Case-Control Study to Evaluate Predictors of Lymphedema After Breast Cancer Surgery

Karen K. Swenson

Mary Jo Nissen

Joseph W. Leach

Janice Post-White

ONF 2009, 36(2), 185-193. DOI: 10.1188/09.ONF.185-193

Purpose/Objectives: To identify risk factors for lymphedema after breast cancer surgery.

Design: Multisite case-control study.

Setting: Lymphedema clinics in the upper midwestern region of the United States.

Sample: 94 patients with lymphedema and 94 controls without lymphedema, matched on type of axillary surgery and surgery date.

Methods: The Measure of Arm Symptom Survey, a patient-completed tool, assessed potential risk factors for lymphedema. Severity of lymphedema was measured by arm circumference, and disease and treatment factors were collected via chart review.

Main Research Variables: Risk factors for lymphedema after breast cancer surgery.

Findings: On univariate analysis, patients with lymphedema were more likely than controls to be overweight (body mass index ≥ 25) (p = 0.009). They also were more likely to have had axillary radiation (p = 0.011), mastectomy (p = 0.008), chemotherapy (p = 0.033), more positive nodes (p = 0.009), fluid aspirations after surgery (p = 0.005), and active cancer status (p = 0.008). Strength training (p = 0.014) and air travel (p = 0.0005) were associated with less lymphedema occurrence. On multivariate analysis, the only factor significantly associated with lymphedema was being overweight (p = 0.022).

Conclusions: Being overweight is an important modifiable risk factor for lymphedema. Axillary radiation, more extensive surgery, chemotherapy, and active cancer status also were predictive of lymphedema.

Implications for Nursing: This study provides evidence that excess weight contributes to lymphedema; strength training and airline travel did not contribute to lymphedema.

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