The Quality of Life and Psychosocial Implications of Cancer-Related Lower-Extremity Lymphedema: A Systematic Review of the Literature

Catharine Bowman, Katherine-Ann Piedalue, Mohamad Baydoun, Linda E Carlson, Catharine Bowman, Katherine-Ann Piedalue, Mohamad Baydoun, Linda E Carlson

Abstract

Lower-extremity lymphedema (LEL) is a progressive, lifelong complication of cancer that places a substantial burden upon cancer survivors' quality of life (QOL) and psychosocial well-being. Despite its prevalence, cancer-related LEL is inconsistently diagnosed, treated, and poorly recognized by health care professionals. The purpose of this systematic review was to summarize and appraise the quantitative literature evaluating the impact of cancer-related LEL on patients' psychosocial well-being and QOL. Three databases (PubMed, PROQuest, and Scopus) were searched for observational research articles published before May 1st, 2020. Twenty-one articles were eligible (cross-sectional (n = 16), prospective cohort designs (n = 3), and retrospective cohort designs (n = 2)). The majority of studies reported a negative relationship between cancer-related LEL and global QOL and/or one or more psychosocial domains including (1) physical and functional; (2) psycho-emotional; (3) social, relational and financial. A greater number of LEL symptoms and higher LEL severity were associated with poorer QOL. Although the evidence to date suggests a negative relationship between cancer-related LEL and patients' QOL and psychosocial well-being, there is a substantial need for longitudinal analyses to examine the directionality and temporality of this effect in order to inform cancer survivorship care modelling and improve patient outcomes after cancer.

Keywords: cancer survivorship; health care delivery; lymphedema; psychosocial oncology; psychosocial well-being; quality of life; systematic review.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The PRISMA flow diagram demonstrating article screening outcomes and reasons for exclusion [20].

References

    1. Rockson S.G. Causes and consequences of lymphatic disease. Ann. N. Y. Acad. Sci. 2010;1207:2–6. doi: 10.1111/j.1749-6632.2010.05804.x.
    1. Gebruers N., Verbelen H., Vrieze T., De Coeck D., Tjalma W. Incidence and Time Path of Lymphedema in Sentinel Node Negative Breast Cancer Patients: A Systematic Review. Arch. Phys. Med. Rehabil. 2015;96:1131–1139. doi: 10.1016/j.apmr.2015.01.014.
    1. Taghian N.R., Miller C.L., Jammallo L.S., O’Toole J., Skolny M.N. Lymphedema following breast cancer treatment and impact on quality of life: A review. Crit. Rev. Oncol. Hematol. 2014;92:227–234. doi: 10.1016/j.critrevonc.2014.06.004.
    1. Fu M.R., Kang Y. The Psychosocial Impact of Living with Cancer-Related Lymphedema. Semin. Oncol. Nurs. 2013;29:50–60. doi: 10.1016/j.soncn.2012.11.007.
    1. Dunberger G., Lindquist H., Waldenström A.C., Nyberg T., Steineck G., Åvall-Lundqvist E. Lower limb lymphedema in gynecological cancer survivors—Effect on daily life functioning. Support. Care Cancer. 2013;21:3063–3070. doi: 10.1007/s00520-013-1879-3.
    1. Omidi Z., Kheirkhah M., Abolghasemi J., Haghighat S. Effect of lymphedema self-management group-based education compared with social network-based education on quality of life and fear of cancer recurrence in women with breast cancer: A randomized controlled clinical trial. Qual. Life Res. 2020;29:1789–1800. doi: 10.1007/s11136-020-02455-z.
    1. Wilson I.B., Cleary P.D. Linking Clinical Variables with Health-Related Quality of Life. J. Am. Med. Assoc. 1995;273:59–65. doi: 10.1001/jama.1995.03520250075037.
    1. Testa M., Simonson D. Assessment of Quality of Life Outcomes. N. Engl. J. Med. 1996;15:231–244. doi: 10.1056/NEJM199603283341306.
    1. Crosby R.D., Kolotkin R.L., Williams G.R. Defining clinically meaningful change in health-related quality of life. J. Clin. Epidemiol. 2003;56:395–407. doi: 10.1016/S0895-4356(03)00044-1.
    1. Cormier J.N., Askew R.L., Mungovan K.S., Xing Y., Ross M.I., Armer J.M. Lymphedema beyond breast cancer. Cancer. 2010;116:5138–5149. doi: 10.1002/cncr.25458.
    1. Rockson S.G., Rivera K.K. Estimating the Population Burden of Lymphedema. Ann. N. Y. Acad. Sci. 2008;154:147–154. doi: 10.1196/annals.1413.014.
    1. Starritt E.C., Joseph D., McKinnon J.G., Lo S.K., De Wilt J.H.W., Thompson J.F. Lymphedema after complete axillary node dissection for melanoma: Assessment using a new, objective definition. Ann. Surg. 2004;240:866–874. doi: 10.1097/01.sla.0000143271.32568.2b.
    1. Loprinzi P.D., Cardinal B.J., Winters-Stone K., Smit E., Loprinzi C.L. Physical Activity and the Risk of Breast Cancer Recurrence: A Literature Review. Oncol. Nurs. Forum. 2012;39:269–274. doi: 10.1188/12.ONF.269-274.
    1. Baibergenova A., Drucker A., Shear N. Hospitalizations for cellulitis in Canada: A database study. J. Cutan. Med. Surg. 2014;18:33–37. doi: 10.2310/7750.2013.13075.
    1. Ridner S.H., Bonner C.M., Deng J., Sinclair V.G. Voices from the Shadows: Living with Lymphedema. Cancer Nurs. 2012;35:E18. doi: 10.1097/NCC.0b013e31821404c0.
    1. Tiwari P., Coriddi M., Salani R., Povoski S.P. Breast and gynecologic cancer-related extremity lymphedema: A review of diagnostic modalities and management options. World J. Surg. Oncol. 2013;11:237. doi: 10.1186/1477-7819-11-237.
    1. Ryan M., Hons B.N., Stainton M.C., Jaconelli C., Nurs D., Medsurgnurs G., Watts S., Mackenzie P., Mansberg T. The Experience of Lower Limb Lymphedema for Women after Treatment for Gynecologic Cancer. Oncol. Nurs. Forum. 2003;30:417–423. doi: 10.1188/03.ONF.417-423.
    1. Brayton K.M., Hirsch A.T., O’Brien P.J., Cheville A., Karaca-Mandic P., Rockson S.G. Lymphedema prevalence and treatment benefits in cancer: Impact of a therapeutic intervention on health outcomes and costs. PLoS ONE. 2014;9:e114597. doi: 10.1371/journal.pone.0114597.
    1. Stolldorf D.P., Dietrich M.S., Ridner S.H. Symptom frequency, intensity, and distress in patients with lower limb lymphedema. Lymphat. Res. Biol. 2016;14:78–87. doi: 10.1089/lrb.2015.0027.
    1. Moher D., Liberati A., Tetzlaff J., Altman D., The PRISMA Group Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med. 2009;6:e1000097. doi: 10.1371/journal.pmed.1000097.
    1. Baydoun M., Oberoi D., Flynn M., Moran C., McLennan A., Piedalue K.-A.L., Carlson L.E. Effects of Yoga-based Interventions on Cancer-Associated Cognitive Decline: A Systematic Review. Curr. Oncol. Rep. 2020;22:1–10. doi: 10.1007/s11912-020-00960-5.
    1. National Institutes of Health NIH Study Quality Assessment Tools [Internet] [(accessed on 1 March 2020)]; Available online:
    1. Beesley V.L., Rowlands I.J., Hayes S.C., Janda M., O’Rourke P., Marquart L., Quinn M.A., Spurdle A.B., Obermair A., Brand A., et al. Incidence, risk factors and estimates of a woman’s risk of developing secondary lower limb lymphedema and lymphedema-specific supportive care needs in women treated for endometrial cancer. Gynecol. Oncol. 2015;136:87–93. doi: 10.1016/j.ygyno.2014.11.006.
    1. De Melo Ferreira A.P., De Figueiredo E.M., Lima R.A., Cândido E.B., De Castro Monteiro M.V., De Figueiredo Franco T.M.R., Traiman P., Da Silva-Filho A.L. Quality of life in women with vulvar cancer submitted to surgical treatment: A comparative study. Eur. J. Obstet. Gynecol. Reprod. Biol. 2012;165:91–95. doi: 10.1016/j.ejogrb.2012.06.027.
    1. Leitao M.M., Zhou Q.C., Gomez-Hidalgo N.R., Iasonos A., Baser R., Mezzancello M., Chang K., Ward J., Chi D.S., Long Roche K., et al. Patient-reported outcomes after surgery for endometrial carcinoma: Prevalence of lower-extremity lymphedema after sentinel lymph node mapping versus lymphadenectomy. Gynecol. Oncol. 2020;156:147–153. doi: 10.1016/j.ygyno.2019.11.003.
    1. Ferrandina G., Mantegna G., Petrillo M., Fuoco G., Venditti L., Terzano S., Moruzzi C., Lorusso D., Marcellusi A., Scambia G. Quality of life and emotional distress in early stage and locally advanced cervical cancer patients: A prospective, longitudinal study. Gynecol. Oncol. 2012;124:389–394. doi: 10.1016/j.ygyno.2011.09.041.
    1. Kim S.H., Kang S., Kim Y.M., Kim B.G., Seong S.J., Do Cha S., Park C.Y., Yun Y.H. Prevalence and predictors of anxiety and depression among cervical cancer survivors in Korea. Int. J. Gynecol. Cancer. 2010;20:1017–1024. doi: 10.1111/IGC.0b013e3181e4a704.
    1. Farrell R., Gebski V., Hacker N.F. Quality of life after complete lymphadenectomy for vulvar cancer: Do women prefer sentinel lymph node biopsy? Int. J. Gynecol. Cancer. 2014;24:813–819. doi: 10.1097/IGC.0000000000000101.
    1. Yost K., Cheville A., Al-Hilli M., Mariani A., Barrette B., McGree M., Weaver A., Dowdy S. Lymphedema after Surgery for Endometrial Cancer: Prevalence, Risk Factors, and Quality of Life. Obstet. Gynecol. 2014;124:307–315. doi: 10.1097/AOG.0000000000000372.
    1. Cromwell K.D., Chiang Y.J., Armer J., Heppner P.P., Mungovan K., Ross M.I., Gershenwald J.E., Lee J.E., Royal R.E., Lucci A., et al. Is surviving enough? Coping and impact on activities of daily living among melanoma patients with lymphoedema. Eur. J. Cancer Care Engl. 2015;24:724–733. doi: 10.1111/ecc.12311.
    1. Franks P.J., Moffatt C.J., Doherty D.C., Williams A.F., Jeffs E., Mortimer P.S. Assessment of health-related quality of life in patients with lymphedema of the lower limb. Wound Repair Regen. 2006;14:110–118. doi: 10.1111/j.1743-6109.2006.00099.x.
    1. Gane E.M., Steele M.L., Janda M., Ward L.C., Reul-Hirche H., Carter J., Quinn M., Obermair A., Hayes S.C. The prevalence, incidence, and quality-of-life impact of lymphedema after treatment for vulvar or vaginal cancer. Rehabil. Oncol. 2018;36:48–55. doi: 10.1097/01.REO.0000000000000102.
    1. Omichi C., Nakamura K., Haraga J., Ida N., Saijo M., Nishida T., Kusumoto T., Masuyama H. The influence of adverse effects on quality of life of survivors of gynecologic cancer. Int. J. Gynecol. Cancer. 2017;27:2014–2019. doi: 10.1097/IGC.0000000000001125.
    1. Beesley V., Janda M., Eakin E., Obermair A., Battistutta D. Lymphedema after gynecological cancer treatment: Prevalence, correlates, and supportive care needs. Cancer. 2007;109:2607–2614. doi: 10.1002/cncr.22684.
    1. Stolldorf D.P., Dietrich M.S., Ridner S.H. A Comparison of the Quality of Life in Patients With Primary and Secondary Lower Limb Lymphedema: A Mixed-Methods Study. West. J. Nurs. Res. 2016;38:1313–1334. doi: 10.1177/0193945916647961.
    1. Rowlands I.J., Beesley V.L., Janda M., Hayes S.C., Obermair A., Quinn M.A., Brand A., Leung Y., McQuire L., Webb P.M. Quality of life of women with lower limb swelling or lymphedema 3–5 years following endometrial cancer. Gynecol. Oncol. 2014;133:314–318. doi: 10.1016/j.ygyno.2014.03.003.
    1. Kusters I., Williams M., Obermair A., Janda M. Women with self-reported lower limb lymphedema after treatment for gynecological cancers: Are they more likely to self-report psychosocial symptoms and less likely to use services? J. Community Support. Oncol. 2015;13:55–61. doi: 10.12788/jcso.0109.
    1. Brown J., Chu C., Cheville A., Schmitz K. The Prevalence of Lymphedema Symptoms among Long-Term Cancer Survivors with or at-risk for Lower Limb Lymphedema. Am. J. Phys. Med. Rehabil. 2013;92:223–231. doi: 10.1097/PHM.0b013e31826edd97.
    1. Brown J., Lin L., Segal S., Chu C., Haggerty A., Ko E., Schmitz K. Physical Activity, Daily Walking, and Lower Limb Lymphedema Associate with Physical Function among Uterine Cancer Survivors. Physiol. Behav. 2016;176:139–148. doi: 10.1007/s00520-014-2306-0.
    1. Cheville A., Almoza M., Courmier J., Basford J. A Prospective Cohort Study Defining Utilities Using Time Trade-Offs and the Euroqol-5D to Assess the Impact of Cancer-Related Lymphedema. Cancer. 2010;116:3722–3731. doi: 10.1002/cncr.25068.
    1. Gjorup C.A., Groenvold M., Hendel H.W., Dahlstroem K., Drzewiecki K.T., Klausen T.W., Hölmich L.R. Health-related quality of life in melanoma patients: Impact of melanoma-related limb lymphoedema. Eur. J. Cancer. 2017;85:122–132. doi: 10.1016/j.ejca.2017.07.052.
    1. Kim S.I., Lim M.C., Lee J.S., Lee Y., Park K.B., Joo J., Seo S.S., Kang S., Chung S.H., Park S.Y. Impact of lower limb lymphedema on quality of life in gynecologic cancer survivors after pelvic lymph node dissection. Eur. J. Obstet. Gynecol. Reprod. Biol. 2015;192:31–36. doi: 10.1016/j.ejogrb.2015.06.011.
    1. Brown J.C., Lin L.L., Segal S., Chu C.S., Haggerty A.E., Ko E.M., Schmitz K.H. Physical activity, daily walking, and lower limb lymphedema associate with physical function among uterine cancer survivors. Support Care Cancer. 2014;22:3017–3025. doi: 10.1007/s00520-014-2306-0.
    1. Thomas R., Hamilton R. Illustrating the (in)visible: Understanding the impact of loss in adults living with secondary lymphedema after cancer. Int. J. Qual. Stud. Health Well-Being. 2014;9:24354. doi: 10.3402/qhw.v9.24354.
    1. Winch C.J., Sherman K.A., Smith K.M., Koelmeyer L.A., Mackie H., Boyages J. “You’re naked, you’re vulnerable”: Sexual well-being and body image of women with lower limb lymphedema. Body Image. 2016;18:123–134. doi: 10.1016/j.bodyim.2016.06.002.
    1. Beesley V., Eakin E., Steginga S., Aitken J., Dunn J., Battistutta D. Unmet needs of gynaecological cancer survivors: Implications for developing community support services. Psychooncology. 2008;17:392–400. doi: 10.1002/pon.1249.
    1. Frid M., Strang P., Friedrichsen M.J., Johansson K. Lower limb lymphedema: Experiences and perceptions of cancer patients in the late palliative stage. J. Palliat. Care. 2006;22:5–11. doi: 10.1177/082585970602200102.
    1. Ahmed R.L., Prizment A., Lazovich D.A., Schmitz K.H., Folsom A.R. Lymphedema and quality of life in breast cancer survivors: The Iowa Women’s Health Study. J. Clin. Oncol. 2008;26:5689–5696. doi: 10.1200/JCO.2008.16.4731.
    1. Vassard D., Olsen M.H., Zinckernagel L., Vibe-Petersen J., Dalton S.O., Johansen C. Psychological consequences of lymphoedema associated with breast cancer: A prospective cohort study. Eur. J. Cancer. 2010;46:3211–3218. doi: 10.1016/j.ejca.2010.07.041.
    1. Stout N.L., Weiss R., Feldman J.L., Stewart B.R., Armer J.M., Cormier J.N., Shih Y.C.T. A systematic review of care delivery models and economic analyses in lymphedema: Health policy impact (2004–2011) Lymphology. 2013;46:27–41.
    1. McCabe M.S., Bhatia S., Oeffinger K.C., Reaman G.H., Tyne C., Wollins D.S., Hudson M.M. American society of clinical oncology statement: Achieving high-quality cancer survivorship care. J. Clin. Oncol. 2013;31:631–640. doi: 10.1200/JCO.2012.46.6854.
    1. Amir M., Roziner I., Knoll A., Neufeld M.Y. Self-efficacy and social support as mediators in the relation between disease severity and quality of life in patients with epilepsy. Epilepsia. 1999;40:216–224. doi: 10.1111/j.1528-1157.1999.tb02078.x.
    1. Auld J.P., Mudd J.O., Gelow J.M., Hiatt S.O., Lee C.S. Self-care Moderates the Relationship between Symptoms and Health-Related Quality of Life in Heart Failure. J. Cardiovasc. Nurs. 2018;33:217–224. doi: 10.1097/JCN.0000000000000447.
    1. Banegas M.P., Guy G.P., de Moor J.S., Ekwueme D.U., Virgo K.S., Kent E.E., Nutt S., Zheng Z., Rechis R., Yabroff K.R. For working-age cancer survivors, medical debt and bankruptcy create financial hardships. Health Aff. 2016;35:54–61. doi: 10.1377/hlthaff.2015.0830.
    1. Roland K.B., Rodriguez J.L., Patterson J.R., Trivers K.F. A literature review of the social and psychological needs of ovarian cancer survivors. Psychooncology. 2013;22:2408–2418. doi: 10.1002/pon.3322.
    1. Komblith A., Powell M., Regan M., Bennett S., Krasner C., Moy B., Jerry Y., Goodman A., Berkowitze R., Winer E. Long-term psychosocial adjustment of older vs youngersurvivors of breast and endometrial cancer. Psychooncology. 2007;16:895–903. doi: 10.1002/pon.1146.

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