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Keywords

breast neoplasms, diagnosis, lymphedema, symptoms

 

Authors

  1. Armer, Jane M.
  2. Radina, M. Elise
  3. Porock, Davina
  4. Culbertson, Scott D.

Abstract

Objectives: This study aimed to determine the accuracy of using self-reported signs and symptoms to identify the presence of lymphedema as well as the usefulness of identifying clinically measurable lymphedema on the basis of certain symptoms elicited by the Lymphedema Breast Cancer Questionnaire (LBCQ).

 

Methods: This analysis used logistic regression to identify symptoms predictive of differences between symptom experiences of participants belonging to two distinct groups (study A): those with known post-breast cancer lymphedema (n = 40) and those in a control group of women with no history of breast cancer or lymphedema (n = 40). Symptoms in this model of best fit were used to examine their relation to limb circumferences of breast cancer survivors in a second independent data set (study B; n = 103) in which a diagnosis of known lymphedema was not previously determined using symptom experiences.

 

Results: The presence of lymphedema was predicted by three symptoms comprising a model of best fit for study A (c = .952): "heaviness in past year," "swelling now," and "numbness in past year." Using this model, prediction of absolute maximal circumferential limb difference (i.e., >=2 cm) in study B showed that "heaviness in the past year" (p = .0279) and "swelling now" (p = .0007) were predictive. "Numbness in the past year" was not predictive. However, those with lesser limb differences reported this symptom more often.

 

Conclusions: The findings suggest that changes in sensations may be indicators of early lymphedema or other treatment-related sequelae that must be assessed carefully at each follow-up visit and over time. A combination of symptom assessment and limb volume measurement may provide the best clinical assessment data for identifying changes associated with post-breast cancer lymphedema.

 

Secondary lymphedema is a chronic aftereffect of breast cancer treatment. With the increasing number of women surviving treatment (American Cancer Society, 2003), there is a growing population of women at risk for the development of this complication. In the Western world, breast cancer and its treatment are the leading causes of secondary lymphedema (hereafter referred to as lymphedema).

 

Although the potential impact of lymphedema is extensive, it is largely unrecognized and underdiagnosed. This is partly because the historical focus has largely been on acute treatment, lack of uniformity in diagnostic criteria, and the complexities in valid and reliable limb measurement (Armer, Heppner, & Mallinckrodt, 2002). Because clinical assessment of lymphedema with regard to changes in arm volume appears to lack optimal accuracy for sufficient diagnosis of lymphedema, other assessment options should be considered. Self-reported signs and symptoms over time may be most revealing of subjective limb changes indicating a need for further lymphedema assessment and follow-up management (Kosir et al., 2001). Thus, sensation changes (e.g., limb heaviness, swelling, change in fit of garments, redness, and tenderness) and functional changes (e.g., reduced range of motion) also must be assessed in addition to anthropometric measurements.

 

To date, no research has explicitly investigated the relation between the symptoms women experience as early indicators and limb volume changes. Early indicators allow for early intervention with acute lymphedema that can be reversible, reducing the risk of chronic lymphedema development (Petrek, Pressman, & Smith, 2000;Rockson, 1998). Furthermore, early intervention is associated with better overall outcomes (Petrek et al., 2000). Thus, the purpose of this study was to test the predictive and discriminatory validity of using symptom experiences related to limb volume change secondary to post-breast cancer lymphedema to determine the presence of clinically measurable lymphedema.