Lower Limb Lymphedema and Quality of Life in Gynecologic Cancer Patients

Sun Young Yu; Jeong Hye Kim

doi:10.5388/aon.2017.17.1.20

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Yu and Kim: Lower Limb Lymphedema and Quality of Life in Gynecologic Cancer Patients

Original Article

Asian Oncology Nursing 2017; 17(1): 20-28.

Published online: 31 March 2017

DOI: https://doi.org/10.5388/aon.2017.17.1.20

Lower Limb Lymphedema and Quality of Life in Gynecologic Cancer Patients

Sun Young Yu¹, Jeong Hye Kim²

¹Department of Nursing, Asan Medical Center, Seoul, Korea.

²Department of Clinical Nursing, University of Ulsan, Seoul, Korea.

Address reprint requests to: Kim, Jeong Hye. Department of Clinical Nursing, University of Ulsan, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea. Tel: +82-2-3010-5335, Fax: +82-2-3010-5332, kimjh@amc.seoul.kr

Received 30 November 2016 Revised 3 January 2017 Accepted 21 March 2017

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to identify the lower limb lymphedema (LLL) and quality of life in gynecologic cancer patients.

Methods

A sample of 143 patients who have received pelvic lymphadenectomy and/or para-aortic lymphadenectomy recruied in the descriptive study. The instruments used were the Korean Version of the Gynecologic Cancer Lymphedema Questionnaire (GCLQ-K) and the European Organization for Research and Treatment of Cancer QOL Questionnaire-C30 (EORTC QLQ C-30).

Results

The level of LLL for all patients was 4.31±3.86. The level of GCLQ-K score was higher in the LLL group than the non LLL group (8.38±2.92 vs 1.76±1.41). The all functional scale score was lower in the LLL group than the non LLL group, and all symptom scale score except for appetite loss and financial difficulties was higher in the LLL group than the non LLL group. The global health status score was lower in the LLL group than the non LLL group.

Conclusion

The above results show that in the LLL patients after pelvic and/or para-aortic, lymphadenectomy was common. The quality of life was lower in the LLL group than the non LLL group. It is important to develop nursing intervention regarding prevention and management about LLL in gynecologic cancer patients.

Keywords: Gynecology, Lower Extremity, Lymphedema, Quality of Life

Figures and Tables

Table 1

General Characteristics of Participants (N=143)

Variables	Categories	n (%) or M ± SD
Age (year)	≤40	18 (12.6)
	41~50	42 (29.4)
	51~60	62 (43.3)
	≥61	21 (14.7)
		51.1 ± 9.9
Education	≤Middle School	23 (16.1)
	High School	69 (48.2)
	≥College	51 (35.7)
Economic status (10,000 won/month) (n=133)	＜100	15 (11.3)
	100~499	77 (57.9)
	≥500	41 (30.8)
Type of cancer	Ovarian	103 (72.0)
	Endometrial	11 (7.7)
	Cervical	20 (14.0)
	Others	9 (6.3)
Stage of cancer (n=141)	Stage I	29 (19.9)
	Stage II	24 (17.0)
	Stage III	62 (44.0)
	Stage IV	27 (19.1)
Cancer recurrence	Yes	93 (65.0)
Cancer recurrence	No	50 (35.0)
Time period since surgery (month)	≤12	62 (43.3)
	13~24	39 (27.3)
	≥25	42 (29.4)
		17.18 ± 11.94
Number of removal lymphnode (n=142)		42.51 ± 23.10
Node metastasis (n=142)	Yes	89 (62.7)
Node metastasis (n=142)	No	53 (37.3)
Type oflymphadenectomy	PLND	95 (66.4)
Type oflymphadenectomy	PLND & PALND	48 (33.6)
Chemotherapy	Yes	139 (97.2)
Chemotherapy	No	4 (2.8)
Radiotherapy	Yes	21 (14.7)
Radiotherapy	No	122 (85.3)
Comorbodity	Yes	36 (25.2)
Comorbodity	No	107 (74.8)
Lower limb lymphedema	Yes	55 (38.5)
Lower limb lymphedema	No	88 (61.5)

PLND= Pelvic lymphadenectomy: PALND= Pelvic & Para-aortic lymphadenectomy.

Table 2

Lower Limb Lymphedema of Participants (N=143)

Subscale	Item number	Items	n (%) or M ± SD
Physical function	1	Limited movement of your hip	16 (11.2)
	2	Limited movement of your knee	22 (15.4)
	3	Limited movement of your ankle	18 (12.6)
	4	Limited movement of your foot	25 (17.5)
	5	Limited movement of your toes	33 (23.1)
	6	Leg or foot feels weak	85 (59.4)
Swelling [general]	8	Experienced swelling	47 (32.9)
	9	Experienced swelling with pitting	25 (17.5)
	20	Experienced pockets of fluid	1 (0.7)
Infection	10	Experienced redness	15 (10.5)
	11	Experienced blistering	5 (3.5)
	13	Experienced increased temperature in the leg	27 (18.9)
Neuropathy	7	Experienced tenderness	22 (15.4)
	12	Experienced firmness/tightness	39 (27.3)
	15	Experienced numbness	35 (24.5)
	16	Experienced stiffness	51 (35.7)
Swelling [limb]	18	Experienced hip swelling	10 (7.0)
Swelling [limb]	19	Experienced groin swelling	24 (16.8)
Heaviness	14	Experienced heaviness	60 (42.0)
Ache	17	Experienced aching	56 (39.2)

Table 3

Lower Limb Lymphedema according to General Characteristics (N=143)

Variables	Categories	LLL (n=55)	Non LLL (n=88)	χ² or t (p)
Variables	Categories	n (%) or M ± SD	n (%) or M ± SD	χ² or t (p)
Age (year)	≤40	7 (12.7)	11 (12.6)	2.51 (.473)
	41~50	14 (25.5)	28 (31.8)
	51~60	28 (50.9)	34 (38.6)
	≥61	6 (10.9)	15 (17.0)
		50.6 ± 9.3	51.3 ± 10.3	0.41 (.683)
Education	≤Middle school	11 (20.0)	12 (13.6)	2.07 (.356)
	High school	28 (50.9)	41 (46.6)
	≥College	16 (29.1)	35 (39.8)
Economic status (10,000 won/month) (n=133)	<100	7 (13.5)	8 (9.9)	0.43 (.808)
	100~499	29 (55.8)	48 (59.2)
	≥500	16 (30.7)	25 (30.9)
Type of cancer	Ovarian	38 (69.1)	65 (73.9)	1.35 (.717)
	Endometrial	4 (7.3)	7 (7.9)
	Cervical	10 (18.2)	10 (11.4)
	Others	3 (5.4)	6 (6.8)
Stage of cancer (n=141)	Stage I	11 (20.4)	17 (19.5)	3.33 (.344)
	Stage II	6 (11.1)	18 (20.7)
	Stage III	28 (51.8)	34 (39.1)
	Stage IV	9 (16.7)	18 (20.7)
Cancer recurrence	Yes	40 (72.7)	53 (60.2)	2.33 (.151)
Cancer recurrence	No	15 (27.3)	35 (39.8)	2.33 (.151)
Time period since surgery (month)	≤12	22 (40.0)	40 (45.4)	0.58 (.750)
	13~24	15 (27.3)	24 (27.3)
	≥25	18 (32.7)	24 (27.3)
		18.04 ± 12.42	16.65 ± 11.67	−0.68 (.501)
Number of removal lymphnode (n=142)		47.31 ± 23.38	39.47 ± 22.54	−1.99 (.049)
Node metastasis (n=142)	Yes	39 (70.9)	50 (57.5)	2.60 (.114)
Node metastasis (n=142)	No	16 (29.1)	37 (42.5)	2.60 (.114)
Type of lymphadenectomy	PLND	16 (29.1)	22 (25.0)	0.29 (.698)
Type of lymphadenectomy	PLND & PALND	39 (70.9)	66 (75.0)	0.29 (.698)
Chemotherapy	Yes	54 (98.2)	84 (95.5)	0.75 (.649)
Chemotherapy	No	1 (1.8)	4 (4.5)	0.75 (.649)
Radiotherapy	Yes	12 (21.8)	9 (10.2)	3.63 (.087)
Radiotherapy	No	43 (78.2)	79 (89.8)	3.63 (.087)
Comorbidity	Yes	15 (27.3)	21 (23.9)	0.21 (.694)
Comorbidity	No	40 (72.7)	67 (76.1)	0.21 (.694)

LLL= Lower Limb Lymphedema; PLND= Pelvic lymphadenectomy; PALND= Pelvic & Para-aortic lymphadenectomy.

Table 4

Level of Lower Limb Lymphedema and Quality of Life (N=143)

Variables	Categories	Total	LLL (n=55)	Non LLL (n=88)	t (p)
Variables	Categories	M ± SD	M ± SD	M ± SD	t (p)
Level of LLL		4.31 ± 3.86	8.38 ± 2.92	1.76 ± 1.41	−15.67 (<.001)
Quality of life	Functional scale
	Physical functioning	73.75 ± 16.10	62.54 ± 15.42	80.75 ± 12.10	7.44 (<.001)
	Role functioning	70.16 ± 24.69	54.84 ± 23.71	79.73 ± 20.12	6.71 (<.001)
	Emotional functioning	74.35 ± 21.21	66.81 ± 23.43	79.07 ± 18.30	3.49 (.001)
	Cognitive functioning	77.97 ± 18.72	73.63 ± 21.44	80.68 ± 16.35	2.22 (.028)
	Social functioning	65.38 ± 26.76	56.06 ± 26.71	71.21 ± 25.23	3.42 (.001)
	Symptom scales
	Fatigue	38.22 ± 20.24	49.69 ± 21.58	31.06 ± 15.63	−5.56 (<.001)
	Nausea and vomiting	16.90 ± 23.73	24.54 ± 26.99	12.12 ± 20.17	−2.94 (.004)
	Pain	24.35 ± 26.14	38.18 ± 28.44	15.71 ± 20.42	−5.09 (<.001)
	Dyspnea	20.97 ± 27.02	32.12 ± 31.40	14.01 ± 21.27	−4.11 (<.001)
	Insomnia	30.30 ± 31.37	40.60 ± 34.36	23.86 ± 27.65	−3.20 (.002)
	Appetite loss	24.24 ± 28.30	29.69 ± 31.21	20.83 ± 27.65	−1.84 (.068)
	Constipation	25.40 ± 30.11	38.78 ± 33.80	17.04 ± 24.23	−4.15 (<.001)
	Diarrhea	12.12 ± 22.21	18.18 ± 28.55	8.30 ± 16.18	−2.33 (.009)
	Financial difficulties	25.40 ± 29.59	29.69 ± 29.86	22.72 ± 29.27	−1.37 (.171)
	Global health status/QOL
	Global health status	58.68 ± 22.37	50.45 ± 21.60	63.82 ± 21.40	3.62 (<.001)

LLL= Lower Limb Lymphedema; QOL= quality of life.

Table 5

Correlation between Lower Limb Lymphedema and Quality of Life (N=143)

Variables	Categories	Total	LLL (n=55)	Non LLL (n=88)
Variables	Categories	r (p)	r (p)	r (p)
Functional scale	Physical functioning	−.64 (<.001)	−.42 (.001)	−.36 (.001)
	Role functioning	−.53 (<.001)	−.17 (.216)	−.39 (<.001)
	Emotional functioning	−.24 (.004)	.04 (.761)	−.10 (.359)
	Cognitive functioning	−.31 (<.001)	−.26 (.056)	−.38 (<.001)
	Social functioning	−.32 (<.001)	−.16 (.254)	−.22 (.043)
Symptom scale	Fatigue	.46 (<.001)	.15 (.274)	.21 (.054)
	Nausea and vomiting	.29 (<.001)	.32 (.019)	−.15 (.175)
	Pain	.48 (<.001)	.32 (.019)	.19 (.075)
	Dyspnea	.35 (<.001)	.07 (.600)	.30 (.004)
	Insomnia	.30 (<.001)	.25 (.068)	.01 (.925)
	Appetite loss	.21 (.012)	.19 (.162)	.11 (.327)
	Constipation	.34 (<.001)	.15 (.284)	.01 (.939)
	Diarrhea	.26 (.002)	.20 (.136)	.02 (.847)
	Financial difficulties	.21 (.012)	.21 (.130)	.24 (.022)
Global health status/QOL	Global health status Quality of life	−.34 (<.001)	−.06 (.644)	−.34 (.001)

LLL= Lower Limb Lymphedema; QOL= Quality of life.

Notes

The article is a revision of the first author's mater's thesis from Ulsan University.

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