Meme Kanseri Sonrası Lenfödem Evresine Göre Semptom Yükü ve Yaşam Kalitesi

Öz

Meme kanseri ilişkili lenfödem (MKİL), semptom yüküne katkıda bulunan ve yaşam kalitesini bozan kronik bir durumdur. Bu tek merkezli kesitsel çalışmada, MKİL olan 63 hastada klinik lenfödem evresi, hasta tarafından bildirilen semptom yükü ve yaşam kalitesi arasındaki ilişki değerlendirilmiştir. Lenfödem evresi Uluslararası Lenfoloji Derneği (ISL) kriterlerine göre sınıflandırılmış olup, hastaların 11'i (%17,5) Evre I, 39'u (%61,9) Evre II ve 13'ü (%20,6) Evre III olarak değerlendirilmiştir. Hasta tarafından bildirilen semptom yükü ve fonksiyonel kısıtlılık Lymph-ICF-UL anketi ile, yaşam kalitesi ise Kanser Tedavisi İşlevsel Değerlendirmesi-Meme artı kol morbidite alt ölçeği (FACT-B+4) ile değerlendirilmiştir. Gruplar arası karşılaştırmalar parametrik olmayan yöntemlerle yapılmış; klinik evrenin bağımsız ilişkisi yaş, vücut kitle indeksi, radyoterapi, kemoterapi, çıkarılan lenf nodu sayısı, diyabet ve lenfödem süresine göre düzeltilmiş çok değişkenli doğrusal regresyon ile değerlendirilmiştir. Semptom yükü ve fonksiyonel kısıtlılık evre ilerledikçe artmıştır (p<0,001); medyan Lymph-ICF-UL toplam skorları Evre I'de 16,0 (IQR: 14,8-16,6) iken Evre III'te 47,8'e (IQR: 47,0-50,6) yükselmiştir. Yaşam kalitesi de paralel olarak azalmıştır (p<0,001); medyan FACT-B+4 skorları Evre I'de 115,2 (IQR: 110,4-118,5) iken Evre III'te 75,4'e (IQR: 73,9-77,1) gerilemiştir. Çok değişkenli düzeltme sonrasında Evre III, Evre I'e kıyasla daha yüksek Lymph-ICF-UL skoru (β=32,57; %95 GA: 30,09-35,06) ve daha düşük FACT-B+4 skoru (β=−40,75; %95 GA: −46,25 ile −35,25) ile ilişkili bulunmuştur. Bu bulgular, MKİL'in klinik değerlendirmesinde hasta tarafından bildirilen sonuç ölçütlerinin rolüne işaret etmekte ve evreyle ilişkili hasta deneyimi farklılıklarına ilişkin gözlemsel kanıt sunmakta olup, daha büyük boylamsal kohortlarda doğrulanması gerekmektedir.

Anahtar Kelimeler

• Meme kanseri
• lenfödem
• hasta bildirimli sonuçlar
• yaşam kalitesi
• Lymph-ICF-UL
• FACT-B+4

Symptom Burden and Quality of Life by Lymphedema Stage After Breast Cancer

Öz

Breast cancer-related lymphedema (BCRL) is a chronic condition that contributes to symptom burden and impairs quality of life. This single-center cross-sectional study evaluated the association between the clinical stage of lymphedema, patient-reported symptom burden, and quality of life in 63 patients with BCRL. Lymphedema stage was classified according to the International Society of Lymphology (ISL) criteria, with 11 patients (17.5%) in Stage I, 39 (61.9%) in Stage II, and 13 (20.6%) in Stage III. Symptom burden and functional impairment were assessed using the Lymph-ICF-UL, and quality of life using the FACT-B+4. Group comparisons were performed using non-parametric methods, and multivariable linear regression was used to evaluate the independent association of clinical stage after adjustment for age, body mass index, radiotherapy, chemotherapy, lymph node count, diabetes, and lymphedema duration. Symptom burden and functional impairment increased with advancing stage (p<0.001): median Lymph-ICF-UL total scores rose from 16.0 (interquartile range [IQR]: 14.8-16.6) in Stage I to 47.8 (IQR: 47.0-50.6) in Stage III. Quality of life declined in parallel (p<0.001), with median FACT-B+4 scores decreasing from 115.2 (IQR: 110.4-118.5) in Stage I to 75.4 (IQR: 73.9-77.1) in Stage III. After multivariable adjustment, Stage III remained associated with higher Lymph-ICF-UL scores (β=32.57; 95% confidence interval [CI]: 30.09 to 35.06) and lower FACT-B+4 scores (β=−40.75; 95% CI: −46.25 to −35.25) compared with Stage I. These findings suggest a role for patient-reported outcome measures in the clinical assessment of BCRL and provide observational evidence for stage-related differences in patient experience, requiring confirmation in larger longitudinal cohorts.

Anahtar Kelimeler

• Breast cancer
• lymphedema
• patient-reported outcomes
• quality of life
• Lymph-ICF-UL
• FACT-B+4

Kaynakça

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