Lymphedema following gynecological cancer: Results from a prospective, longitudinal cohort study on prevalence, incidence and risk

S.C. Hayes, et al., Gynecol Oncol (2017)

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Abstract

Lymphedema following gynecological cancer: Results from a prospective, longitudinal cohort study on prevalence, incidence and risk

S.C. Hayes, et al., Gynecol Oncol (2017)

Objective

Cancer-related lymphedema is a debilitating condition that adversely influences function, health and quality of life. The purpose of this study was to assess the prevalence, incidence, and risk factors of lower-limb lymphedema pre- through to 24 months post-surgery for gynecological cancer.

Methods

A clinic-based sample of women (n=408) with gynecological cancer participated in a prospective, longitudinal study (2008-2011) using self-reported measures (swelling in one or both legs) and objectively measured lymphedema (bioimpedance spectroscopy) at baseline (pre-surgery), six weeks-three months, six-12 months, and 15-24 months post-surgery.

Results

At pre-surgery, 15% of women self-reported lymphedema and 27% had measurable evidence of lymphedema. By 24 months post-surgery, incidence of new self-reported or measured lymphedema was 45% and 37%, respectively. Three-quarters of these new cases presented by 12-months post-treatment. While lymphedema was transient for some women, 60% had persistent lymphedema. More extensive lymph node dissection, receipt of chemotherapy and radiation therapy, increasing body mass index, insufficient levels of physical activity, diagnosis of vulvar/vaginal cancer and presence of pre-treatment lymphedema were identified as potential risk factors (p<0·05). Conclusion

Findings support the need for integration of pre-surgical assessment, and prospective, post-treatment surveillance of lymphedema into gynecological cancer care. Future research exploring the role of maintaining healthy body weight, regular physical activity and education about early detection of lymphedema to improve gynecological cancer survivorship is warranted.

Main findings

  • This is a significant prospective, longitudinal design study including objective and self-report assessments. Lymphoedema was the primary outcome.
  • Assessment included bioimpedance and self-report over 2 years. To note not all participants completed the full study and results may be underestimated.
  • Using bioimpedance spectroscopy and self-report, 27% and 15% of women showed evidence of lymphedema at baseline, before they had treatment for gynecological cancer
  • 50% of women showed evidence of lymphedema within 2 years post-gynecological cancer.
  • 60% of lymphoedema cases are persistent; 40% are transient.
  • Incidence of lower limb lymphoedema increased over time.
  • Between 73 and 100% of new cases, presented by 12-months post-surgery.
  • Modifiable lymphedema risk factors: body mass index and physical activity levels.
  • More extensive lymph node removal, presence of lymphoedema at baseline, increasing age, time since surgery, receipt of adjuvant therapy (both chemotherapy and radiation therapy), increasing body mass index and insufficient physical activity levels, were identified as risk factors.
  • Being insufficiently physically active or sedentary was associated with increased odds of lymphoedema (assessed via bioimpedance) compared with those undertaking 150 + min of moderate –intensity physical activity each week. This supports growing evidence that physical activity may reduce the risk of developing lymphoedema.