Upper extremity lymphedema is a well-described complication of breast cancer treatment. Risk factors for lymphedema development include axillary lymph node dissection (ALND), obesity, increasing age, radiation and postoperative complications. In this study, we seek to evaluate a cohort of patients who have either self-referred or been referred to the department of physical therapy for lymphedema treatment. Our goal is to evaluate specific risk factors associated with the severity of lymphedema in this patient population.

All patients who presented to the Wexner Medical Center at the Ohio State University between January 1, 2009 and December 31, 2010 with a chief complaint of upper extremity lymphedema following breast cancer treatment were reviewed retrospectively. Upper extremity lymphedema index (UELI) was used as a severity indicator and patient factors including demographics and breast cancer treatments were evaluated. Univariate and multivariate statistical analyses were performed.

Fifty (4.5%) patients presented for upper extremity lymphedema treatment following breast cancer treatment (total of 1106 patients treated surgically for breast cancer). Greater UELI's were found in patients 50 years and older, those with ALND, radiation, chemotherapy, pathologic stage greater than 3, and an International Society of Lymphology (ISL) lymphedema stage 2 (p<0.05). The multivariate model showed age greater than 50 and pathologic stage greater than 3 were significant predictors of higher UELI (p<0.05).

In this study, we report that in patients who present for lymphedema treatment, increased UELI is significantly related to ALND, radiation therapy, chemotherapy, age and pathologic stage. An improved understanding of the patient population referred for lymphedema treatment, will allow for the identification of patients who may be candidates for therapeutic intervention.