Upper limb symptoms in breast cancer survivors with lymphedema: A latent class analysis and network analysis

Objective

Breast cancer survivors (BCS) with lymphedema experience multiple symptoms in upper limbs that significantly impact their quality of life. The complexity of symptomology and the connection among these symptoms are unclear. This study aimed to identify upper limb symptom subgroups and symptom networks among BCS.

Methods

This secondary analysis included individuals with lymphedema (defined as an inter-limb circumference difference of ≥ 2 cm) from three cross-sectional studies among post-surgery BCS. Upper limb symptoms were assessed by the Breast Cancer and Lymphedema Symptom Experience Index. Descriptive analysis, latent class analysis, logistic regression analysis, and network analysis were performed.

Results

A total of 341 BCS with upper limb lymphedema were included. Swelling, heaviness and tightness were the most prevalent symptoms. Four distinct latent classes were identified: “Severe symptom” group (Class 1: 9.4%), “Movement-limitation and lymph-stasis” group (Class 2: 24.6%), “Lymph-stasis” group (Class 3: 37.5%), and “Mild symptom” group (Class 4: 28.4%). BCS with axillary lymph node dissection, radiotherapy, longer post-surgery duration, and without medical insurance were less likely to belong to the mild symptom group (P ​< ​0.001). Symptom network density decreased from Class 1 to 4. Core symptoms for each symptom network were tenderness, firmness, arm-swelling, and heaviness, respectively.

Conclusions

This study identified four distinct categories of upper limb symptoms and influencing factors among individuals with breast cancer-related lymphedema (BCRL). Our findings suggest the need to consider individualized approaches to symptom management and support for BCRL, taking into account their specific symptom clusters and associated risk factors.