Self‐reported signs and symptoms of secondary upper limb lymphoedema related to breast cancer treatment: Systematic review

Abstract

Introduction Breast cancer survivors with secondary upper limb lymphoedema (ULL) may report a wide range of self‐reported symptoms. At the moment, no overview of ULL‐specific symptoms is available. The first aim, therefore, was to compare the prevalence rates of self‐reported signs and symptoms in people with and without secondary ULL due to breast cancer treatment. The second aim was to determine whether symptoms of lymphoedema could be predictive for the development of ULL. The third aim was to describe the association between the presence/severity of symptoms and the presence/severity of ULL. Methods A systematic search was conducted in Medline, Scopus, CINAHL and EMBASE databases, with key words related to breast cancer, symptoms and ULL. Results Twenty‐nine articles were eligible. The most frequently reported signs and symptoms were swelling (80.9%) and heaviness (66.7%) in the ULL group and tenderness (37%) and numbness (27%) in the non‐ULL group. Perceived larger arm size, as well as feelings of arm tightness, stiffness, puffiness, pain, sensory disturbances and functional changes were predictive for the development of ULL. Moderate correlations were found between the presence of swelling, firmness in the past year and tightness now and severity of ULL. There was also moderate correlation between the presence of swelling and heaviness now and the presence of ULL. Conclusions Swelling and heaviness are the most commonly reported symptoms in patients with ULL. The presences of these two symptoms are moderately correlated with the presence and/or severity of ULL. Although limited information regarding the predictive self‐reported symptoms for the development of ULL was found. Further research with standardised definitions of ULL and validated questionnaires for self‐reported signs and symptoms are needed to confirm which signs and symptoms are related to ULL and which to other upper limb morbidities.

Sensory signs and symptoms in women with self-reported breast cancer–related lymphedema: a case–control study close up

“…Decreased sensitivity for mechanical stimuli has previously been reported in the surgical region compared to the same region on the non-affected side, both in breast cancer participants with and without pain in this area [41]. As described in literature, local sensory loss seems prevalent after breast cancer surgery [4,41], although not necessarily related to the presence of measurable BCRL. The twopoint discrimination threshold does not significantly differ between groups after correction for multiple testing.…”

“…A recent review revealed that a total of 35 signs and symptoms of BCRL have been described in the literature [4]. The main symptoms reported were swelling, heaviness, and tightness/firmness of the arm [4].…”

“…A recent review revealed that a total of 35 signs and symptoms of BCRL have been described in the literature [4]. The main symptoms reported were swelling, heaviness, and tightness/firmness of the arm [4]. People with BCRL may also report signs such as trophic changes of the skin, including alterations in color and increase in thickness [5].…”

“…This is illustrated by the fact that up to 40% of the women presenting to lymphedema services with symptoms do not have objective measurable arm swelling [15][16][17][18]. Although patients are educated to seek care when experiencing certain signs and symptoms because of their possible association with BCRL, the relationship between these signs and symptoms, and in particular pain and sensory changes, and the objective measures of BCRL is unclear [4,19]. Changes in body perception after breast cancer treatment, particularly after invasive surgery such as mastectomy, may also drive patients to seek care [20]; however whether the perception of a larger than actual limb size is associated with self-reported BCRL has not yet been investigated [21].…”

Upper limb sensory evaluations and ultrasonographic skin measurements in breast cancer–related lymphedema receiving complex decongestive physiotherapy

“…Therefore, in addition to lymphedema, breast cancer patients might also suffer other conditions after surgery, radiotherapy, or chemotherapy, such as neuropathy up to 30%, myofascial pain up to 44%, fatigue up to 94%, 20-40% upper body problems, and 18-54% functional limitations [2][3][4][5][6][7][8], which contribute to patients' particular complaints, such as arm pain, numbness, or feeling of heaviness [9,10]. Women with lymphedema more frequently report pain and demonstrate bilateral impairments in shoulder range of motion, greater restrictions in upper limb activities and upper limb strength, and sensory disturbances compared to women without lymphedema [9,11]. While there are several studies in the literature on physical, functional, and emotional problems in women with BCRL, the effects of lymphedema on sensory parameters have not been explored.…”