Psychologic and social sequelae of secondary lymphedema - A review

BACKGROUND. The psychological and social sequelae of secondary lymphedema (SLE) have been an underrecognized and little-researched complication of treatment for breast carcinoma. The reported incidence and prevalence of SLE varied widely (0-48%). Reported reasons for the differences are related to the lack of standard diagnostic and universal assessment criteria. METHODS. A comprehensive, computerized search was performed. All combinations of the following keywords were used: arm lymphedema, arm swelling, breast cancer, psychological and social, and quality of life (QOL). Eighteen studies were identified. RESULTS. The literature supported the view that SLE leads to psychological and social sequelae. Psychological sequelae included frustration, distress, depression and anxiety. Social sequelae comprised changes in role function, lack of social support and pain and disability. Pain was a significant predictor of psychological and social morbidity. These experiences resulted in diminution of QOL, particularly psychological and social health. This was particularly worrisome because women must attend daily to the precautions and treatments for SLE. CONCLUSIONS. Researchers should use psychological and social measures along with physiologic parameters when evaluating the impacts of SLE. Clinicians should work to develop standardized primary prevention programs and limb circumference should be measured at the time of breast carcinoma diagnosis. Gaps in knowledge related to intra/interethnic diversity, poverty, and comorbidities of women with breast carcinoma-related SLE need to be explored. The combined efforts of researchers and clinicians would reinforce awareness and knowledge for women at risk and provide important baseline data for research and practice. (c) 2005 American Cancer Society.