Shen Aomei, Lukkahatai Nada, Zhang Zijuan, Zhao Hongmeng, Salim Nezar Ahmed, Han Gyumin, Qiang Wanmin, Lu Qian
Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University Ministry of Education, Tianjin, China.
Peking University School of Nursing, Beijing, China.
Asia Pac J Oncol Nurs. 2025 May 2;12:100713. doi: 10.1016/j.apjon.2025.100713. eCollection 2025 Dec.
Breast cancer survivors (BCS) with lymphedema experience multiple symptoms in upper limbs that significantly impact their quality of life. The complexity of symptomology and the connection among these symptoms are unclear. This study aimed to identify upper limb symptom subgroups and symptom networks among BCS.
This secondary analysis included individuals with lymphedema (defined as an inter-limb circumference difference of ≥ 2 cm) from three cross-sectional studies among post-surgery BCS. Upper limb symptoms were assessed by the Breast Cancer and Lymphedema Symptom Experience Index. Descriptive analysis, latent class analysis, logistic regression analysis, and network analysis were performed.
A total of 341 BCS with upper limb lymphedema were included. Swelling, heaviness and tightness were the most prevalent symptoms. Four distinct latent classes were identified: "Severe symptom" group (Class 1: 9.4%), "Movement-limitation and lymph-stasis" group (Class 2: 24.6%), "Lymph-stasis" group (Class 3: 37.5%), and "Mild symptom" group (Class 4: 28.4%). BCS with axillary lymph node dissection, radiotherapy, longer post-surgery duration, and without medical insurance were less likely to belong to the mild symptom group ( < 0.001). Symptom network density decreased from Class 1 to 4. Core symptoms for each symptom network were tenderness, firmness, arm-swelling, and heaviness, respectively.
This study identified four distinct categories of upper limb symptoms and influencing factors among individuals with breast cancer-related lymphedema (BCRL). Our findings suggest the need to consider individualized approaches to symptom management and support for BCRL, taking into account their specific symptom clusters and associated risk factors.
患有淋巴水肿的乳腺癌幸存者（BCS）在上肢会经历多种症状，这些症状会显著影响他们的生活质量。症状学的复杂性以及这些症状之间的联系尚不清楚。本研究旨在识别BCS中的上肢症状亚组和症状网络。
这项二次分析纳入了来自三项乳腺癌术后BCS横断面研究中患有淋巴水肿（定义为双侧肢体周长差异≥2 cm）的个体。通过乳腺癌和淋巴水肿症状体验指数评估上肢症状。进行了描述性分析、潜在类别分析、逻辑回归分析和网络分析。
共纳入341例患有上肢淋巴水肿的BCS。肿胀、沉重感和紧绷感是最常见的症状。识别出四个不同的潜在类别：“严重症状”组（第1类：9.4%）、“运动受限和淋巴淤滞”组（第2类：24.6%）、“淋巴淤滞”组（第3类：37.5%）和“轻度症状”组（第4类：28.4%）。接受腋窝淋巴结清扫、放疗、术后时间较长且没有医疗保险的BCS属于轻度症状组的可能性较小（<0.001）。症状网络密度从第1类到第4类逐渐降低。每个症状网络的核心症状分别是压痛、硬结、手臂肿胀和沉重感。
本研究识别出了与乳腺癌相关淋巴水肿（BCRL）个体的四类不同的上肢症状及其影响因素。我们的研究结果表明，需要考虑针对BCRL进行症状管理和支持的个性化方法，同时考虑他们的特定症状集群和相关风险因素。
