A prospective cohort study defining utilities using time trade‐offs and the Euroqol‐5D to assess the impact of cancer‐related lymphedema

Abstract

BACKGROUND The devastating impact of lymphedema on cancer survivors’ quality of life has prompted consideration of several changes in medical and surgical care. Unfortunately, our understanding of the benefits gained from these approaches relative to their cost remains limited. This study was designed to estimate utilities for lymphedema and characterize how utilities differ between subgroups defined by lymphedema etiology and distribution. METHODS A consecutive sample of 236 subjects with lymphedema seen at a lymphedema clinic completed both a time trade-off (TTO) exercise and the Euroqol 5D. Responses were adjusted in multivariate regression models for demographic factors, comorbidities, and lymphedema severity/location. RESULTS Most participants (167 of 236, 71%) had lymphedema as a consequence of cancer treatment; 123 with breast cancer and upper extremity involvement. Mean TTO utility estimates were consistently higher than Euroqol 5D estimates. Unadjusted TTO (0.85; standard deviation [SD], 0.21) and Euroqol 5D (0.76; SD, 0.18) scores diminished with increasing lymphedema stage and patient body mass index (BMI). Adjusted utility scores were lowest in patients with cancer-related lower extremity lymphedema (TTO=0.82; SD, 0.04 and Euroqol 5D=0.80; SD, 0.03). Breast cancer patients also had lower adjusted Euroqol 5D scores (0.80; SD, 0.02). CONCLUSIONS Lymphedema-associated utilities are in the range of 0.80. Lower utilities are observed for patients with higher lymphedema stages, elevated BMI, and cancer-related lymphedema. Greater expenditures for the prevention and treatment of cancer-related lymphedema are warranted.

Risk factors for lower-limb lymphedema after surgery for cervical cancer

“…Stage I lymphedema was excluded because it is easily overlooked by physicians. Given that lymphedema obviously exacerbates the patients' quality of life even in stage I [2], and because immediate intervention is particularly important in preventing lymphedema progression, it may be worthwhile to include stage I cases in a reevaluation of the risk factors for LLL while incorporating methods to quantitatively evaluate mild lymphedema, such as volume measurement.…”

“…Because of its chronic and incurable nature, lymphedema causes problems for gynecological cancer survivors in the form of functional and aesthetic defects as well as psychological sequelae, thereby reducing their quality of life [1][2][3].…”

Would complex decongestive therapy reveal long term effect and lymphoscintigraphy predict the outcome of lower-limb lymphedema related to gynecologic cancer treatment?

“…Chronic lymphedema that arises as a consequence of impaired lymphatic drainage causes symptomatic, functional and aesthetic defects as well as psychological sequelae, thereby reducing the quality of life for gynecological cancer survivors [1][2][3]. The reported frequency of lower limb lymphedema secondary to treatment of gynecological cancers ranges from 10% to 49% [4,5].…”

Bowenwork for symptom management of women breast cancer survivors with lymphedema: A pilot study

“…Reaching into rural areas with a wider socioeconomic range would be beneficial. Other studies have reported that women with lower income and cormbidities have experienced higher inidence of lymphedema (Cheville, Almoza, Courmier, & Basford, 2010;S. H. Ridner & Dietrich, 2008).…”