Symptom report in detecting breast cancer-related lymphedema

Mei R. Fu, Deborah Axelrod, Charles M. Cleland, Zeyuan Qiu, Amber A. Guth, Robin Kleinman, Joan Scagliola, Judith Haber

Research output: Contribution to journalArticle

Abstract

Breast cancer-related lymphedema is a syndrome of abnormal swelling coupled with multiple symptoms resulting from obstruction or disruption of the lymphatic system associated with cancer treatment. Research has demonstrated that with increased number of symptoms reported, breast cancer survivors’ limb volume increased. Lymphedema symptoms in the affected limb may indicate a latent stage of lymphedema in which changes cannot be detected by objective measures. The latent stage of lymphedema may exist months or years before overt swelling occurs. Symptom report may play an important role in detecting lymphedema in clinical practice. The purposes of this study were to: 1) examine the validity, sensitivity, and specificity of symptoms for detecting breast cancer-related lymphedema and 2) determine the best clinical cutoff point for the count of symptoms that maximized the sum of sensitivity and specificity. Data were collected from 250 women, including healthy female adults, breast cancer survivors with lymphedema, and those at risk for lymphedema. Lymphedema symptoms were assessed using a reliable and valid instrument. Validity, sensitivity, and specificity were evaluated using logistic regression, analysis of variance, and areas under receiver operating characteristic curves. Count of lymphedema symptoms was able to differentiate healthy adults from breast cancer survivors with lymphedema and those at risk for lymphedema. A diagnostic cutoff of three symptoms discriminated breast cancer survivors with lymphedema from healthy women with a sensitivity of 94% and a specificity of 97% (area under the curve =0.98). A diagnostic cutoff of nine symptoms discriminated at-risk survivors from survivors with lymphedema with a sensitivity of 64% and a specificity of 80% (area under the curve =0.72). In the absence of objective measurements capable of detecting latent stages of lymphedema, count of symptoms may be a cost-effective initial screening tool for detecting lymphedema.

Original languageEnglish (US)
Pages (from-to)345-352
Number of pages8
JournalBreast Cancer: Targets and Therapy
Volume7
DOIs
StatePublished - Oct 15 2015

Keywords

  • Heaviness
  • Pain
  • Risk
  • Screening
  • Sensitivity
  • Swelling

ASJC Scopus subject areas

  • Oncology

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  • Cite this

    Fu, M. R., Axelrod, D., Cleland, C. M., Qiu, Z., Guth, A. A., Kleinman, R., Scagliola, J., & Haber, J. (2015). Symptom report in detecting breast cancer-related lymphedema. Breast Cancer: Targets and Therapy, 7, 345-352. https://doi.org/10.2147/BCTT.S87854