The relation between the severity of breast cancer-related lymphedema and quality-of-life

Abstract

Background: Breast cancer-related lymphedema (BCRL) is a common problem that affects many breast cancer patients and may have a significant detrimental impact on their quality of life (QoL). The aim of the current study was to investigate the relation between the severity of BCRL and QoL of breast cancer patients. Methods: The study included 102 breast cancer patients, of whom 64% had clinically evident arm lymphedema. BCRL was assessed by measuring the difference in circumference of upper limbs at four points (metacarpophalangeal joint, wrist and 10 cm above and below elbow). At each point the ratio of difference was calculated by dividing the difference in circumference by the circumference of the healthy arm. The sum of ratio differences was divided by 4 to get the average inter-limb circumference discrepancy (AICD). BCRL was defined as an AICD ≥5%. The severity of arm lymphedema was classified into grades 0 (no or <5% AICD), 1 (5-10% AICD), 2 (>10- < 30% AICD) and 3 (>30% AICD). QoL was assessed using the Functional Assessment of Cancer Therapy for Breast cancer patients with Lymphedema (FACT-B + 4). Results: The average scores of the Functional Assessment of Cancer Therapy - General (FACT-G), Breast Cancer Subscale (BCS), Trial Outcome Index (TOI) and FACT-B + 4 differed significantly according to the presence of BCRL and its severity (table). The lowest QoL scores were observed among patient with grade 3 BCRL. Conclusions: The results of the current study illustrated a significant relationship between the severity of BCRL and QoL. This suggests that studies investigating the QoL of breast cancer patients should not only include BCRL as a dichotomous (absent/ present) variable, but patients should be stratified according to the severity of BCRL as well. (Table Presented).