Ge Li-Ping, Tang Lichen, Zuo WenJia, Zhou Changmin, Gao Tianhao, Li Yun, Fu Cuixia, Qiu Jiajia, Li Ping, Lu Rongrong, Chen Li, Xue Yunzi, Shen Zhou, Shao Zhimin, Di Genhong, Feng Wei
Department of Breast Surgery, Fudan University Shanghai Cancer Center; Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
Breast Cancer (Dove Med Press). 2024 Dec 6;16:867-876. doi: 10.2147/BCTT.S485827. eCollection 2024.
Lymphedema and psychological distress, including anxiety and depression, are common in breast cancer patients post-surgery. This study aimed to assess the incidence and determinants of anxiety and depression in patients with acute lymphedema (ALE) following breast cancer surgery.
A retrospective study was conducted on 1613 breast cancer patients who underwent surgery at Fudan University Shanghai Cancer Center in 2018. ALE was defined as lymphatic fluid accumulation causing limb swelling and was classified by the difference in arm circumference. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale (HADS) at discharge. Descriptive statistics and logistic regression were used to identify psychological distress-related factors.
Among the 1613 patients, 363 (22.5%) had ALE. Anxiety was observed in 31% and depression in 21% of patients. ALE significantly impacted anxiety in the multivariate analysis (OR = 1.57, 95% CI: [1.04-2.38], P = 0.033). Multivariate analysis of ALE patients showed that longer hospital stays (OR = 0.51, 95% CI: [0.30-0.88], P = 0.017) and invasive disease (OR = 0.39, 95% CI: [0.19-0.78], P = 0.008) were associated with reduced anxiety; while lymph-vessel invasive disease was associated with increased anxiety (OR = 5.97, 95% CI: [1.15-30.97], P = 0.034). ALE had no significant impact on depression in the multivariate analysis. However, menopause (OR = 0.72, 95% CI: [0.56-0.94], P = 0.014) and longer hospitalization (OR = 1.30, 95% CI: [1.00-1.68], P = 0.047) influenced depression in all patients. In the ALE group, lymph node surgery was the only significant factor for depression (OR = 8.67, 95% CI: [1.56-48.23], P = 0.014) in the multivariate analysis.
Psychological stress, influenced by both surgical factors and emotional states, is associated with ALE development. Addressing both psychological and surgical factors is crucial for improving outcomes and quality of life in post-surgery breast cancer patients.
淋巴水肿以及包括焦虑和抑郁在内的心理困扰在乳腺癌术后患者中很常见。本研究旨在评估乳腺癌手术后急性淋巴水肿（ALE）患者焦虑和抑郁的发生率及相关因素。
对2018年在复旦大学附属肿瘤医院接受手术的1613例乳腺癌患者进行回顾性研究。ALE定义为导致肢体肿胀的淋巴液积聚，并根据上臂周长差异进行分类。出院时使用医院焦虑抑郁量表（HADS）评估焦虑和抑郁情况。采用描述性统计和逻辑回归分析来确定与心理困扰相关的因素。
在1613例患者中，363例（22.5%）发生ALE。患者中焦虑发生率为31%，抑郁发生率为21%。多因素分析显示ALE对焦虑有显著影响（OR = 1.57，95%CI：[1.04 - 2.38]，P = 0.033）。对ALE患者的多因素分析表明，住院时间较长（OR = 0.51，95%CI：[0.30 - 0.88]，P = 0.017）和侵袭性疾病（OR = 0.39，95%CI：[0.19 - 0.78]，P = 0.008）与焦虑减轻相关；而淋巴管侵袭性疾病与焦虑增加相关（OR = 5.97，95%CI：[1.15 - 30.97]，P = 0.034）。多因素分析中ALE对抑郁无显著影响。然而，绝经（OR = 0.72，95%CI：[0.56 - 0.94]，P = 0.014）和住院时间较长（OR = 1.30，95%CI：[1.00 - 1.68]，P = 0.047）对所有患者的抑郁有影响。在ALE组中，多因素分析显示淋巴结手术是抑郁的唯一显著因素（OR = 8.67，95%CI：[1.56 - 48.23]，P = 0.014）。
心理压力受手术因素和情绪状态影响，与ALE的发生有关。解决心理和手术因素对于改善乳腺癌术后患者的预后和生活质量至关重要。
