Quality of life as a predictor of therapeutic response in women with secondary lymphedema after breast cancer, undergoing complex physical therapy

Abstract

Introduction: Lymphedema is one of the major secondary complications related to breast cancer and the complex physical therapy (CPT) has emerged as the best approach to control the volume of lymphedema of the upper limb. The therapeutic response to any treatment provided depends not only on the physiological actions of the treatment, but also of cultural, social, psychological and physical conditions of each patient. One of these components that may influence the therapeutic response is quality of life (QOL). Objective: Assess QOL as a predictor of treatment response in women undergoing in CPT treatment of lymphedema of upper limb. Methods: An intervention study was conducted in 57 women with secondary lymphedema following breast cancer undergoing CPT for the treatment of lymphedema was performed. The main outcome (treatment response) was considered the percentage reduction in excess limb volume between the beginning and the end of treatment. As the main predictor variable was considered the mean score of quality of life at baseline, assessed by EORTC QLQ-C30 and BR23. This study was approved by the Ethics Committee in Research of the National Cancer Institute under the registration number 011/07. Results: The mean age of the study population was 63 years, consisting mostly of overweight and obesity. The average time after surgery until the development of lymphedema was 37 months. At the beginning of the treatment, lymphedema has been present on average for 61 months. At baseline, the mean excess volume (EV) between the upper limbs was 776.16 ml, corresponding to a percent excess volume (PEV) 44.2%. In measuring the quality of life for the EORTC QLQ-C30 questionnaire subscale of functionality, the worst score for emotional function (55 points) and better social function score (89 points) were observed. In the symptom scales, which showed the worst pain averaged (66 points), followed by fatigue (68 points). The overall quality of life showed low score (40 points). When evaluating the quality of life by BR 23 module, low score was observed in the field of future perspective (47 points) and symptoms in the arm (53 points). After treatment of lymphedema, absolute reduction of excess volume between the upper limbs of 282 ml was observed,
representing a percentage reduction of 15%. No association between the domains of quality of life and response to treatment of lymphedema was observed. Conclusion: This study included 57 women with advanced and chronic lymphedema in early treatment with CPT and low scores for quality of life. The lymphedema therapeutic response was not influenced by the QOL at the beginning of treatment.