Sentinel symptoms of breast cancer-related lymphedema across different lymphedema severity classes

Twenty percent of post-surgery breast cancer patients exhibited lymphedema, which is typically classified into various severity classes. Sentinel symptoms that are crucial for identifying each lymphedema class remain unclear. This study aims to examine the sentinel symptoms of patients at different classes of lymphedema.

This secondary data analysis examined two cross-sectional studies of post-surgery breast cancer patients. Participants' symptoms occurrence and distress were assessed using the Breast Cancer and Lymphedema Symptom Experience Index. Lymphedema severity classes were defined based on interarm circumference differences. Apriori algorithms combined with the symptom occurrence was employed to determine the sentinel symptoms for each lymphedema class.

A total of 894 participants, aged 54.32 ± 11.28 years (range 26-85) were included. The prevalence of lymphedema was 28.64 %. The top three most frequent limb symptoms were arm-swelling heaviness, and fatigue. Based on interarm circumference difference, participants were classified into non-lymphedema (n = 371), subclinical (n = 267), mild (n = 135), or moderate-to-severe (n = 121) lymphedema. Sentinel symptoms for each class were as follows: fatigue, heaviness, and arm-swelling for the subclinical lymphedema; arm-swelling, limited-elbow-movement, limited-arm-movement, and firmness for the mild lymphedema; and fibrosis, stiffness, and limited-wrist-movement for the moderate-to-severe lymphedema (Support >40 %, Confidence >60 %, Lift >1).

This evidence supported that sentinel symptoms are associated with different lymphedema classes. It emphasizes prompt identification and management of sentinel symptoms during follow-up care for breast cancer patients. Future research should validate these sentinel symptoms, explore the underlying mechanisms, and develop targeted interventions to alleviate them.