title: Analysis of factors contributing to severity of breast cancer-related lymphedema.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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 after 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.
  
  
  RESULTS
  Fifty (4.5%) patients presented for upper extremity lymphedema treatment after breast cancer treatment (total of 1106 patients treated surgically for breast cancer). Greater UELIs were found in patients 50 years and older, those with ALND, radiation, chemotherapy, pathologic stage greater than 3, and an International Society of Lymphology lymphedema stage II (P < 0.05). The multivariate model showed age older than 50 years and pathologic stage greater than 3 were significant predictors of higher UELI (P < 0.05).
  
  
  CONCLUSIONS
  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.
authors.affiliation: From the *Department of Plastic Surgery, Ohio State University Wexner Medical Center; and †Center for Biostatistics, Ohio State University Wexner Medical Center, Columbus, OH.
authors.forename: Michelle
authors.initials: M
authors.lastname: Coriddi
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Khansa
authors.forename: Julie
authors.initials: J
authors.lastname: Stephens
authors.forename: Michael
authors.initials: M
authors.lastname: Miller
authors.forename: James
authors.initials: J
authors.lastname: Boehmler
authors.forename: Pankaj
authors.initials: P
authors.lastname: Tiwari
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016014:Linear Models; D008197:Lymph Node Excision; D008209:Lymphedema / Q000209:etiology*; D008408:Mastectomy; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index