Swelling Among Women Who Need Education About Leg Lymphedema: A Descriptive Study of Lymphedema in Women Undergoing Surgery for Endometrial Cancer

Abstract

Objectives In addition to hysterectomy and bilateral salpingo-oophorectomy, comprehensive surgical staging for endometrial cancer includes pelvic and para-aortic lymphadenectomy. Clarifying and addressing the morbidity from these surgical procedures is imperative. The goal of this study was to assess the prevalence of lower extremity swelling following surgery for endometrial cancer. Methods/materials We performed a descriptive, cross-sectional survey study of women who underwent surgery for endometrial cancer at our institution from 2006–2008. Survey information included symptoms, management, and education regarding lymphedema. Demographic information such as race and education was collected in addition to clinical data such as body mass index (BMI) and age. Results Of the 482 patients identified, 440 were determined eligible and 305 (69.3%) responded to the survey with information on lower limb swelling (LLS). Of the 108 (35%) responders who reported swelling, only 68 (22%) participants reported a diagnosis of lower limb lymphedema (LLL). The most commonly experienced symptoms among those who reported LLS were tightness, pain/tenderness and heaviness. Among those with a diagnosis of LLL, a majority (60%) stated it affected their daily activities and noted exacerbating factors such as prolonged standing, heat, and walking. The most common therapies utilized to reduce symptoms included leg elevation (96%), compression stockings (65%), diuretics (46%), massage therapy (35%), and bandaging (25%). There was no association between LLS or LLL diagnosis and BMI, age, race, tobacco use. Only 8% of responders reported receiving preoperative education regarding risks for LLS and a desire for more comprehensive education was frequently noted. Conclusions The patient-reported incidence of LLS occurred in approximately 35% of survey participants who underwent surgery for endometrial cancer. However, only 22% reported a diagnosis of LLL. Efforts to obtain the true incidence of LLL and to develop effective educational materials and programs to improve the management of lymphedema are warranted.

Differences of symptoms in head and neck cancer patients with and without lymphedema

“…Second, individuals with head and neck lymphedema in the matched pair group reported more frequent and severe spontaneous pain involving the musculoskeletal system and skin. Pain has been reported in individuals with arm or leg lymphedema [25][26][27], but with much less frequency and severity [28]. Thus, this was an important finding.…”

“…For instance, Armer et al reported that heaviness, numbness, and swelling were the symptoms that detect lymphedema at an earlier stage of development in breast cancer patients [5]. Salani et al identified that women undergoing surgery for endometrial cancer reported tightness, heaviness, and pain/ tenderness as the most commonly experienced symptoms on their lymphedema-affected legs [25]. Similar findings were reported in a recent publication; that is, individuals with arm or leg lymphedema frequently reported heaviness and numbness as their major symptoms [26,27].…”

Lymphedema after treatment for endometrial cancer − A review of prevalence and risk factors

“…Therefore the populations of EC survivors may also be expected to have higher BMI than the average population. In three of the descriptive studies where the participants answered a questionnaire concerning LLL, higher BMI was significantly associated with more LLL symptoms [34,42,44,45] while in other studies such an association between BMI and risk for LLL was not demonstrated [8,24,28,41,46]. Higher levels of physical activity have been associated with a significantly reduced risk for LLL.…”

“…Ferrandina et al showed that women over 60 years had a higher risk for LLL but only in a univariate analysis [48]. Several studies have shown no such association between age and risk for development of LLL [22,24,28,40,41,46]. Thus, it remains unclear whether BMI or age truly are risk factors for LLL in EC patients.…”

Medical Morbidities in Endometrial Cancer Patients

“…One previous study, which evaluated lower limb swelling after surgery for EMC, found that only 8% of the patients were counseled before treatment about this complication. 22 We planned for a future prospective study involving a detailed posttreatment evaluation and care during surveillance.…”