Functional impairment following arm-lymphedema after breast cancer treatment: A mixed method study of associated factors

Introduction & Aim: Impairment of functions following lymphedema are well-established and affect an increasing number of women due to continually improved survival. The aim of the present mixed method study was to examine the impact of breast cancer treatment on perceived swelling/sensation of heaviness (lymphedema) and on function in subgroups of modern treatment. Methods: 51 women between 18 and 70 years of age were operated for unilateral primary breast cancer were recruited. Exclusion criteria were: non standardized treatment, reconstruction or corrective breast surgery, cancer relapse, contra-lateral breast cancer, other malignant disease. A detailed questionnaire was designed based upon questions and topics identified in the literature and on open interviews with 15 women operated for breast cancer. Before study start, the questionnaire was tested and revised twice in accordance with the comments from the pilot tests in 10 patients. Univariate and multivariate logistic regression models were applied to examine the influence of different factors.Results: In univariate models, younger age, mastectomy, axillary lymph node dissection (ALND), radiotherapy and chemotherapy were significantly associated with swelling/heaviness. In multivariate models, the most important association was between swelling/heaviness and axillary procedure (OR=4.56; CI: 3.40-6.05, p < 0.0001). Regional radiotherapy was significantly associated with swelling/heaviness (OR = 1.62; CI: 1.20-2.07, p = 0.0003). Finally, younger age, ALND, chemotherapy, time elapsed since surgery, and surgery on the dominant side, were also associated with an increased risk of reporting impairment of function.Conclusion: Regional radiotherapy, younger age and ALND increase lymphedema risk. However, risk varied by combinations of exposures

Keywords:

breast cancer , secondary lymphedema , Functional Impairment