Early diagnosis, treatment, and Health-Related Quality of Life in women with mild Breast Cancer-Related Lymphedema

Abstract: Background: Early diagnosis and treatment of Breast Cancer-RelatedLymphedema (BCRL) are important to prevent lymphedema progress and impacton Health-Related Quality of Life (HRQOL). The treatment includes self-care andtreatment with compression garment. In mild BCRL, the lymphedema can be local, without an increase in arm volume. Tissue Dielectric Constant (TDC), measuring local tissue water in skin and subcutis, had not been used for diagnosis and to evaluate treatment in mild BCRL before. Also, knowledge about the effect of wearing a compression garment and its impact on HRQOL was unknown. The overall aim of this thesis was to evaluate diagnostic methods, treatment, and HRQOL in women with mild BCRL.Methods: Women treated with axillary node dissection and diagnosed with mildBCRL were included. In paper I (n=72), the proportion of mild BCRL detected withTDC and/or Water Displacement Method (WDM) in combination with skinpalpation at diagnosis were evaluated. Also, association between TDC and WDMmeasurements and lymphedema related factors were examined. In paper II,(n= 46),changes in local tissue water (TDC) and Lymphedema Relative Volume (LRV) measured with WDM after 1,2,3 and 6 months standard treatment were examined. In paper III, (n=70), differences between compression group (CG) and non compression group (NCG) in changes of local tissue water (TDC), LRV (WDM), and subjective symptoms after 1,2,3 and 6 months were investigated. Also, adherence to self-care at 6 months was examined. In paper IV, (n=51), difference between CG and NCG in disease specific HRQOL was investigated with the Lymphedema Quality of Life Inventory (LyQLI) at 6 months.Results: The TDC method detected more patients with mild BCRL, earlier aftersurgery and at a lower LRV compared to the WDM method, but both methodstogether with skin palpation for diagnosis were needed. Also, there was a negative association between local tissue water and LRV (paper I). Both TDC and WDM could detect a significant reduction in BCRL over a 6 months period of standard treatment. The participants with BCRL, detected with TDC, decreased in local tissue water, but all participants had a similar decrease in LRV. Also, in a majority of participants, the site with the highest TDC ratio changed to another site (paper II). Early treatment with a compression garment for 6 months could prevent progression in mild BCRL, showing smaller proportion of progression in LRV, larger reduction in LRV and local tissue water, and early reduced experience of tension, compared to NCG. However, 43% in the NCG group did not showprogression and could manage without compression. Adherence to self-care wascomparable in both groups (paper III). The participants in both CG and NCG rated a high HRQOL, but the CG experienced a higher negative impact on HRQOL in the practical domain and in some of the items in the psychosocial domain compared to the NCG (paper IV).Conclusions: TDC and WDM can be used together with skin palpation for earlydiagnosis. Both methods could detect changes in mild BCRL during treatment and can be used to evaluate treatment. Early treatment with compression garment for 6 months could prevent progression of mild BCRL, but almost half of the participants in the NCG did not show progression. Wearing a compressiongarment has a minor negative impact on HRQOL and needs to be considered inrelation to the preventive effect. The results have important clinical implications for diagnosing, treatment, clinical decision making and patient education in women with mild BCRL.