Metric indicators of lymphedema and their impact on symptoms and quality of life in breast cancer patients: A longitudinal real-world study.

Abstract

e12713 Background: Upper-limb lymphedema is a frequent complication of breast cancer, with impact on symptoms and quality of life (QoL). Although its severity can be objectively quantified, longitudinal real-world data remain limited. The aim of this study was to evaluate associations between lymphedema metric changes, clinical evolution, and QoL in breast cancer patients. Methods: Real-world data from 298 breast cancer patients with lymphedema were analyzed at lymphedema diagnosis (T1) and after rehabilitation program (T2). Upper-limb circumferences were aggregated into proximal (arm, elbow, forearm) and distal (wrist region, hand) indices. Symptoms (pain, fatigue), QoL, muscle strength, and joint range of motion (ROM) were assessed using validated instruments. Longitudinal associations (ΔT2–T1) were analyzed using Spearman correlations with false discovery rate (FDR) adjustment. Results: Although proximal circumference reductions were more frequent, distal metrics showed stronger associations with symptoms and QoL. Reductions in distal upper-limb circumferences were longitudinally associated with reductions in fatigue (ρ≈0.21; q_FDR≈0.001–0.002), improvement in total FACT-G7 score (ρ≈0.14–0.17; q_FDR < 0.05), and increases in global health status score (QLQ-GHS) (ρ≈−0.18; q_FDR < 0.01). At T1, higher muscle strength values were associated with lower levels of pain (ρ≈−0.27; q_FDR < 0.0001) and fatigue (ρ≈−0.25; q_FDR < 0.0001). Longitudinally, increases in muscle strength were correlated with reductions in pain and fatigue between T1-T2. ROM parameters showed significant associations with patient-reported scores. At T1, abduction correlated with physical functioning (QLQ-PF) (ρ = 0.189; q_FDR = 0.006), total FACT-G7 score (ρ = −0.175; q_FDR = 0.006), and QLQ-GHS (ρ = 0.170; q_FDR = 0.007). Flexion correlated with FACT-G7 (ρ = −0.181; q_FDR = 0.006) and QLQ-PF (ρ = 0.128; q_FDR = 0.043). Longitudinally, increases in abduction between T1-T2 were associated with reductions in total FACT-G7 score (ρ = −0.195; q_FDR = 0.006). Conclusions: In real-world practice, upper-limb metric and functional parameters in breast cancer lymphedema are longitudinally associated with pain, fatigue, and QoL. Despite more frequent proximal circumference reductions, distal edema dynamics emerge as a key determinant of QoL outcomes. These results support integrated metric, ROM, and patient-reported assessment pathways and therapeutic approaches for supportive oncology care.