A count of symptoms may be a cost-effective initial screening tool for lymphedema, according to a new study published in Breast Cancer: Targets and Therapy (doi:10.2147/BCTT.S87854). In this study, researchers from the New York University College of Nursing (NYUCN) examined the validity, sensitivity, and specificity of various symptoms indicative of breast cancer-related lymphedema. They also determined the best cutoff points for diagnosing lymphedema and risk of lymphedema in breast cancer survivors.
Lymphedema has a latency of months to years before its overt swelling occurs. The effect is usually caused by an obstruction or disruption of the lymphatic system that occurs either immediately or 1 to 5 years after cancer treatment. However, the adverse effect can manifest even 20 years later. During this latency, changes in the affected limb cannot be detected with objective measures; the persistence of other symptoms is the only clinical clue. Therefore, self-reporting plays an important role in early detection.
The NYUCN researchers collected data from a total of 250 women categorized into three cohorts: 60 healthy female adults, 42 breast cancer survivors with previously diagnosed lymphedema, and 148 breast cancer survivors at risk of developing lymphedema.
The healthy participants were significantly younger than the breast cancer survivors with lymphedema and the at-risk survivors. Also notable, considerably more survivors with lymphedema were nonwhite.
“In part 1 of our review we evaluated 22 symptoms associated with breast cancer-related lymphedema, and in part 2, we assessed different dimensions of symptom distress,” explained Mei R. Fu, PhD, RN, ACNS-BC, FAAN, associate professor of Chronic Disease Management at NYUCN and the first author of the study.
The risks of developing lymphedema were more than 5 times higher in women who reported arm heaviness, arm firmness, increased arm temperature, tightness, limited arm movement, tingling, and arm aching; and more than 4 times higher in women who reported limited finger movement, limited elbow movement, and limited wrist movement, compared with women who did not have these symptoms. Pain in the affected arm indicated the risk was nearly twice that of women who did not experience pain in the affected arm.
“While each of these symptoms and its dimensions is diagnostically relevant, we found that we could differentiate healthy adults from breast cancer survivors with lymphedema and those at risk for lymphedema by a count of their symptoms,” said Fu.
Presence of 3 symptoms distinguished breast cancer survivors with lymphedema from healthy women with a sensitivity of 94% and a specificity of 97%, and presence of 9 symptoms distinguished at-risk survivors from survivors with lymphedema with a sensitivity of 64% and a specificity of 80%.
Based on their findings, Fu and colleagues encourage using symptom count in the absence of objective measurements to detect latent-stage lymphedema in breast cancer survivors.