title: Factors associated with fear of lymphedema after treatment for breast cancer.
abstract: OBJECTIVE
  To identify demographic and treatment characteristics associated with postoperative fear of lymphedema.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Outpatient breast clinic at a comprehensive cancer center in the northeastern United States.
  
  
  METHODS
  324 patients undergoing treatment for unilateral breast cancer.
  
  
  METHODS
  Women with breast cancer were prospectively screened for lymphedema (relative volume change of 10% or greater) preoperatively and every three to eight months postoperatively via Perometer arm volume measurements. Fear was simultaneously evaluated via questionnaire. Multivariate linear mixed-effects regression models were used to identify factors associated with mean postoperative fear score and to plot the average fear score over time within axillary surgery type subgroups.
  
  
  METHODS
  Postoperative fear of lymphedema.
  
  
  RESULTS
  Higher preoperative fear score (p < 0.0001), younger age at diagnosis (p = 0.0038), and axillary lymph node dissection (ALND) (p < 0.0001) were significantly associated with higher mean postoperative fear score. The average fear score changed nonlinearly over time (p < 0.0001), decreasing from preoperative to 24 months postoperative and leveling thereafter.
  
  
  CONCLUSIONS
  Preoperative fear, younger age at diagnosis, and ALND may contribute to postoperative fear of lymphedema.
  
  
  CONCLUSIONS
  Individualized education that begins preoperatively, continues throughout treatment, and is re-emphasized 24 months postoperatively may help minimize fear of lymphedema.
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital in Boston.
authors.forename: Lauren S
authors.initials: LS
authors.lastname: Jammallo
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital in Boston.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Miller
authors.affiliation: Biostatistics Center, Massachusetts General Hospital in Boston.
authors.forename: Nora K
authors.initials: NK
authors.lastname: Horick
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital in Boston.
authors.forename: Melissa N
authors.initials: MN
authors.lastname: Skolny
authors.affiliation: Department of Physical and Occupational Therapy, Massachusetts General Hospital in Boston.
authors.forename: Jean
authors.initials: J
authors.lastname: O'Toole
authors.affiliation: Division of Surgical Oncology, Massachusetts General Hospital in Boston.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Specht
authors.affiliation: Department of Radiation Oncology, Harvard Medical School.
authors.forename: Alphonse G
authors.initials: AG
authors.lastname: Taghian
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000150:complications / Q000523:psychology / Q000601:surgery* / Q000628:therapy; D003131:Combined Modality Therapy; D005239:Fear; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008209:Lymphedema / Q000209:etiology / Q000523:psychology*; D008408:Mastectomy; D008875:Middle Aged; D010353:Patient Education as Topic; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology / Q000523:psychology*; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: Perometer; breast cancer; fear; lymphedema; quality of life