Quality of life among breast cancer patients with lymphedema: A systematic review of patient-reported outcome instruments and outcomes Journal Article


Authors: Pusic, A. L.; Cemal, Y.; Albornoz, C.; Klassen, A.; Cano, S.; Sulimanoff, I.; Hernandez, M.; Massey, M.; Cordeiro, P.; Morrow, M.; Mehrara, B.
Article Title: Quality of life among breast cancer patients with lymphedema: A systematic review of patient-reported outcome instruments and outcomes
Abstract: Purpose: Lymphedema following breast cancer surgery remains a common and feared treatment complication. Accurate information on health-related quality of life (HRQOL) outcomes among patients with lymphedema is critically needed to inform shared medical decision making and evidence-based practice in oncologic breast surgery. Our systematic review aimed to (1) identify studies describing HRQOL outcomes in breast cancer-related lymphedema (BCRL) patients, (2) assess the quality of these studies, and (3) assess the quality and appropriateness of the patient-reported outcome (PRO) instruments used. Methods: Using the PRISMA statement, we performed a systematic review including studies describing HRQOL outcomes among BCRL patients. Studies were classified by levels of evidence and fulfillment of the Efficace criteria. PRO instruments were assessed using the COSMIN criteria. Results: Thirty-nine studies met inclusion criteria, including 8 level I and 14 level II studies. Sixteen of 39 studies were compliant with the Efficace criteria. Seventeen HRQOL instruments were used, two specific to lymphedema patients. Exercise and complex decongestive therapy treatment interventions were associated with improved HRQOL. Conclusions: High-quality data on HRQOL outcomes is required to inform surgical decisions for breast cancer management and survivors. Of the lymphedema-specific PRO instruments, the Upper Limb Lymphedema 27 (ULL-27) was found to have strong psychometric properties. Future studies should strive to use high-quality condition- specific PRO instruments, follow existing guidelines for HRQOL measurement and to consider economic burdens of BCRL. Implications for Cancer Survivors: As lymphedema may develop many years after breast cancer surgery, the ULL-27 may offer greater content validity for use in survivorship research. © 2012 Springer Science+Business Media New York.
Keywords: quality of life; breast cancer; lymphedema
Journal Title: Journal of Cancer Survivorship
Volume: 7
Issue: 1
ISSN: 1932-2259
Publisher: Springer  
Date Published: 2013-03-01
Start Page: 83
End Page: 92
Language: English
DOI: 10.1007/s11764-012-0247-5
PROVIDER: scopus
PUBMED: 23212603
PMCID: PMC3683656
DOI/URL:
Notes: --- - "Export Date: 1 March 2013" - "Source: Scopus"
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MSK Authors
  1. Monica Morrow
    455 Morrow
  2. Andrea Pusic
    281 Pusic
  3. Babak Mehrara
    257 Mehrara
  4. Peter G Cordeiro
    239 Cordeiro
  5. Yeliz Cemal
    10 Cemal