Department of Cancer Prevention and Control, School of Medicine, West Virginia University, Morgantown, WV, USA.
Department of Health Policy, Management, and Leadership, School of Public Health, West Virginia University, Morgantown, WV, USA.
Med Oncol. 2024 Oct 14;41(11):274. doi: 10.1007/s12032-024-02474-7.
Extensive research supports an evidence-base for cancer treatment-related risk factors, including extent of lymph node dissection and use of radiotherapy, as contributing to secondary lymphedema. Additionally, comorbidities, such as higher body mass index, and vascular-related conditions are identified to further augment risk. While social determinants of health (SDOH) and socioeconomic factors are widely regarded as influencing an individual's healthcare outcomes, including cancer risk and survival, these factors have not been explored as risk factors for developing secondary lymphedema. A rapid literature review explored the current evidence for SDOH as risk factors for lymphedema. Studies that were published over the last 10 years and that specifically analyzed social factors as variables associated with lymphedema were included. Studies that only characterized the social determinants of the study population were not included. Forty-nine studies were identified through a rapid literature review, and 13 studies that expressly analyzed social determinants as risk factors for secondary lymphedema were reviewed and extracted. All studies were conducted in patients with breast cancer-related lymphedema. Social risk factors included race, educational level, insurance type, and income level. These are consistent with the socioeconomic inequalities related to cancer survival. SDOH may influence the risk of developing cancer treatment-related health conditions like secondary lymphedema. Research trials studying cancer treatment-related conditions should collect consistent and robust data across social, behavioral, environmental, and economic domains and should analyze these variables to understand their contribution to study endpoints. Risk prediction modeling could be a future pathway to better incorporate social determinants, along with medical and co-morbidity data, to holistically understand lymphedema risk.
大量研究支持癌症治疗相关风险因素的循证医学证据，包括淋巴结清扫范围和放疗的使用，这些因素导致继发性淋巴水肿。此外，还确定了合并症，如较高的体重指数和血管相关疾病，以进一步增加风险。虽然健康的社会决定因素（SDOH）和社会经济因素被广泛认为会影响个体的医疗保健结果，包括癌症风险和生存，但这些因素尚未被探索为发展继发性淋巴水肿的风险因素。一项快速文献综述探讨了 SDOH 作为淋巴水肿风险因素的现有证据。纳入了过去 10 年发表的、专门分析社会因素作为与淋巴水肿相关变量的研究。未纳入仅描述研究人群社会决定因素的研究。通过快速文献综述确定了 49 项研究，其中有 13 项研究明确分析了社会决定因素作为继发性淋巴水肿的风险因素，并进行了综述和提取。所有研究均在乳腺癌相关淋巴水肿患者中进行。社会风险因素包括种族、教育水平、保险类型和收入水平。这些与癌症生存相关的社会经济不平等一致。SDOH 可能会影响癌症治疗相关健康状况（如继发性淋巴水肿）的发病风险。研究癌症治疗相关疾病的临床试验应在社会、行为、环境和经济领域收集一致和可靠的数据，并分析这些变量，以了解它们对研究终点的贡献。风险预测模型可能是未来的一个途径，可以更好地将社会决定因素与医疗和合并症数据结合起来，全面了解淋巴水肿风险。
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