Impact of breast cancer–related lymphedema on working women

Abstract

Background: The professional impact of upper limb lymphedema, which affects 15–20% of women after breast cancer treatment, has been poorly evaluated. Objective: 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. Methods: Patients received a standardized, anonymous, self-administered questionnaire at consultation/hospitalization for treatment in a specialized lymphedema management center. Results: 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%). Conclusion: 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.