Mild symptoms matter: Results from a prospective, longitudinal study on the relationship between symptoms, lymphedema and health-related outcomes post-gynecological cancer

Melanie L Plinsinga; Sheree Rye; Tamara Jones; Dimitrios Vagenas; Leigh Ward; Monika Janda; Andreas Obermair; Sandra C Hayes

doi:10.1016/j.ygyno.2024.10.011

Mild symptoms matter: Results from a prospective, longitudinal study on the relationship between symptoms, lymphedema and health-related outcomes post-gynecological cancer

Gynecol Oncol. 2024 Oct 17:191:158-164. doi: 10.1016/j.ygyno.2024.10.011. Online ahead of print.

Authors

Melanie L Plinsinga¹, Sheree Rye², Tamara Jones³, Dimitrios Vagenas⁴, Leigh Ward⁵, Monika Janda⁶, Andreas Obermair⁷, Sandra C Hayes⁸

Affiliations

¹ School of Health Sciences and Social Work, Griffith University, Nathan, Queensland, Australia. Electronic address: m.plinsinga@griffith.edu.au.
² School of Health Sciences and Social Work, Griffith University, Nathan, Queensland, Australia.
³ School of Health Sciences and Social Work, Griffith University, Nathan, Queensland, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia.
⁴ School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
⁵ School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, Queensland, Australia.
⁶ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia.
⁷ Queensland Centre for Gynaecological Cancer Research, The University of Queensland, Herston, Queensland, Australia.
⁸ School of Health Sciences and Social Work, Griffith University, Nathan, Queensland, Australia; Cancer Council Queensland, Fortitude Valley, Queensland, Australia.

PMID: 39423553
DOI: 10.1016/j.ygyno.2024.10.011

Abstract

Objectives: To describe lower-limb symptoms pre- through to 2-years post-surgery following newly diagnosed gynecological cancer; to explore relationships between lower-limb symptoms, lower-limb lymphedema, body image, quality of life, anxiety and depression; and to determine whether lower-limb symptoms predict lower-limb lymphedema.

Methods: Fourteen lower-limb symptoms, lymphedema, body image, anxiety, depression, and quality of life were prospectively collected in 408 women with gynecological cancer pre-surgery, and at 6-, 12-, and 24-months post-surgery. Point prevalence and cumulative incidence were calculated for symptoms. Cross-sectional relationships were explored between symptoms, lower-limb lymphedema and health-related outcomes at all timepoints, while regression analyses were used to assess the predictive relationships between lower-limb symptoms at 6-months post-surgery, and lymphedema at 12- and 24-months post-surgery.

Results: Participants were on average 59 (SD: 11) years of age, and 58 %, 28 %, 9 % and 5 % were diagnosed with endometrial, ovarian, cervical, and vulvar/vaginal cancer, respectively. Prevalence of any given lower limb symptom among all cancer types ranged between 11 and 59 %, with the most prevalent symptoms being pain, stiffness, and aching (prevalence >40 % across all time-points). The presence of symptoms was associated with higher anxiety and depression, poorer overall quality of life and body image (p < 0.01). Compared to those without symptoms, one or more lower limb symptoms of at least mild severity increased the odds of developing lymphedema up to 24 months post-surgery (OR > 1.3).

Conclusions: Self-reported symptoms are associated with adverse health-related outcomes. Assessment and management of symptoms, irrespective of symptom severity, has potential for improving health outcomes, including lymphedema, in those following gynecological cancer.

Keywords: Epidemiology; Gynecological cancer; Lymphoedema.