title: Incidence, risk factors and estimates of a woman's risk of developing secondary lower limb lymphedema and lymphedema-specific supportive care needs in women treated for endometrial cancer.
abstract: OBJECTIVE
  Few studies have assessed the risk and impact of lymphedema among women treated for endometrial cancer. We aimed to quantify cumulative incidence of, and risk factors for developing lymphedema following treatment for endometrial cancer and estimate absolute risk for individuals. Further, we report unmet needs for help with lymphedema-specific issues.
  
  
  METHODS
  Women treated for endometrial cancer (n = 1243) were followed-up 3-5 years after diagnosis; a subset of 643 completed a follow-up survey that asked about lymphedema and lymphedema-related support needs. We identified a diagnosis of secondary lymphedema from medical records or self-report. Multivariable logistic regression was used to evaluate risk factors and estimates.
  
  
  RESULTS
  Overall, 13% of women developed lymphedema. Risk varied markedly with the number of lymph nodes removed and, to a lesser extent, receipt of adjuvant radiation or chemotherapy treatment, and use of nonsteroidal anti-inflammatory drugs (pre-diagnosis). The absolute risk of developing lymphedema was >50% for women with 15+ nodes removed and 2-3 additional risk factors, 30-41% for those with 15+ nodes removed plus 0-1 risk factors or 6-14 nodes removed plus 3 risk factors, but ≤ 8% for women with no nodes removed or 1-5 nodes but no additional risk factors. Over half (55%) of those who developed lymphedema reported unmet need(s), particularly with lymphedema-related costs and pain.
  
  
  CONCLUSIONS
  Lymphedema is common; experienced by one in eight women following endometrial cancer. Women who have undergone lymphadenectomy have very high risks of lymphedema and should be informed how to self-monitor for symptoms. Affected women need greater levels of support.
authors.affiliation: Gynaecological Cancers Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia. Electronic address: Vanessa.Beesley@qimrberghofer.edu.au.
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Beesley
authors.affiliation: Gynaecological Cancers Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
authors.forename: Ingrid J
authors.initials: IJ
authors.lastname: Rowlands
authors.affiliation: School of Public Health, Queensland University of Technology, Brisbane, QLD, Australia.
authors.forename: Sandi C
authors.initials: SC
authors.lastname: Hayes
authors.affiliation: School of Public Health, Queensland University of Technology, Brisbane, QLD, Australia.
authors.forename: Monika
authors.initials: M
authors.lastname: Janda
authors.affiliation: Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: O'Rourke
authors.affiliation: Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Marquart
authors.affiliation: Department of Obstetrics & Gynaecology, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Quinn
authors.affiliation: Molecular Cancer Epidemiology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
authors.forename: Amanda B
authors.initials: AB
authors.lastname: Spurdle
authors.affiliation: Queensland Centre for Gynaecological Cancer, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
authors.forename: Andreas
authors.initials: A
authors.lastname: Obermair
authors.affiliation: Department of Gynaecological Oncology, Westmead Hospital, Sydney, NSW, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Brand
authors.affiliation: Department of Gynaecological Oncology, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Martin K
authors.initials: MK
authors.lastname: Oehler
authors.affiliation: School of Women's and Infants' Health, University of Western Australia, Perth, WA, Australia.
authors.forename: Yee
authors.initials: Y
authors.lastname: Leung
authors.affiliation: Consumer Representative, Sydney, NSW, Australia.
authors.forename: Lesley
authors.initials: L
authors.lastname: McQuire
authors.affiliation: Gynaecological Cancers Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
authors.forename: Penelope M
authors.initials: PM
authors.lastname: Webb
mesh_terms: D000368:Aged; D001315:Australia / Q000453:epidemiology; D016889:Endometrial Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D007866:Leg; D016015:Logistic Models; D008209:Lymphedema / Q000453:epidemiology* / Q000628:therapy*; D008875:Middle Aged; D020380:Needs Assessment; D010166:Palliative Care / Q000379:methods*; D012307:Risk Factors
keywords: Endometrial cancer; Lower limb lymphedema; Risk factors; Unmet needs