Effects of Lymphedema Severity on Quality of Life, Upper Limb Function, and Physical Activity Level in Patients with Breast Cancer Treatment-related Lymphedema

Yıl 2019, , 189 - 198, 24.10.2019

Ceren Orhan Serap Özgül , Gülbala Nakip , Emine Baran , Esra Üzelpasacı Gamze Nalan Çinar Sercan Aksoy Türkan Akbayrak

https://doi.org/10.21673/anadoluklin.554019

Cited By: 3

Öz

Aim: The aim of the present study was to
compare the quality of life, the functional status of upper extremity, and physical
activity level among women with mild, moderate, or severe breast cancer
treatment related lymphedema.

Materials
and Methods: Eighty-three women with a diagnosis of lymphedema (24%
mild, 41% moderate, and 35% severe) participated in the present study. The presence
and severity of lymphedema were evaluated by circumferential measurement. The
Turkish versions of the Lymphedema Quality of Life (LYMQOL), Quick Disability
of Arm, Shoulder and Hand (DASH), International Physical Activity
Questionnaire-Short Form (IPAQ-SF) were used to assess quality of life, the
functional status of upper extremity, and physical activity level, respectively.

Results: There were
significant differences in quality
of life and functional status of upper extremity among patients with mild, moderate,
and severe lymphedema (p<0.05). However,
there was no significant difference in physical activity level among the three
groups (p>0.05). Based on the
findings of pairwise analyses, function, appearance, and symptom subscales of quality
of life and the functional status of upper extremity was found to be more
influenced in patients with severe lymphedema than those with mild lymphedema (p<0.016). The significant, but weak
associations between lymphedema severity and the LYMQOL function, and
appearance, and symptom subscales, and the DASH score were found (p≤0.01).

Discussion and
Conclusion: It was found that quality of life and the functional status of upper
extremity were more influenced in patients with severe lymphedema than those in
patients with mild lymphedema. These results indicate that quality of life and
upper extremity functionality may be affected when lymphoedema progress from
mild to severe in patients undergoing breast cancer surgery. Therefore, it is
important to determine and treat lymphedema in the early stages in order to
prevent or reduce this influence.

Anahtar Kelimeler

breast cancer, lymphedema, upper extremity, quality of life, function, physical activity

Meme Kanseri Tedavisiyle İlişkili Lenfödemi Olan Hastalarda Lenfödem Şiddetinin Yaşam Kalitesi, Üst Ekstremite Fonksiyonu ve Fiziksel Aktivite Düzeyi Üzerindeki Etkileri

Öz

Amaç: Bu çalışmanın amacı, meme kanseri
tedavisi ile ilişkili hafif, orta ve şiddetli lenfödemi olan hasta grupları
arasında yaşam kalitesi, üst ekstremitenin fonksiyonel durumu ve fiziksel
aktivite düzeyindeki karşılaştırmaktı.

Gereç ve Yöntemler: Bu çalışmaya, meme
kanseri tedavisi ile ilişkili lenfödem tanısı olan 83 kadın (% 24 hafif, % 41
orta, % 35 şiddetli) katıldı. Lenfödemin varlığı ve şiddeti çevre ölçümü ile
belirlendi. Lenfödem Yaşam Kalite Ölçeği (LYKÖ), Kol, Omuz ve El Sorunları Anketi’nin
kısa versiyonu (DASH) ve Uluslararası Fiziksel Aktivite Anketi’nin kısa formu (UFAA-KF),
sırasıyla yaşam kalitesi, üst ekstremitenin fonksiyonel durumu ve fiziksel
aktivite düzeyinin değerlendirilmesi için kullanıldı.

Bulgular: Hafif,
orta ve şiddetli lenfödemi olan hastalar arasında yaşam kalitesi ve üst
ekstremitenin fonksiyonel durumu açısından istatistiksel olarak anlamlı fark
vardı (p<0.05). Ancak, fiziksel
aktivite düzeyinden üç grup arasında anlamlı fark yoktu (p>0.05). İkili analizlerin sonuçlarına göre, şiddetli lenfödemi
olan hastalarda, yaşam kalitesinin fonksiyon, görünüm ve semptom alt
alanlarının ve üst ekstremitenin fonksiyonel durumunun hafif derecede lenfödemi
olan hastalara göre daha fazla etkilendiği bulundu (p<0.016). Lenfödem şiddeti ile LYKÖ fonksiyon, görünüm ve
semptom alt alanları ve DASH arasında istatistiksel olarak anlamlı ancak zayıf
bir ilişki bulundu (p≤0.01).

Tartışma ve Sonuç: Şiddetli
lenfödemi olan hastalarda yaşam kalitesinin ve üst ekstremitenin fonksiyonel
durumunun hafif lenfödemi olan hastalara göre daha fazla etkilendiği bulundu.
Bu sonuçlar, meme kanseri cerrahisi geçiren bireylerde lenfödem hafif düzeyden
ileri düzeye geçtiğinde yaşam kalitesi ve üst ekstremite fonksiyonelliğinin etkilenebileceğini
göstermektedir. Dolayısıyla bu etkilenimi önlemek veya azaltmak için lenfödemin
erken dönemde belirlenmesi ve tedavi edilmesi önemlidir.

Anahtar Kelimeler

meme kanseri, lenfödem, üst ekstremite, yaşam kalitesi, fonksiyon, fiziksel aktivite

Kaynakça

• 1. Khan F, Amatya B, Pallant JF, Rajapaksa I. Factors associated with long-term functional outcomes and psychological sequelae in women after breast cancer. Breast. 2012;21(3):314-20.
• 2. Türkiye Halk Sağlığı Kurumu, Kanser Daire Başkanlığı. 2016. Türkiye Kanser Kontrol Programı. Erişim:https://hsgm.saglik.gov.tr/depo/birimler/kanser-db/yayinlar/raporlar/Ulusal_Kanser_Kontrol_Plani_2013_2018.pdf (erişildi: 13.04.2019).
• 3. Hayes SC, Rye S, Battistutta D, DiSipio T, Newman B. Upper-body morbidity following breast cancer treatment is common, may persist longer-term and adversely influences quality of life. Health Qual Life Outcomes. 2010;8:92.
• 4. Hidding JT, Beurskens CH, van der Wees PJ, van Laarhoven HW, Nijhuis-van der Sanden MW. Treatment related impairments in arm and shoulder in patients with breast cancer: a systematic review. PLoS One. 2014;9(5):e96748.
• 5. Pusic AL, Cemal Y, Albornoz C, Klassen A, Cano S, Sulimanoff I, et al. Quality of life among breast cancer patients with lymphedema: a systematic review of patient-reported outcome instruments and outcomes. J Cancer Surviv. 2013;7(1):83-92.
• 6. Executive C. The Diagnosis and Treatment of Peripheral Lymphedema: 2016 Consensus Document of the International Society of Lymphology. Lymphology. 2016;49(4):170-84.
• 7. Tiwari P, Coriddi M, Salani R, Povoski SP. Breast and gynecologic cancer-related extremity lymphedema: a review of diagnostic modalities and management options. World J Surg Oncol. 2013;11:237.
• 8. DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol. 2013;14(6):500-15.
• 9. Gebruers N, Verbelen H, De Vrieze T, Vos L, Devoogdt N, Fias L, et al. Current and future perspectives on the evaluation, prevention and conservative management of breast cancer related lymphoedema: A best practice guideline. Eur J Obstet Gynecol Reprod Biol. 2017;216:245-53.
• 10. Park JE, Jang HJ, Seo KS. Quality of life, upper extremity function and the effect of lymphedema treatment in breast cancer related lymphedema patients. Ann Rehabil Med. 2012;36(2):240-7.
• 11. Taghian NR, Miller CL, Jammallo LS, O'Toole J, Skolny MN. Lymphedema following breast cancer treatment and impact on quality of life: a review. Crit Rev Oncol Hematol. 2014;92(3):227-34.
• 12. Vassard D, Olsen MH, Zinckernagel L, Vibe-Petersen J, Dalton SO, Johansen C. Psychological consequences of lymphoedema associated with breast cancer: a prospective cohort study. Eur J Cancer. 2010;46(18):3211-8.
• 13. Fu MR. Breast cancer-related lymphedema: Symptoms, diagnosis, risk reduction, and management. World J Clin Oncol. 2014;5(3):241-7.
• 14. Herrera JE, Stubblefield MD. Rotator cuff tendonitis in lymphedema: a retrospective case series. Arch Phys Med Rehabil. 2004;85(12):1939-42.
• 15. Klernas P, Johnsson A, Horstmann V, Kristjanson LJ, Johansson K. Lymphedema Quality of Life Inventory (LyQLI)-Development and investigation of validity and reliability. Qual Life Res. 2015;24(2):427-39.
• 16. Schmitz KH, Troxel AB, Cheville A, Grant LL, Bryan CJ, Gross CR, et al. Physical Activity and Lymphedema (the PAL trial): assessing the safety of progressive strength training in breast cancer survivors. Contemp Clin Trials. 2009;30(3):233-45.
• 17. Hormes JM, Bryan C, Lytle LA, Gross CR, Ahmed RL, Troxel AB, et al. Impact of lymphedema and arm symptoms on quality of life in breast cancer survivors. Lymphology. 2010;43(1):1-13.
• 18. Kwan W, Jackson J, Weir LM, Dingee C, McGregor G, Olivotto IA. Chronic arm morbidity after curative breast cancer treatment: prevalence and impact on quality of life. J Clin Oncol. 2002;20(20):4242-8.
• 19. Lee TS, Morris CM, Czerniec SA, Mangion AJ. Does Lymphedema Severity Affect Quality of Life? Simple Question. Challenging Answers. Lymphat Res Biol. 2018;16(1):85-91.
• 20. Pekyavas NO, Tunay VB, Akbayrak T, Kaya S, Karatas M. Complex decongestive therapy and taping for patients with postmastectomy lymphedema: a randomized controlled study. Eur J Oncol Nurs. 2014;18(6):585-90.
• 21. Fu MR, Axelrod D, Cleland CM, Qiu Z, Guth AA, Kleinman R, et al. Symptom report in detecting breast cancer-related lymphedema. Breast Cancer (Dove Med Press). 2015;7:345-52.
• 22. International Society of L. The diagnosis and treatment of peripheral lymphedema: 2013 Consensus Document of the International Society of Lymphology. Lymphology. 2013;46(1):1-11.
• 23. Keeley V, Crooks S, Locke J, Veigas D, Riches K, Hilliam R. A quality of life measure for limb lymphoedema (LYMQOL). J Lymphoedema. 2010;5(1):26-37.
• 24. Bakar Y, Tugral A, Ozdemir O, Duygu E, Uyeturk U. Translation and Validation of the Turkish Version of Lymphedema Quality of Life Tool (LYMQOL) in Patients with Breast Cancer Related Lymphedema. Eur J Breast Health. 2017;13(3):123-8.
• 25. Gummesson C, Ward MM, Atroshi I. The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH. BMC Musculoskelet Disord. 2006;7:44.
• 26. Koldas Dogan S, Ay S, Evcik D, Baser O. Adaptation of Turkish version of the questionnaire Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) in patients with carpal tunnel syndrome. Clin Rheumatol. 2011;30(2):185-91.
• 27. Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35(8):1381-95.
• 28. Saglam M, Arikan H, Savci S, Inal-Ince D, Bosnak-Guclu M, Karabulut E, et al. International physical activity questionnaire: reliability and validity of the Turkish version. Percept Mot Skills. 2010;111(1):278-84.
• 29. Coriddi M, Khansa I, Stephens J, Miller M, Boehmler J, Tiwari P. Analysis of factors contributing to severity of breast cancer-related lymphedema. Ann Plast Surg. 2015;74(1):22-5.
• 30. Vignes S, Arrault M, Dupuy A. Factors associated with increased breast cancer-related lymphedema volume. Acta Oncol. 2007;46(8):1138-42.
• 31. Pain SJ, Vowler SL, Purushotham AD. Is physical function a more appropriate measure than volume excess in the assessment of breast cancer-related lymphoedema (BCRL)? Eur J Cancer. 2003;39(15):2168-72.
• 32. Chachaj A, Malyszczak K, Pyszel K, Lukas J, Tarkowski R, Pudelko M, et al. Physical and psychological impairments of women with upper limb lymphedema following breast cancer treatment. Psychooncology. 2010;19(3):299-305.
• 33. Viehoff PB, van Genderen FR, Wittink H. Upper limb lymphedema 27 (ULL27): Dutch translation and validation of an illness-specific health-related quality of life questionnaire for patients with upper limb lymphedema. Lymphology. 2008;41(3):131-8.
• 34. Stanton AL, Danoff-Burg S, Cameron CL, Bishop M, Collins CA, Kirk SB, et al. Emotionally expressive coping predicts psychological and physical adjustment to breast cancer. J Consult Clin Psychol. 2000;68(5):875-82.