Symptom report in detecting breast cancer-related lymphedema.
Identifieur interne : 000B50 ( PubMed/Curation ); précédent : 000B49; suivant : 000B51Symptom report in detecting breast cancer-related lymphedema.
Auteurs : Mei R. Fu [États-Unis] ; Deborah Axelrod [États-Unis] ; Charles M. Cleland [États-Unis] ; Zeyuan Qiu [États-Unis] ; Amber A. Guth [États-Unis] ; Robin Kleinman [États-Unis] ; Joan Scagliola [États-Unis] ; Judith Haber [États-Unis]Source :
- Breast cancer (Dove Medical Press) [ 1179-1314 ] ; 2015.
Abstract
Breast cancer-related lymphedema is a syndrome of abnormal swelling coupled with multiple symptoms resulting from obstruction or disruption of the lymphatic system associated with cancer treatment. Research has demonstrated that with increased number of symptoms reported, breast cancer survivors' limb volume increased. Lymphedema symptoms in the affected limb may indicate a latent stage of lymphedema in which changes cannot be detected by objective measures. The latent stage of lymphedema may exist months or years before overt swelling occurs. Symptom report may play an important role in detecting lymphedema in clinical practice. The purposes of this study were to: 1) examine the validity, sensitivity, and specificity of symptoms for detecting breast cancer-related lymphedema and 2) determine the best clinical cutoff point for the count of symptoms that maximized the sum of sensitivity and specificity. Data were collected from 250 women, including healthy female adults, breast cancer survivors with lymphedema, and those at risk for lymphedema. Lymphedema symptoms were assessed using a reliable and valid instrument. Validity, sensitivity, and specificity were evaluated using logistic regression, analysis of variance, and areas under receiver operating characteristic curves. Count of lymphedema symptoms was able to differentiate healthy adults from breast cancer survivors with lymphedema and those at risk for lymphedema. A diagnostic cutoff of three symptoms discriminated breast cancer survivors with lymphedema from healthy women with a sensitivity of 94% and a specificity of 97% (area under the curve =0.98). A diagnostic cutoff of nine symptoms discriminated at-risk survivors from survivors with lymphedema with a sensitivity of 64% and a specificity of 80% (area under the curve =0.72). In the absence of objective measurements capable of detecting latent stages of lymphedema, count of symptoms may be a cost-effective initial screening tool for detecting lymphedema.
DOI: 10.2147/BCTT.S87854
PubMed: 26527899
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Fu</name><affiliation wicri:level="1"><nlm:affiliation>College of Nursing, New York University, New York, NY, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>College of Nursing, New York University, New York, NY</wicri:regionArea></affiliation></author><author><name sortKey="Axelrod, Deborah" sort="Axelrod, Deborah" uniqKey="Axelrod D" first="Deborah" last="Axelrod">Deborah Axelrod</name><affiliation wicri:level="1"><nlm:affiliation>Department of Surgery, NYU School of Medicine, New York, NY, USA ; NYU Clinical Cancer Center, New York, NY, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Surgery, NYU School of Medicine, New York, NY, USA ; NYU Clinical Cancer Center, New York, NY</wicri:regionArea></affiliation></author><author><name sortKey="Cleland, Charles M" sort="Cleland, Charles M" uniqKey="Cleland C" first="Charles M" last="Cleland">Charles M. 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Fu</name><affiliation wicri:level="1"><nlm:affiliation>College of Nursing, New York University, New York, NY, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>College of Nursing, New York University, New York, NY</wicri:regionArea></affiliation></author><author><name sortKey="Axelrod, Deborah" sort="Axelrod, Deborah" uniqKey="Axelrod D" first="Deborah" last="Axelrod">Deborah Axelrod</name><affiliation wicri:level="1"><nlm:affiliation>Department of Surgery, NYU School of Medicine, New York, NY, USA ; NYU Clinical Cancer Center, New York, NY, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Surgery, NYU School of Medicine, New York, NY, USA ; NYU Clinical Cancer Center, New York, NY</wicri:regionArea></affiliation></author><author><name sortKey="Cleland, Charles M" sort="Cleland, Charles M" uniqKey="Cleland C" first="Charles M" last="Cleland">Charles M. Cleland</name><affiliation wicri:level="1"><nlm:affiliation>College of Nursing, New York University, New York, NY, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>College of Nursing, New York University, New York, NY</wicri:regionArea></affiliation></author><author><name sortKey="Qiu, Zeyuan" sort="Qiu, Zeyuan" uniqKey="Qiu Z" first="Zeyuan" last="Qiu">Zeyuan Qiu</name><affiliation wicri:level="1"><nlm:affiliation>Department of Chemistry and Environmental Science, New Jersey Institute of Technology, Newark, NJ, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Chemistry and Environmental Science, New Jersey Institute of Technology, Newark, NJ</wicri:regionArea></affiliation></author><author><name sortKey="Guth, Amber A" sort="Guth, Amber A" uniqKey="Guth A" first="Amber A" last="Guth">Amber A. Guth</name><affiliation wicri:level="1"><nlm:affiliation>Department of Surgery, NYU School of Medicine, New York, NY, USA ; NYU Clinical Cancer Center, New York, NY, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Surgery, NYU School of Medicine, New York, NY, USA ; NYU Clinical Cancer Center, New York, NY</wicri:regionArea></affiliation></author><author><name sortKey="Kleinman, Robin" sort="Kleinman, Robin" uniqKey="Kleinman R" first="Robin" last="Kleinman">Robin Kleinman</name><affiliation wicri:level="1"><nlm:affiliation>Department of Surgery, NYU School of Medicine, New York, NY, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Surgery, NYU School of Medicine, New York, NY</wicri:regionArea></affiliation></author><author><name sortKey="Scagliola, Joan" sort="Scagliola, Joan" uniqKey="Scagliola J" first="Joan" last="Scagliola">Joan Scagliola</name><affiliation wicri:level="1"><nlm:affiliation>Department of Surgery, NYU School of Medicine, New York, NY, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Surgery, NYU School of Medicine, New York, NY</wicri:regionArea></affiliation></author><author><name sortKey="Haber, Judith" sort="Haber, Judith" uniqKey="Haber J" first="Judith" last="Haber">Judith Haber</name><affiliation wicri:level="1"><nlm:affiliation>College of Nursing, New York University, New York, NY, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>College of Nursing, New York University, New York, NY</wicri:regionArea></affiliation></author></analytic><series><title level="j">Breast cancer (Dove Medical Press)</title><idno type="ISSN">1179-1314</idno><imprint><date when="2015" type="published">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Breast cancer-related lymphedema is a syndrome of abnormal swelling coupled with multiple symptoms resulting from obstruction or disruption of the lymphatic system associated with cancer treatment. Research has demonstrated that with increased number of symptoms reported, breast cancer survivors' limb volume increased. Lymphedema symptoms in the affected limb may indicate a latent stage of lymphedema in which changes cannot be detected by objective measures. The latent stage of lymphedema may exist months or years before overt swelling occurs. Symptom report may play an important role in detecting lymphedema in clinical practice. The purposes of this study were to: 1) examine the validity, sensitivity, and specificity of symptoms for detecting breast cancer-related lymphedema and 2) determine the best clinical cutoff point for the count of symptoms that maximized the sum of sensitivity and specificity. Data were collected from 250 women, including healthy female adults, breast cancer survivors with lymphedema, and those at risk for lymphedema. Lymphedema symptoms were assessed using a reliable and valid instrument. Validity, sensitivity, and specificity were evaluated using logistic regression, analysis of variance, and areas under receiver operating characteristic curves. Count of lymphedema symptoms was able to differentiate healthy adults from breast cancer survivors with lymphedema and those at risk for lymphedema. A diagnostic cutoff of three symptoms discriminated breast cancer survivors with lymphedema from healthy women with a sensitivity of 94% and a specificity of 97% (area under the curve =0.98). A diagnostic cutoff of nine symptoms discriminated at-risk survivors from survivors with lymphedema with a sensitivity of 64% and a specificity of 80% (area under the curve =0.72). In the absence of objective measurements capable of detecting latent stages of lymphedema, count of symptoms may be a cost-effective initial screening tool for detecting lymphedema.</div></front></TEI><pubmed><MedlineCitation Status="PubMed-not-MEDLINE" Owner="NLM"><PMID Version="1">26527899</PMID><DateCreated><Year>2015</Year><Month>11</Month><Day>03</Day></DateCreated><DateCompleted><Year>2015</Year><Month>11</Month><Day>03</Day></DateCompleted><DateRevised><Year>2017</Year><Month>02</Month><Day>20</Day></DateRevised><Article PubModel="Electronic-eCollection"><Journal><ISSN IssnType="Print">1179-1314</ISSN><JournalIssue CitedMedium="Print"><Volume>7</Volume><PubDate><Year>2015</Year></PubDate></JournalIssue><Title>Breast cancer (Dove Medical Press)</Title><ISOAbbreviation>Breast Cancer (Dove Med Press)</ISOAbbreviation></Journal><ArticleTitle>Symptom report in detecting breast cancer-related lymphedema.</ArticleTitle><Pagination><MedlinePgn>345-52</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.2147/BCTT.S87854</ELocationID><Abstract><AbstractText>Breast cancer-related lymphedema is a syndrome of abnormal swelling coupled with multiple symptoms resulting from obstruction or disruption of the lymphatic system associated with cancer treatment. Research has demonstrated that with increased number of symptoms reported, breast cancer survivors' limb volume increased. Lymphedema symptoms in the affected limb may indicate a latent stage of lymphedema in which changes cannot be detected by objective measures. The latent stage of lymphedema may exist months or years before overt swelling occurs. Symptom report may play an important role in detecting lymphedema in clinical practice. The purposes of this study were to: 1) examine the validity, sensitivity, and specificity of symptoms for detecting breast cancer-related lymphedema and 2) determine the best clinical cutoff point for the count of symptoms that maximized the sum of sensitivity and specificity. Data were collected from 250 women, including healthy female adults, breast cancer survivors with lymphedema, and those at risk for lymphedema. Lymphedema symptoms were assessed using a reliable and valid instrument. Validity, sensitivity, and specificity were evaluated using logistic regression, analysis of variance, and areas under receiver operating characteristic curves. Count of lymphedema symptoms was able to differentiate healthy adults from breast cancer survivors with lymphedema and those at risk for lymphedema. A diagnostic cutoff of three symptoms discriminated breast cancer survivors with lymphedema from healthy women with a sensitivity of 94% and a specificity of 97% (area under the curve =0.98). A diagnostic cutoff of nine symptoms discriminated at-risk survivors from survivors with lymphedema with a sensitivity of 64% and a specificity of 80% (area under the curve =0.72). In the absence of objective measurements capable of detecting latent stages of lymphedema, count of symptoms may be a cost-effective initial screening tool for detecting lymphedema.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Fu</LastName><ForeName>Mei R</ForeName><Initials>MR</Initials><AffiliationInfo><Affiliation>College of Nursing, New York University, New York, NY, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Axelrod</LastName><ForeName>Deborah</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Department of Surgery, NYU School of Medicine, New York, NY, USA ; NYU Clinical Cancer Center, New York, NY, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Cleland</LastName><ForeName>Charles M</ForeName><Initials>CM</Initials><AffiliationInfo><Affiliation>College of Nursing, New York University, New York, NY, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Qiu</LastName><ForeName>Zeyuan</ForeName><Initials>Z</Initials><AffiliationInfo><Affiliation>Department of Chemistry and Environmental Science, New Jersey Institute of Technology, Newark, NJ, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Guth</LastName><ForeName>Amber A</ForeName><Initials>AA</Initials><AffiliationInfo><Affiliation>Department of Surgery, NYU School of Medicine, New York, NY, USA ; NYU Clinical Cancer Center, New York, NY, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kleinman</LastName><ForeName>Robin</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Department of Surgery, NYU School of Medicine, New York, NY, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Scagliola</LastName><ForeName>Joan</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Surgery, NYU School of Medicine, New York, NY, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Haber</LastName><ForeName>Judith</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>College of Nursing, New York University, New York, NY, USA.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><GrantID>P60 MD000538</GrantID><Acronym>MD</Acronym><Agency>NIMHD NIH HHS</Agency><Country>United States</Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2015</Year><Month>10</Month><Day>15</Day></ArticleDate></Article><MedlineJournalInfo><Country>New Zealand</Country><MedlineTA>Breast Cancer (Dove Med Press)</MedlineTA><NlmUniqueID>101591856</NlmUniqueID><ISSNLinking>1179-1314</ISSNLinking></MedlineJournalInfo><CommentsCorrectionsList><CommentsCorrections RefType="Cites"><RefSource>Lymphology. 2009 Dec;42(4):161-75</RefSource><PMID Version="1">20218084</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Ann Surg Oncol. 2010 Jul;17(7):1847-53</RefSource><PMID Version="1">20140528</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>J Clin Oncol. 2008 Nov 10;26(32):5213-9</RefSource><PMID Version="1">18838709</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Semin Oncol Nurs. 2013 Feb;29(1):50-60</RefSource><PMID Version="1">23375066</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Breast Cancer Res Treat. 2006 Feb;95(3):279-93</RefSource><PMID Version="1">16163445</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Eur J Oncol Nurs. 2016 Feb;20:10-6</RefSource><PMID Version="1">26071198</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Nurs Res. 2003 Nov-Dec;52(6):370-9</RefSource><PMID Version="1">14639083</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Arch Phys Med Rehabil. 2011 Apr;92(4):603-10</RefSource><PMID Version="1">21440706</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Ann Surg Oncol. 2014 Oct;21(11):3481-9</RefSource><PMID Version="1">24809302</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Am J Epidemiol. 2006 Apr 1;163(7):670-5</RefSource><PMID Version="1">16410346</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Cancer. 1950 Jan;3(1):32-5</RefSource><PMID Version="1">15405679</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Lymphology. 2003 Jun;36(2):84-91</RefSource><PMID Version="1">12926833</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>J Pain Symptom Manage. 2009 Dec;38(6):849-59</RefSource><PMID Version="1">19819668</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Cancer Epidemiol Biomarkers Prev. 2007 Apr;16(4):775-82</RefSource><PMID Version="1">17416770</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Psychooncology. 2013 Jul;22(7):1466-84</RefSource><PMID Version="1">23044512</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Psychooncology. 2010 Mar;19(3):299-305</RefSource><PMID Version="1">19399782</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>J Am Coll Surg. 2013 Mar;216(3):380-9; 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