Lymphedema after treatment for breast cancer : a pilot study

Despite more conservative surgical treatment for breast cancer, lymphedema and arm dysfunction remain sources of significant morbidity. The study for this thesis was conducted to explore methods for defining and identifying lymphedema and arm dysfunction after treatment for breast cancer.In order to establish cut-points in the differences in the sizes of arms to define the presence of lymphedema among women previously treated for breast cancer, the distributions of the differences in the sizes of arms, using measures of circumference and volume, among 40 women with no history of breast cancer were determined. The selected cut-points in the differences were defined as the mean plus one, two, or three standard deviations.A questionnaire (referred to as the Lymphedema Identification Tool) based on self-reported symptoms was developed to identify women with lymphedema. The Lymphedema Identification Tool and the 'Disabilities of the Arm, Shoulder and Hand' (DASH) questionnaire were sent to 596 women previously treated for stage I or II breast cancer and 50 women attended an evaluation session. At this evaluation session, measurements of the sizes of their arms were made and the Lymphedema Identification Tool and the DASH were repeated. This allowed for the evaluation of test-retest reliability, internal consistency reliability, and criterion validity of the Lymphedema Identification Tool.From these measurements and responses to the questionnaires, the association between arm dysfunction, as assessed by the DASH questionnaire, and the presence of lymphedema, as determined by the measurements of arm sizes and by women's self-report was determined. In addition, through the development of logistic regression models, the Lymphedema Identification Tool, the DASH questionnaire, age at diagnosis, and body mass index were found to predict the presence of lymphedema, as defined by the measurements of arms.Lymphedema appears to be a condition associated with a spectrum of symptoms and functional impairment varying from mild to severe. This thesis, even though results are preliminary, suggests a methodology for identifying lymphedema and arm dysfunction