TY - JOUR
T1 - Lymphedema Signs, Symptoms, and Diagnosis in Women Who Are in Minority and Low-Income Groups and Have Survived Breast Cancer
AU - Flores, Ann Marie
AU - Nelson, Jason
AU - Sowles, Lee
AU - Stephenson, Rebecca G.
AU - Robinson, Kathryn
AU - Cheville, Andrea
AU - Sander, Antoinette P.
AU - Blot, William J.
N1 - Funding Information:
Concept/idea/research design: A. M. Flores, A. P. Sander, W.J. Blot Writing: A. M. Flores, J. Nelson, L. Sowles, R. G. Stephenson, K. Robinson, A. Cheville, A. P. Sander, W. J. Blot Data collection: A. M. Flores Data analysis: A. M. Flores, J. Nelson, L. Sowles, W. J. Blot Project management: A. M. Flores, L. Sowles Fund procurement: A. M. Flores, W.J. Blot Providing participants: A. M. Flores, W.J. Blot Providing facilities/equipment: A. M. Flores Providing institutional liaisons: A. M. Flores, W.J. Blot Clerical/secretarial support: A. M. Flores, L. Sowles Consultation (including review of manuscript before submitting): J. Nelson, L. Sowles, R.G. Stephenson, K. Robinson, A. Cheville, A. P. Sander, W.J. Blot This work was supported by the National Institutes of Health (R21 CA137483 to A.M.F. and R01 CA092447 to W.J.B.).
Funding Information:
The authors received funding from the U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute (R01 CA092447 [PI: W.J. Blot; Co-I: A.M. Flores] and R21 CA137483 [PI: A.M. Flores; Co-I: W.J. Blot]).
Publisher Copyright:
© 2020 American Physical Therapy Association.
PY - 2020/3/10
Y1 - 2020/3/10
N2 - Background: Breast cancer-related lymphedema (BCRL) is a well-known side effect of cancer and its treatment with wide-ranging prevalence estimates. Objective: This study describes associations between breast cancer-related lymphedema (BCRL) signs, symptoms, and diagnosis for women who were African American, white, or had a low income and survived breast cancer. Design: This is a cross-sectional, observational study that used a computer-assisted telephone interview. Methods: Women who had survived breast cancer were queried on the presence of 5 lymphedema signs and symptoms (edema in the breast, axilla, arm, and/or hand; tissue fibrosis; pitting; hemosiderin staining; heaviness) and whether they had a diagnosis of BCRL. Relationships between signs/symptoms and diagnosis for each group were evaluated with kappa and chi-square statistics. Results: The study sample included 528 women who had survived breast cancer (266 white and 262 African American), with 514 reporting complete data on household income; 45% of the latter reported an annual household income of ≤$20,000. Women who were African American or had a low income were nearly twice as likely as women who were white to have any of 8 signs/symptoms of BCRL. Regardless of race and income, >50% of women with all BCRL signs and symptoms reported that they were not diagnosed with BCRL. Limitations: The main limitations of our study are the lack of medical chart data and longitudinal design. Conclusions: Women who were African American or had a low income and had survived breast cancer had a greater burden of BCRL signs and symptoms than women who were white. The lack of a strong association between BCRL signs, symptoms, and diagnosis suggests that BCRL may be underdiagnosed. These findings suggest that more rigorous screening and detection of BCRL-especially for women who are African American or have a low income-may be warranted. Cancer rehabilitation programs may be able to fill this gap.
AB - Background: Breast cancer-related lymphedema (BCRL) is a well-known side effect of cancer and its treatment with wide-ranging prevalence estimates. Objective: This study describes associations between breast cancer-related lymphedema (BCRL) signs, symptoms, and diagnosis for women who were African American, white, or had a low income and survived breast cancer. Design: This is a cross-sectional, observational study that used a computer-assisted telephone interview. Methods: Women who had survived breast cancer were queried on the presence of 5 lymphedema signs and symptoms (edema in the breast, axilla, arm, and/or hand; tissue fibrosis; pitting; hemosiderin staining; heaviness) and whether they had a diagnosis of BCRL. Relationships between signs/symptoms and diagnosis for each group were evaluated with kappa and chi-square statistics. Results: The study sample included 528 women who had survived breast cancer (266 white and 262 African American), with 514 reporting complete data on household income; 45% of the latter reported an annual household income of ≤$20,000. Women who were African American or had a low income were nearly twice as likely as women who were white to have any of 8 signs/symptoms of BCRL. Regardless of race and income, >50% of women with all BCRL signs and symptoms reported that they were not diagnosed with BCRL. Limitations: The main limitations of our study are the lack of medical chart data and longitudinal design. Conclusions: Women who were African American or had a low income and had survived breast cancer had a greater burden of BCRL signs and symptoms than women who were white. The lack of a strong association between BCRL signs, symptoms, and diagnosis suggests that BCRL may be underdiagnosed. These findings suggest that more rigorous screening and detection of BCRL-especially for women who are African American or have a low income-may be warranted. Cancer rehabilitation programs may be able to fill this gap.
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U2 - 10.1093/ptj/pzaa002
DO - 10.1093/ptj/pzaa002
M3 - Article
C2 - 32031628
AN - SCOPUS:85081945265
SN - 0031-9023
VL - 100
SP - 487
EP - 499
JO - Physical Therapy
JF - Physical Therapy
IS - 3
ER -