title: The psychosocial impact of lymphedema-related distress among breast cancer survivors in the WHEL Study.
abstract: OBJECTIVE
  Lymphedema is a distressing and chronic condition affecting up to 30% of breast cancer survivors. Using a cross-sectional study design, we examined the impact of self-reported lymphedema-related distress on psychosocial functioning among breast cancer survivors in the Women's Healthy Eating and Living Study. The Women's Healthy Eating and Living Study has a dataset that includes self-report data on lymphedema status, symptoms, and distress.
  
  
  METHODS
  Chi-square tests and binary logistic regression models were used to examine how specific participant characteristics, including lymphedema-related distress, were associated with physical health and mental health as measured by the SF-36-Item Health Survey and depressive symptoms assessed by the Center for Epidemiologic Studies Depression Scale screening form.
  
  
  RESULTS
  Of the 2431 participants included in the current study population, 692 (28.5%) self-reported ever having lymphedema. A total of 335 (48.9%) women reported moderate to extreme distress as a result of their lymphedema and were classified as having lymphedema-related distress. The logistic regression models showed that women with lymphedema-related distress had 50% higher odds of reporting poor physical health (p = 0.01) and 73% higher odds of having poor mental health (p < 0.01) when compared with women without lymphedema. In contrast, even though lymphedema-related distress was significantly associated (p = 0.03) with elevated depressive symptoms in the bivariate analyses, it was not significant in the logistic regression models.
  
  
  CONCLUSIONS
  Breast cancer survivors with lymphedema-related distress had worse physical health and mental health outcomes than women with lymphedema who were not distressed and women with no lymphedema. Our findings provide further evidence of the relationship between lymphedema and psychosocial outcomes in breast cancer survivors.
authors.affiliation: Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA, USA.
authors.forename: Sally A
authors.initials: SA
authors.lastname: Dominick
authors.forename: Loki
authors.initials: L
authors.lastname: Natarajan
authors.forename: John P
authors.initials: JP
authors.lastname: Pierce
authors.forename: Hala
authors.initials: H
authors.lastname: Madanat
authors.forename: Lisa
authors.initials: L
authors.lastname: Madlensky
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000150:complications* / Q000523:psychology; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008209:Lymphedema / Q000209:etiology / Q000523:psychology*; D008603:Mental Health; D008875:Middle Aged; D011788:Quality of Life; D018434:Sickness Impact Profile; D012944:Social Support; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D014481:United States
keywords: Breast cancer survivors; Depressive symptoms; Distress; Lymphedema; Oncology; Quality of life