Lymphedema symptom trajectories and patient-reported outcomes after axillary lymph node dissection for breast cancer: A prospective cohort study.
- 1Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Breast Center, Peking University Cancer Hospital & Institute, Beijing, China.
Abstract
To characterize lymphedema symptom trajectories and associations with quality of life, anxiety, depression, and upper limb function in Chinese breast cancer survivors after axillary lymph node dissection (ALND). In this prospective cohort study, 332 women undergoing ALND at a cancer center were assessed preoperatively and annually through 24 months using the Breast Cancer and Lymphedema Symptom Experience Index (BCLE-SEI), Short Form-36 version 2 (SF-36v2; physical component summary [PCS], mental component summary [MCS]), Hospital Anxiety and Depression Scale (HADS), and Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH). Group-based trajectory modeling (GBTM) identified trajectories; mixed-effects models compared patient-reported outcomes (PROs) changes across groups, and multivariable regression examined trajectory-PRO associations. GBTM identified three trajectories: persistent-low (64.2%), high-stable (19.3%), and low-rapid-progression (16.6%). Significant group-by-time interactions emerged for PCS and DASH, with 12-month interactions for MCS and HADS subscales in the low-rapid-progression group. This group showed less PCS improvement and greater DASH deterioration at 12 and 24 months. For MCS, HADS-anxiety subscale (HADS-A), and HADS-depression subscale (HADS-D), interactions were significant at 12 but not 24 months, though outcomes remained worse in this group (physical-psychological dissociation). Low-rapid-progression membership was independently associated with poorer quality of life, greater upper limb impairment, and higher anxiety and depression risk (all P < 0.05). Symptom trajectories were independently associated with PROs after ALND. The low-rapid-progression trajectory was associated with poorer quality of life, greater upper limb impairment, and elevated anxiety and depression risk. Early identification may support risk-stratified surveillance, though whether targeted intervention improves PROs requires prospective studies. The study was registered in the Chinese Clinical Trial Registry (ChiCTR2200060685).
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BibTeX
@article{wen2026lymphedema,
title = {{Lymphedema symptom trajectories and patient-reported outcomes after axillary lymph node dissection for breast cancer: A prospective cohort study.}},
author = {Cuiju Wen and Hongjuan Sun and Xiang Li and Jingyan Xu and Jie Zhang and Lize Wang and Yang Yang and Zhaoqing Fan and Xinying Yu},
journal = {Asia-Pacific journal of oncology nursing},
year = {2026},
month = oct,
doi = {10.1016/j.apjon.2026.101041},
url = {https://europepmc.org/article/MED/42997082},
note = {CC BY},
}
RIS
TY - JOUR
TI - Lymphedema symptom trajectories and patient-reported outcomes after axillary lymph node dissection for breast cancer: A prospective cohort study.
AU - Cuiju Wen
AU - Hongjuan Sun
AU - Xiang Li
AU - Jingyan Xu
AU - Jie Zhang
AU - Lize Wang
AU - Yang Yang
AU - Zhaoqing Fan
AU - Xinying Yu
PY - 2026
DA - 2026/10/05
JO - Asia-Pacific journal of oncology nursing
DO - 10.1016/j.apjon.2026.101041
UR - https://europepmc.org/article/MED/42997082
AB - To characterize lymphedema symptom trajectories and associations with quality of life, anxiety, depression, and upper limb function in Chinese breast cancer survivors after axillary lymph node dissection (ALND). In this prospective cohort study, 332 women undergoing ALND at a cancer center were assessed preoperatively and annually through 24 months using the Breast Cancer and Lymphedema Symptom Experience Index (BCLE-SEI), Short Form-36 version 2 (SF-36v2; physical component summary [PCS], mental component summary [MCS]), Hospital Anxiety and Depression Scale (HADS), and Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH). Group-based trajectory modeling (GBTM) identified trajectories; mixed-effects models compared patient-reported outcomes (PROs) changes across groups, and multivariable regression examined trajectory-PRO associations. GBTM identified three trajectories: persistent-low (64.2%), high-stable (19.3%), and low-rapid-progression (16.6%). Significant group-by-time interactions emerged for PCS and DASH, with 12-month interactions for MCS and HADS subscales in the low-rapid-progression group. This group showed less PCS improvement and greater DASH deterioration at 12 and 24 months. For MCS, HADS-anxiety subscale (HADS-A), and HADS-depression subscale (HADS-D), interactions were significant at 12 but not 24 months, though outcomes remained worse in this group (physical-psychological dissociation). Low-rapid-progression membership was independently associated with poorer quality of life, greater upper limb impairment, and higher anxiety and depression risk (all P < 0.05). Symptom trajectories were independently associated with PROs after ALND. The low-rapid-progression trajectory was associated with poorer quality of life, greater upper limb impairment, and elevated anxiety and depression risk. Early identification may support risk-stratified surveillance, though whether targeted intervention improves PROs requires prospective studies. The study was registered in the Chinese Clinical Trial Registry (ChiCTR2200060685).
SN - 2347-5625
SN - 2349-6673
ER -