There is abundant evidence that supports the correlation between breast cancer related lymphedema(BCRL) and poor outcomes in quality of life(QOL). But, whether and how the treatment and decrement of lymphedema in BCRL have beneficial effects upon QOL is scarcely researched and still debated.
We analyzed the change of QOL and factors which potentially affect QOL improvement and aim to suggest the clinical assistance to care of lymphedema in BCRL patients.
A total of 332 subjects’ medical records were collected in out-patient visits of lymphedema of BCRL, at least twice from July 2017 to September 2018. Subjects reported questionnaires of QOL(EORTC-QLQ C30 and BR23) and were checked lymphedema status in each visit. All of the scales of QOL range in score from 0 to 100. A high scale score represents a higher QOL. Lymphedema status was the circumference and the volume of both upper extremities(U/E) measured by perometer. Other medical records including the type of surgery, chemotherapy, and radiation therapy were gathered.
The duration between the two visits was 153±76 days. The change in the volume of lymphedema was minimal(-6.44±99.75ml). 54.2% of subjects were diagnosed as an advanced stage of cancer(stage 3 or 4).
Overall, there were significant improvements of scales of QOL (i.e. Physical functioning +2.526, 95% CI +0.802~+4.249; Role functioning +2.982, 95% CI +0.272~+5.692; Emotional functioning +3.245, 95% CI +0.498~+5.993; Cognitive functioning +3.157, 95% CI +0.648~+5.667; Social functioning +2.982, 95% CI +0.028~+5.936; Future perspective +5.263, 95% CI +1.669~+8.856).
There was a significant difference in a scale of QOL (i.e. Physical functioning 13.395), between severe lymphedema subjects (≥600ml) and mild lymphedema subjects (<100ml).
However, the decrement or increase of lymphedema based on volume difference 200ml was not correlated with QOL improvement significantly. Furthermore, there was no relation between QOL improvement and whether the subject received an intervention for reducing the volume of lymphedema (e.g. CDT or SGB).
As a conclusion, lymphedema was a factor which influences the patients' QOL. And treatment for lymphedema has a beneficial effect upon QOL. But it seems there is little relation between QOL and change of lymphedema status. Speaking differently, focusing on lymphedema volume status when managing BCRL could not be sufficient to improve the QOL of patients. Therefore, we suggest holistic approaching and establishing a long-term plan in managing breast cancer related lymphedema. |
