCAaronson  NKYarnold  JR  et al.  Cosmetic and functional outcomes of breast conserving treatment for early stage breast cancer 1: comparison of patients' ratings, observers' ratings, and objective assessments.  Radiother Oncol. 1992;25153- 159Google ScholarCrossref
18.
Passik  SDNewman  MLBrennan  MTunkel  R Predictors of psychological distress, sexual dysfunction and physical functioning among women with upper extremity lymphedema related to breast cancer.  Psychooncology. 1995;4255- 263Google ScholarCrossref
19.
Passik  SNewman  MBrennan  MHolland  J Psychiatric consultation for women undergoing rehabilitation for upper-extremity lymphedema following breast cancer treatment.  J Pain Symptom Manage. 1993;8226- 233Google ScholarCrossref
20.
Carter  BJ Women's experience of lymphedema.  Oncol Nurs Forum. 1997;24875- 882Google Scholar
21.
Woods  MTobin  MMortimer  P The psychosocial morbidity of breast cancer patients with lymphoedema.  Cancer Nurs. 1995;18467- 471Google ScholarCrossref
22.
Schrenk  PRieger  RShamiyeh  AWayand  W Morbidity following sentinel lymph node biopsy versus axillary lymph node dissection for patients with breast carcinoma.  Cancer. 2000;88608- 614Google ScholarCrossref
23.
Gerber  LLampert  MWood  C  et al.  Comparison of pain, motion, and edema after modified radical mastectomy vs local excision with axillary dissection and radiation.  Breast Cancer Res Treat. 1992;21139- 145Google ScholarCrossref
24.
Erickson  VSPearson  MLGanz  PAAdams  JKahn  K Arm edema in breast cancer patients.  J Natl Cancer Inst. 2001;9396- 111Google ScholarCrossref
25.
Werner  RSMcCormick  BPetrek  J  et al.  Arm edema in conservatively managed breast cancer: obesity is a major predictive factor.  Radiology. 1991;180177- 184Google Scholar
Original Article
November 2002

Lymphedema and Quality of Life in Survivors of Early-Stage Breast Cancer

Author Affiliations

From the Departments of Epidemiology and Biostatistics (Ms Beaulac and Drs McNair and LaMorte) and Surgery (Ms Scott and Drs LaMorte and Kavanah), Boston University Medical Center, Boston, Mass.

Arch Surg. 2002;137(11):1253-1257. doi:10.1001/archsurg.137.11.1253
Abstract

Background  The standard of care for early-stage breast cancer includes surgical removal of the tumor and axillary lymph node dissection (ALND). Despite increased use of breast-conserving surgery, lymphedema rates are similar to those with more radical surgery.

Hypothesis  Women who experience breast cancer–related lymphedema have a measurable reduction in quality of life compared with women without lymphedema.

Design  In a retrospective cohort study, we explored the association between lymphedema and quality of life, controlling for patient demographics, surgical factors, and treatment types.

Settings  An urban academic medical center and a community hospital.

Participants  A total of 151 women surgically treated for early-stage breast cancer (stages 0-II) were assessed at least 1 year after their ALND. The women had been treated with either conservative surgery and radiation or mastectomy without radiation.

Main Outcome Measures  Arm volume was measured by water displacement. Grip strength and range-of-motion measurements assessed arm function. The Functional Assessment of Cancer Therapy–Breast (FACT-B) quality-of-life instrument assessed breast, emotional, functional, physical, and social well-being.

Results  Lymphedema (an arm volume difference ≥200 cm3) was measured in 42 women (27.8%). Mastectomy or conservative surgery patients had similar lymphedema rates. Women with lymphedema in both surgical groups scored significantly lower on 4 of the 5 subsections than women without lymphedema, even after adjusting for other factors influencing quality of life.

Conclusions  Lymphedema occurs at appreciable rates, and its impact on long-term quality of life in survivors of early-stage breast cancer should not be underestimated.

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