Factors associated with fear of lymphedema after treatment for breast cancer.

PURPOSE/OBJECTIVES: To identify demographic and treatment characteristics associated with postoperative fear of lymphedema.

DESIGN

Prospective cohort study.

SETTING

Outpatient breast clinic at a comprehensive cancer center in the northeastern United States.

SAMPLE

324 patients undergoing treatment for unilateral breast cancer.

METHODS

Women with breast cancer were prospectively screened for lymphedema (relative volume change of 10% or greater) preoperatively and every three to eight months postoperatively via Perometer arm volume measurements. Fear was simultaneously evaluated via questionnaire. Multivariate linear mixed-effects regression models were used to identify factors associated with mean postoperative fear score and to plot the average fear score over time within axillary surgery type subgroups.

MAIN RESEARCH VARIABLES

Postoperative fear of lymphedema.

FINDINGS

Higher preoperative fear score (p < 0.0001), younger age at diagnosis (p = 0.0038), and axillary lymph node dissection (ALND) (p < 0.0001) were significantly associated with higher mean postoperative fear score. The average fear score changed nonlinearly over time (p < 0.0001), decreasing from preoperative to 24 months postoperative and leveling thereafter.

CONCLUSIONS

Preoperative fear, younger age at diagnosis, and ALND may contribute to postoperative fear of lymphedema.

IMPLICATIONS FOR NURSING

Individualized education that begins preoperatively, continues throughout treatment, and is re-emphasized 24 months postoperatively may help minimize fear of lymphedema.