Lymphedema and quality of life in survivors of early-stage breast cancer

Background: The standard of care for early-stage breast cancer includes surgical removal of the tumor and axillary lymph node dissection (ALND). Despite increased use of breast-conserving surgery, lymphedema rates are similar to those with more radical surgery. Hypothesis: Women who experience breast cancer-related lymphedema have a measurable reduction in quality of life compared with women without lymphedema. Design: In a retrospective cohort study, we explored the association between lymphedema and quality of life, controlling for patient demographics, surgical factors, and treatment types. Settings: An urban academic medical center and a community hospital. Participants: A total of 151 women surgically treated for early-stage breast cancer (stages 0-11) were assessed at least I year after their ALND. The women had been treated with either conservative surgery and radiation or mastectomy without radiation. Main Outcome Measures: Arm volume was measured by water displacement. Grip strength and range-of-motion measurements assessed arm function. The Functional Assessment of Cancer Therapy-Breast (FACT-B) quality-of-life instrument assessed breast, emotional, functional, physical, and social well-being. Results: Lymphedema (an arm volume difference 200 cm(3)) was measured in 42 women (27.8%). Mastectomy or conservative surgery patients had similar lymphedema rates. Women with lymphedema in both surgical groups scored significantly lower on 4 of the 5 subsections than women without lymphedema, even after adjusting for other factors influencing quality of life. Conclusions: Lymphedema occurs at appreciable rates, and its impact on long-term quality of life in survivors of early-stage breast cancer should not be underestimated.