A prospective cohort study defining utilities using time trade-offs and the Euroqol-5D to assess the impact of cancer-related lymphedema.
BACKGROUND
The devastating impact of lymphedema on cancer survivors' quality of life has prompted consideration of several changes in medical and surgical care. Unfortunately, our understanding of the benefits gained from these approaches relative to their cost remains limited. This study was designed to estimate utilities for lymphedema and characterize how utilities differ between subgroups defined by lymphedema etiology and distribution.


METHODS
A consecutive sample of 236 subjects with lymphedema seen at a lymphedema clinic completed both a time trade-off (TTO) exercise and the Euroqol 5D. Responses were adjusted in multivariate regression models for demographic factors, comorbidities, and lymphedema severity/location.


RESULTS
Most participants (167 of 236, 71%) had lymphedema as a consequence of cancer treatment; 123 with breast cancer and upper extremity involvement. Mean TTO utility estimates were consistently higher than Euroqol 5D estimates. Unadjusted TTO (0.85; standard deviation [SD], 0.21) and Euroqol 5D (0.76; SD, 0.18) scores diminished with increasing lymphedema stage and patient body mass index (BMI). Adjusted utility scores were lowest in patients with cancer-related lower extremity lymphedema (TTO=0.82; SD, 0.04 and Euroqol 5D=0.80; SD, 0.03). Breast cancer patients also had lower adjusted Euroqol 5D scores (0.80; SD, 0.02).


CONCLUSIONS
Lymphedema-associated utilities are in the range of 0.80. Lower utilities are observed for patients with higher lymphedema stages, elevated BMI, and cancer-related lymphedema. Greater expenditures for the prevention and treatment of cancer-related lymphedema are warranted.
Cheville
Andrea L
AL
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota 55905, USA. cheville.andrea@mayo.edu
Almoza
Mously
M
Courmier
Janice N
JN
Basford
Jeffrey R
JR
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008209:Lymphedema / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D018434:Sickness Impact Profile