Symptom report in detecting breast cancer-related lymphedema

Figures & data

Table 1 Participants’ demographic characteristics (n=250)

Variable	Lymphedema (n=42)		At risk (n=148)		Healthy (n=60)		P-value
	Mean	SD	Mean	SD	Mean	SD
Age	58.0	10.7	55.8	11.6	36.5	12.8	<0.001
Body mass index	28.8	7.11	25.5	4.99	26.9	7.12	0.02
	n	%	n	%	n	%
Education
Less than high school	1	2.4	0	0	0	0	0.292
High school	6	14.3	12	8.2	5	8.3
Partial college	8	19.0	29	19.7	17	28.3
College graduate	15	35.7	43	29.3	21	35.0
Graduate degree	12	28.6	62	42.2	17	28.3
Marital status
Single/divorced/separated	20	47.6	69	46.6	–	–	1.000
Married	22	52.4	79	53.4	–	–
Employmenta
No	20	48.8	43	29.3	0	0	0.025
Yes	21	51.2	104	70.7	60	100
Racea
White	22	53.7	119	82.1	24	40.0	<0.001
Nonwhite	19	46.3	26	17.9	36	60.0

Note:

a Missing data for one at-risk woman and one woman with lymphedema.

Abbreviation: SD, standard deviation.

Table 2 Clinical characteristics for breast cancer survivors (n=190)

Variable	At risk (n=148)		Lymphedema (n=42)		P-value
	n	%	n	%
Mastectomy	71	48.0	31	73.8	<0.01
Lumpectomy	97	65.5	16	38.1	<0.01
Radiotherapy	74	51.0	28	66.7	0.08
Chemotherapy	67	45.3	34	81.0	<0.01
Sentinel lymph nodes biopsy	134	90.5	23	54.8	<0.01
Axillary lymph nodes dissection	85	57.4	39	92.9	<0.01
	Mean	SD	Mean	SD
Number of nodes removed	8.0	8.7	19.4	11.9	<0.01
Years since cancer diagnosis	2.0	2.3	6.9	8.5	<0.01

Abbreviation: SD, standard deviation.

Table 3 Lymphedema symptoms

Symptomsa,b	Mean + SD	Median	Range
			Min	Max
Healthy adults	0.50+1.58	0	0	8
At-risk survivors	4.81+4.56	4	0	20
Survivors with lymphedema	9.76+4.48	10	1	18

Notes:

a Mean scores differ significantly at P<0.05 between healthy and lymphedema group by the Tukey multiple comparisons of means;

b mean scores differ significantly at P<0.05 between lymphedema and at-risk group by the Tukey multiple comparisons of means.

Abbreviations: SD, standard deviation; Min, minimum; Max, maximum.

Table 4 Symptom profiles

Symptoms	Healthy (n=60), n (%)	At risk (n=150), n (%)	Lymphedema (n=42), n (%)	P-value, lymphedema vs healthy	P-value, lymphedema vs at risk
1. Arm swellinga,b	1 (1.7)	26 (17.3)	42 (100)	<0.001	<0.001
2. Limited shoulder movementa,b	4 (6.7)	42 (28.0)	22 (52.4)	<0.001	0.005
3. Limited fingers movementa,b	0 (0)	15 (10)	11 (26.2)	<0.001	0.011
4. Limited arm movementa,b	2 (3.3)	36 (24)	24 (57.1)	<0.001	<0.001
5. Arm tendernessa	1 (1.7)	71 (47.3)	22 (52.4)	<0.001	0.603
6. Pain in the affected arma	2 (3.3)	60 (40)	19 (45.2)	<0.001	0.596
7. Arm firmnessa,b	0 (0)	36 (24)	29 (69)	<0.001	<0.001
8. Arm tightnessa,b	2 (3.3)	52 (34.7)	30 (71.4)	<0.001	<0.001
9. Arm heavinessa,b	2 (3.3)	23 (15.4)	30 (71.4)	<0.001	<0.001
10. Numbness in the affected arma	2 (3.3)	51 (34.2)	19 (45.2)	<0.001	0.208
11. Stiffness in the affected arma,b	3 (5)	33 (22.1)	18 (42.9)	<0.001	0.010
12. Arm achinga,b	4 (6.7)	45 (30)	26 (61.9)	<0.001	<0.001
13. Burning in the affected arma	0 (0)	17 (11.3)	8 (19)	<0.001	0.202
14. Stabbing in the affected arma	0 (0)	27 (18)	10 (23.8)	<0.001	0.507
15. Tingling in the affected arma,b	3 (5)	41 (27.3)	25 (59.5)	<0.001	<0.001
16. Seroma formationa,b	0 (0)	10 (6.7)	13 (31)	<0.001	<0.001
17. Arm sorenessa	2 (3.)	49 (32.7)	13 (31)	<0.001	1.000
18. Limited elbow movementa,b	0 (0)	9 (6.1)	7 (16.7)	0.001	0.052
19. Limited wrist movementa	0 (0)	11 (7.3)	8 (19)	0.001	0.038
20. Arm rednessa	1 (1.7)	20 (13.3)	9 (21.4)	0.001	0.224
21. Blistering in the affected arm	0 (0)	2 (1.3)	0 (0)	–	1.000
22. Increased arm temperaturea,b	0 (0)	5 (3.4)	8 (19)	0.001	0.002

Notes:

a Fisher’s exact test followed by Bonferroni adjustment, significant difference between the lymphedema group and healthy group. The Bonferroni critical value indicates P<0.002 to be significant;

b Fisher’s exact test followed by Bonferroni adjustment, significant difference between the lymphedema group and at-risk group. The Bonferroni critical value indicates P<0.002 to be significant.

Table 5 Bivariate association between each symptom and lymphedema

Symptom	Odds ratio	95% CI	P-value
1. Arm swelling	561.00	76.04–71,644.49	<0.0001
2. Arm heaviness	17.46	8.22–39.25	<0.0001
3. Arm firmness	10.33	5.04–22.16	<0.0001
4. Increased arm temperature	9.07	2.98–29.94	0.0001
5. Seroma formation	8.61	3.54–21.54	<0.0001
6. Arm tightness	7.78	3.84–16.84	<0.0001
7. Limited arm movement	5.86	2.94–11.93	<0.0001
8. Tingling in affected arm	5.54	2.79–11.26	<0.0001
9. Arm aching	5.14	2.60–10.46	<0.0001
10. Limited fingers movement	4.56	1.92–10.66	0.0008
11. Limited elbow movement	4.39	1.53–12.21	0.0069
12. Limited wrist movement	4.23	1.58–10.99	0.0049
13. Limited shoulder movement	3.84	1.94–7.64	0.0001
14. Stiffness in the affected arm	3.55	1.75–7.16	0.0005
15. Burning in the affected arm	2.86	1.11–6.93	0.0299
16. Arm redness	2.47	1.02–5.66	0.0450
17. Numbness in the affected arm	2.40	1.21–4.71	0.0124
18. Stabbing in the affected arm	2.12	0.92–4.64	0.0769
19. Tenderness in the affected arm	2.07	1.06–4.03	0.0320
20. Pain in the affected arm	1.99	1.01–3.89	0.0463
21. Arm soreness	1.44	0.68–2.92	0.3285
22. Blistering in the affected arm	0.97	0.01–12.22	0.9853

Abbreviation: CI, confidence interval.