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Article

Factors Associated With Fear of Lymphedema After Treatment for Breast Cancer

Lauren S. Jammallo
Cynthia L. Miller
Nora K. Horick
Melissa N. Skolny
Jean O'Toole
Michelle C. Specht
Alphonse G. Taghian
ONF 2014, 41(5), 473-483 DOI: 10.1188/14.ONF.473-483

Purpose/Objectives: To identify demographic and treatment characteristics associated with postoperative fear of lymphedema.

Design: Prospective cohort study.

Setting: Outpatient breast clinic at a comprehensive cancer center in the northeastern United States.

Sample: 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.

Main Research Variables: Postoperative fear of lymphedema.

Findings: 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.

Implications for Nursing: Individualized education that begins preoperatively, continues throughout treatment, and is re-emphasized 24 months postoperatively may help minimize fear of lymphedema.

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