Predicting Breast Cancer-Related Lymphedema Using Self-Reported Symptoms

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Abstract
This study aimed to determine the accuracy of using self-reported signs and symptoms to identify the presence of lymphedema as well as the usefulness of identifying clinically measurable lymphedema on the basis of certain symptoms elicited by the Lymphedema Breast Cancer Questionnaire (LBCQ). This analysis used logistic regression to identify symptoms predictive of differences between symptom experiences of participants belonging to two distinct groups (study A): those with known post-breast cancer lymphedema (n = 40) and those in a control group of women with no history of breast cancer or lymphedema (n = 40). Symptoms in this model of best fit were used to examine their relation to limb circumferences of breast cancer survivors in a second independent data set (study B; n = 103) in which a diagnosis of known lymphedema was not previously determined using symptom experiences. The presence of lymphedema was predicted by three symptoms comprising a model of best fit for study A (c = .952): “heaviness in past year,” “swelling now,” and “numbness in past year.” Using this model, prediction of absolute maximal circumferential limb difference (i.e., ≥2 cm) in study B showed that “heaviness in the past year” (p = .0279) and “swelling now” (p = .0007) were predictive. “Numbness in the past year” was not predictive. However, those with lesser limb differences reported this symptom more often. The findings suggest that changes in sensations may be indicators of early lymphedema or other treatment-related sequelae that must be assessed carefully at each follow-up visit and over time. A combination of symptom assessment and limb volume measurement may provide the best clinical assessment data for identifying changes associated with post-breast cancer lymphedema.