Quality of Life in Patients with Breast Cancer–Related Lymphedema and Reconstructive Breast Surgery

Abstract

Background To evaluate the quality of life (QOL) of breast cancer survivors who have undergone breast reconstruction and have breast cancer-related lymphedema (BCRL). Methods Patients with a unilateral mastectomy with or without breast reconstruction were evaluated for BCRL and their QOL. Patients were divided into a non-BCRL and a BCRL group. Patients with subjective complaints of arm swelling and/or an interlimb volume difference of >200 mL, or undergoing treatment for arm lymphedema were defined as having BCRL. QOL was assessed using cancer-specific (EORTC QLQ-C30 and EORTC QLQ-B23) and disease specific (Lymph-ICF) questionnaires. Results In total, 253 patients with a mean follow-up time of 51.7 (standard deviation = 18.5) months since mastectomy completed the QOL questionnaires. Of these patients, 116 (46%) underwent mastectomy alone and 137 (54%) had additional breast reconstruction. A comparison of the QOL scores of 180 patients in the non-BCRL group showed a significantly better physical function (p = 0.004) for patients with reconstructive surgery compared with mastectomy patients. In the 73 patients with BCRL, a comparison of the QOL scores showed no significant differences between patients with mastectomy and reconstructive surgery. After adjusting for potential confounders, multivariate analysis showed a significant impact of BCRL on physical function (β = - 7.46; p = 0.009), role function (β = - 15.75; p = 0.003), cognitive function (β = - 11.56; p = 0.005), body vision (β = - 11.62; p = 0.007), arm symptoms (β = 20.78; p = 0.000), and all domains of the Lymph-ICF questionnaire. Conclusions This study implies that BCRL has a negative effect on the QOL of breast cancer survivors, potentially negating the positive effects on QOL reconstructive breast surgery has.

A systematic review of factors affecting quality of life after postmastectomy breast reconstruction in women with breast cancer

“…53 Presence of lymphedema was identified as a significant predictor of lower physical well-being on the chest, 10 role function, cognitive function, and body image. 2 Five studies out of six (83%) reported that a higher BMI significantly affected the overall quality of life and its physical, psychosocial and sexual dimensions. 31,37,39,52 Regarding smoking status, both studies that identified this variable consistently reported its negative effects on physical, psychosocial, and sexual function.…”

Low level laser therapy (Photobiomodulation therapy) for breast cancer-related lymphedema: a systematic review

“…This is in concordance with New Zealand specific data; it was estimated that the incidence of BCRL in New Zealand is 23.3% [ 4 ]. BCRL has a significant impact on breast cancer survivors, including declined physical function and increased disability, which negatively affects quality of life [ 5 – 8 ]. While the mainstay of BCRL management approaches include compression garments, manual lymphatic drainage, and remedial exercises [ 5 , 9 , 10 ], these interventions are usually time-consuming and poorly adherent (or unacceptable).…”

Correlation between patency and clinical improvement after lymphaticovenous anastomosis (LVA) in breast cancer-related lymphedema: 12-month follow-up

“…(QoL) such as a swollen limb, pain, heaviness, and erysipelas [5][6][7]. Peripheral lymphedema can be classified clinically into severity stages according to the International Society of Lymphology (ISL) [8].…”

“…Peripheral lymphedema can be classified clinically into severity stages according to the International Society of Lymphology (ISL) [8]. With the increasing breast cancer survival rate and the profound impact on QoL, lymphedema treatment is in high demand [5,6,9,10].…”