PURPOSE

This study aimed to investigate the association between internet-based nursing guidance frequency and postoperative upper limb lymphedema risk in breast cancer patients, and identify influencing factors.

METHODS

A retrospective cohort study included 208 female patients who underwent breast and lymph node surgery (2020-2021). Univariate and multivariate logistic regression analyses were used to assess associations with lymphedema, defined as an arm circumference difference ≥ 2 cm. Internet-based guidance via WeChat included daily education manuals, weekly video exercises, and monthly assessments, with frequency categorized as 0, 1-2, or ≥ 3 times/week.

RESULTS

During a 12-month period, 24% (50/208) developed lymphedema. Multivariate analysis identified the following independent risk factors: high BMI (OR 7.924, 95% CI 3.197-19.638), axillary lymph node dissection (OR 6.144, 95% CI 2.117-17.838), radiotherapy (OR 4.209, 95% CI 1.615-10.971). Urban residents had a lower risk of lymphedema compared to rural residents (OR 0.394, 95% CI 0.168-0.923). Receiving guidance 1-2 times per week, compared with ≥3 times per week, was associated with a higher risk of lymphedema (OR 9.752, 95% CI 3.158-30.111); receiving no guidance, compared with ≥3 times per week, was also associated with an increased risk (OR 4.068, 95% CI 1.346-12.296). Socioeconomic factors (including lower education level and income) were correlated with a higher risk.

CONCLUSION

High BMI, axillary lymph node dissection, and radiotherapy are highly associated with the occurrence of lymphedema after breast cancer surgery, while urban residence and high-frequency internet-based nursing guidance are associated with a lower probability of lymphedema. Future randomized controlled trials are needed to validate the preventive effects of digital health interventions.