Does Lymphedema Severity Affect Quality of Life? Simple Question. Challenging Answers

Teresa S. Lee, Carol M. Morris, Sharon A. Czerniec, and Andrea J. Mangion. Lymphatic Research and Biology 2017

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Abstract

Does Lymphedema Severity Affect Quality of Life? Simple Question. Challenging Answers

Teresa S. Lee, Carol M. Morris, Sharon A. Czerniec, and Andrea J. Mangion. Lymphatic Research and Biology 2017

Purpose: Lymphedema can have a negative impact on the function and quality of life (QOL) of patients, but most studies have examined lymphedema as a binary variable, rather than a multidimensional disease that ranges in severity. This study explored the potential impact of lymphedema severity on function and overall QOL.

Methods and Results: Of the 54 lymphedema patients recruited, 40 reported their most severe swelling to be in a limb. These participants underwent bioimpedance measurement (L-Dex) and completed either the disabilities of the arm, shoulder, and hand (DASH) questionnaire or the lower extremity functional scale (LEFS). All participants completed the lymphedema quality of life questionnaire (LYMQOL) and were categorized for severity using International Society of Lymphology (ISL) stage. Mild (Stage 0-I), moderate (Stage IIa), and severe (Stage IIb-III) lymphedema accounted for 22%, 50%, and 28% of the participants, respectively. The median [inter-quartile range (IQR)] L-Dex score was 17.8 (6.6–52.7) for arm participants and 36.4 (15.9–93.5) for leg participants. Apart from a mild difference in LYMQOL ARM Appearance domain (p=0.046), ISL staging did not have any relationship with DASH, LEFS, and LYMQOL domains, or overall QOL. Higher LDex was related to poorer function (DASH p=0.015; LEFS p=0.019), but was not related to overall QOL of limb lymphedema participants (p>0.05).

Conclusions: Lymphedema severity did not appear to impact QOL. ISL staging may not be used alone to describe lymphedema severity. Other methods such as bioimpedance, imaging, and self-report of symptoms are required to fully evaluate the impact of lymphedema severity on function and QOL.

Main findings

  • Small sample size.
  • The relationship of ISL stage to function and QOL showed that no differences were found between lymphedema severity groups for overall QOL in arm, leg, and head/neck/chest lymphedema participants.
  • The relationship of L-Dex to function and QOL showed that for every one point increase in L-Dex, there was a 30% increase in the DASH score ( disabilities of the arm, shoulder and hand) corresponding with an increased arm and shoulder disability. L-Dex was not significantly related to any of the domains on LYMQOL arm, including QOL.
  • L-Dex was significantly related to Lower Extremity Functional Scale (LEFS). For every point increase in L-Dex, there was a 32% reduction in LEFS, corresponding with a reduced lower extremity function.
  • Relationships between functional questionnaires and QOL found that higher disability on the DASH corresponded with lower overall QOL. Higher function on the LEFS corresponded with higher overall QOL.