Patients with lower limb lymphedema experience symptoms that may differ in intensity and distress. This mixed-methods study compares symptom intensity and distress and the impact of lymphedema on patients’ quality of life by primary and secondary (cancer and noncancer) lymphedema groups. Individuals completed an online questionnaire (i.e., demographic form, Lymphedema Symptom Intensity and Distress Survey–Leg, and an open-ended question). Analyses included descriptive and inferential statistics (quantitative data) and content analysis (qualitative data). Participants differed statistically significantly by gender, employment status, and lymphedema location. Groups differed significantly in lack of self-confidence, χ2(df = 2) = 9.19, p = .010. Cancer patients reported higher intensity and distress scores for some symptoms, but these differences were not statistically significant. Patients reported lacking psychosocial well-being and resources and experiencing physical and functional impairments and treatment and care challenges. Patients with lower limb lymphedema experience psychosocial impairments and problems with quality of and access to care.
AhmedR. L.PrizmentA.LazovichD.SchmitzK. H.FolsomA. R. (2008). Lymphedema and quality of life in breast cancer survivors: The Iowa Women’s Health Study. Journal of Clinical Oncology, 26, 5689-5696. doi:10.1200/Jco.2008.16.4731
2.
AkitaS.MitsukawaN.RikihisaN.KubotaY.OmoriN.MitsuhashiA.. . . SatohK. (2013). Early diagnosis and risk factors for lymphedema following lymph node dissection for gynecologic cancer. Plastic and Reconstructive Surgery, 131, 283-290.
3.
BeesleyV.JandaM.EakinE.ObermairA.BattistuttaD. (2007). Lymphedema after gynecological cancer treatment: Prevalence, correlates, and supportive care needs. Cancer, 109, 2607-2614. doi:10.1002/cncr.22684
4.
BeesleyV. L.RowlandsI. J.HayesS. C.JandaM.O’RourkeP.MarquartL., . . . Australian National Endometrial Cancer Study Group (2015). 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. Gynecologic Oncology, 136, 87-93. doi:10.1016/j.ygyno.2014.11.006
5.
BowlingA.IliffeS. (2011). Psychological approach to successful ageing predicts future quality of life in older adults. Health and Quality of Life Outcomes, 9, 13. doi:10.1186/1477-7525-9-13
6.
BrownJ. C.ChuC. S.ChevilleA. L.SchmitzK. H. (2013). The prevalence of lymphedema symptoms among survivors of long-term cancer with or at risk for lower limb lymphedema. American Journal of Physical Medicine and Rehabilitation, 92, 223-231. doi:10.1097/PHM.0b013e31826edd97
7.
BrownJ. C.LinL. L.SegalS.ChuC. S.HaggertyA. E.KoE. M.SchmitzK. H. (2014). Physical activity, daily walking, and lower limb lymphedema associate with physical function among uterine cancer survivors. Supportive Care in Cancer, 22, 3017-3025. doi:10.1007/s00520-014-2306-0
8.
ChachajA.MalyszczakK.PyszelK.LukasJ.TarkowskiR.PudelkoM.. . . SzubaA. (2010). Physical and psychological impairments of women with upper limb lymphedema following breast cancer treatment. Psycho-Oncology, 19, 299-305. doi:10.1002/pon.1573
9.
CromwellK. D.ChiangY. J.ArmerJ.HeppnerP. P.MungovanK.RossM. I.. . . CormierJ. N. (2015). Is surviving enough? Coping and impact on activities of daily living among melanoma patients with lymphoedema. European Journal of Cancer Care, 24, 724-733. doi:10.1111/ecc.12311
10.
DengJ.FuM. R.ArmerJ. M.CormierJ. N.RadinaE.ThiadensS. R.. . . RidnerS. H. (2013). Self-reported information sources and perceived knowledge in individuals with lymphedema. Lymphology, 46(4), 173-183.
11.
DengJ.RadinaE.FuM. R.ArmerJ. M.CormierJ. N.ThiadensS. R.. . . RidnerS. H. (2015). Self-care status, symptom burden, and reported infections in individuals with lower-extremity primary lymphedema. Journal of Nursing Scholarship, 47, 126-134. doi:10.1111/jnu.12117
12.
DengJ.RidnerS. H.MurphyB. A.DietrichM. S. (2012). Preliminary development of a lymphedema symptom assessment scale for patients with head and neck cancer. Supportive Care in Cancer, 20, 1911-1918. doi:10.1007/s00520-011-1294-6
13.
DunbergerG.LindquistH.WaldenstromA. C.NybergT.SteineckG.Avall-LundqvistE. (2013). Lower limb lymphedema in gynecological cancer survivors—Effect on daily life functioning. Supportive Care in Cancer, 21, 3063-3070. doi:10.1007/s00520-013-1879-3
14.
FinnaneA.HayesS. C.ObermairA.JandaM. (2011). Quality of life of women with lower-limb lymphedema following gynecological cancer. Expert Review of Pharmacoeconomics & Outcomes Research, 11, 287-297. doi:10.1586/erp.11.30
15.
FuM. R. (2014). Breast cancer-related lymphedema: Symptoms, diagnosis, risk reduction, and management. World Journal of Clinical Oncology, 5, 241-247. doi:10.5306/wjco.v5.i3.241
16.
FuM. R.KangY. (2013). Psychosocial impact of living with cancer-related lymphedema. Seminars in Oncology Nursing, 29, 50-60. doi:10.1016/j.soncn.2012.11.007
17.
HuggenbergerK.WagnerS.LehmannS.AeschlimannA.Amann-VestiB.AngstF. (2015). Health and quality of life in patients with primary and secondary lymphedema of the lower extremity. Vasa: European Journal of Vascular Medicine, 44, 129-137. doi:10.1024/0301-1526/a000419
18.
HulettJ. M.ArmerJ. M.StewartB. R.WanchaiA. (2015). Perspectives of the breast cancer survivorship continuum: Diagnosis through 30 months post-treatment. Journal of Personalized Medicine, 5, 174-190. doi:10.3390/jpm5020174
19.
JensenM. R.SimonsenL.KarlsmarkT.BulowJ. (2010). Lymphoedema of the lower extremities—Background, pathophysiology and diagnostic considerations. Clinical Physiology and Functional Imaging, 30, 389-398. doi:10.1111/j.1475-097X.2010.00969.x.
20.
KerchnerK.FleischerA.YosipovitchG. (2008). Lower extremity lymphedema update: Pathophysiology, diagnosis, and treatment guidelines. Journal of the American Academy of Dermatology, 59, 324-331. doi:10.1016/j.jaad.2008.04.013.
21.
KimS. I.LimM. C.LeeJ. S.LeeY.ParkK.JooJ.. . . ParkS. Y. (2015). Impact of lower limb lymphedema on quality of life in gynecologic cancer survivors after pelvic lymph node dissection. European Journal of Obstetrics & Gynecology and Reproductive Biology, 192, 31-36. doi:10.1016/j.ejogrb.2015.06.011
22.
LamR.WallaceA.BurbidgeB.FranksP.MoffattC. (2006). Experiences of patients with lymphoedema. Journal of Lymphoedema, 1, 16-21.
23.
MaxeinerA. M.SagaE.DownerC.ArthurL. (2009). Comparing the psychosocial issues experienced by individuals with primary vs. secondary lymphedema. Rehabilitation Oncology, 27(2), 9-15.
24.
McWayneJ.HeineyS. P. (2005). Psychologic and social sequelae of secondary lymphedema: A review. Cancer, 104, 457-466. doi:10.1002/cncr.21195
25.
MilesM. B.HubermanA. M.SaldanaJ. (2013). Qualitative data analysis: A methods sourcebook. Thousand Oaks, CA: Sage.
26.
MurdacaG.CagnatiP.GulliR.SpanoF.PuppoF.CampisiC.BoccardoF. (2012). Current views on diagnostic approach and treatment of lymphedema. The American Journal of Medicine, 125, 134-140. doi:10.1016/j.amjmed.2011.06.032
27.
Noble-JonesR.FitzpatrickB.SneddonM. C.HendryD. S.LeungH. Y. (2014). Development of the lymphoedema genito-urinary cancer questionnaire. The British Journal of Nursing, 23(Suppl. 18), S14-S19. doi:10.12968/bjon.2014.23.Sup18.S14
28.
NohS.HwangJ. H.YoonT. H.ChangH. J.ChuI. H.KimJ. H. (2015). Limb differences in the therapeutic effects of complex decongestive therapy on edema, quality of life, and satisfaction in lymphedema patients. Annals of Rehabilitation Medicine, 39, 347-359. doi:10.5535/arm.2015.39.3.347
29.
NovackovaM.HalaskaM. J.RobovaH.MalaI.PlutaM.ChmelR.RobL. (2012). A prospective study in detection of lower-limb lymphedema and evaluation of quality of life after vulvar cancer surgery. International Journal of Gynecological Cancer, 22, 1081-1088. doi:10.1097/IGC.0b013e31825866d0
30.
RidnerS. H. (2009). The psycho-social impact of lymphedema. Lymphatic Research and Biology, 7, 109-112.
31.
SpeckR. M.GrossC. R.HormesJ. M.AhmedR. L.LytleL. A.HwangW.-T.SchmitzK. H. (2010). Changes in the Body Image and Relationship Scale following a one-year strength training trial for breast cancer survivors with or at risk for lymphedema. Breast Cancer Research and Treatment, 121, 421-430.
32.
SymvoulakisE. K.AnyfantakisD. I.LionisC. (2010). Primary lower limb lymphedema: A focus on its functional, social and emotional impact. International Journal of Medical Sciences, 7, 353-357.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
