Secondary lymphedema of the arm, the perception of the disease, self-efficacy and depression as determinants of quality of life in patients with breast cancer
Abstract
Background/Aim. Secondary lymphedema of the arm is one of possible side-effects and complications of breast cancer and its treatment which can contribute and precipitate to a number of new psychosocial problems. The aim of this study was to examine the differences in quality of life of patients suffering from breast cancer, with arm lymphedema and those without lymphedema, and to determine the significance of the perception of the disease, depressive symptoms and self-efficacy contribution to overall quality of life. Methods. The research was designed as a cross-sectional study, which included 64 patients – 34 with arm lymphedema and 30 without lymphedema. Questionnaire FACT-B + 4 was applied to assess the quality of life, BIPQ for the perception of the disease, depression was measured by DASS-21 scale, while self-efficacy was tested by SGSE scale. T-test, Mann Whitney U Test, χ2 test and hierarchical regression analysis were applied to data processing. Results. There was not any significant difference between the groups in the total score of quality of life (t = 0.469, p > 0.05), or in the individual subscales: physical well-being (t = 0.535, p > 0.05), social/family well-being (t = 1.43, p > 0.05), emotional well-being (t = 1.35, p > 0.05), functional well-being (z = -0.243, p > 0.05), breast cancer scale (t = -0.839, p > 0.05) and arm scale (t = -0.514, p >0.05), while the perception of the disease (β = -0.603, t = -5.958, p < 0.001) and depression (β = -0.411, t = - 4.101, p < 0.001) proved to be significant predictors of quality of life and explain 50.2% variance of overall quality of life. Conclusion. The results of our study indicate the importance of a comprehensive rehabilitation program, directed both at functional and psychosocial aspects.
References
References
Revicki DA. Health-related quality of life in the evaluation of medical therapy for chronic illness. J Fam Pract 1989; 29(4): 377–92.
Bomar L, Humphrey K. Lymphedema. Rehab Oncol 1999; 17(2): 25–8.
Chan DN, Lui LY, So WK. Effectiveness of exercise pro¬grams on shoulder mobility and lymphedema after axillary lymph node dissection for breast cancer: Systematic re¬view. J Adv Nurs 2010; 66(9): 1902–14.
Chan DN, So WK. Developing an evidence-based exercise guideline on improving shoulder motion and lessening the se-verity of lymphedema for breast cancer patients after axillary lymph-node dissection. Clin Oncol Cancer Res 2010; 7(3): 169–74.
Popović-Petrović S. Risk factors for development of the sec-ondary lymphedema of the arm in malignant breast tu¬mors [dissertation]. Novi Sad: Faculty of Medicine; 2008. (Serbian)
Popović-Petrović S, Tomić S, Popović M. Rehabilitation in on¬cology. HealthMED 2010; 4(4): 815–8.
Popović-Petrović S, Nedeljković M, Popović L, Petrović V. Sec¬ondary lymphedema of the arm in breast carcinoma at the Oncology institute of Vojvodina: 2001-2006. Health¬MED 2011; 5(6): 1719–24.
Popović-Petrović S, Vasović M, Nedeljković M. Prevention and treatment of secondary lymphedema of arm in breast cancer. Arch Oncol 2002; 10(2): 77–8.
Popović-Petrović S, Tomić S, Nedeljković M, Popović L, Ma¬tovina G. Early rehabilitation in patients operated for breast carcinoma. Vojnosanit Pregl 2013; 70(4): 407–10.
Passik SD, McDonald MV. Psychosocial aspects of upper ex-tremity lymphedema in women treated for breast carci¬noma. Cancer 1998; 83(12 Suppl American): 2817–20.
Tobin MB, Lacey HJ, Meyer L, Mortimer PS. The psychologi¬cal morbidity of breast cancer-related arm swelling. Psy¬chological morbidity of lymphoedema. Cancer 1993; 72(11): 3248–52.
Velanovich V, Szymanski W. Quality of life of breast can¬cer pa-tients with lymphedema. Am J Surg 1999; 177(3): 184–7; dis-cussion 188.
Beaulac SM, Mcnair LA, Scott TE, la Morte WW, Kavanah MT. Lymphedema and quality of life in survivors of early-stage breast cancer. Arch Surg 2002; 137(11): 1253–7.
Hormes JM, Bryan C, Lytle LA, Gross CR, Ahmed RL, Troxel AB, et al. Impact of lymphedema and arm symp¬toms on quali-ty of life in breast cancer survivors. Lym¬phology 2010; 43(1): 1–13.
Morgan PA, Franks PJ, Moffatt CJ. Health-related quality of life with lymphoedema: A review of the literature. Int Wound J 2005; 2(1): 47–62.
Bugarski V, Biro M, Novović Z. Relations between the qual¬ity of life and depressive characteristics in patients on haemodialysis. Appl Psychol 2009; 2(1): 5–24.
Leventhal H, Diefenbach M, Leventhal EA. Illness cognition: Us-ing common sense to understand treatment adherence and af-fect cognition interactions. Cogn Ther Res 1992; 16(2): 143–63.
Bandura A, Adams NE, Hardy AB, Howells GN. Tests of the generality of self-efficacy theory. Cogn Ther Res 1980; 4(1): 39–66.
Smith HM, Betz NE. An examination of efficacy and esteem pathways to depression in young adulthood. J Couns Psy¬chol 2002; 49(4): 438–48.
Kohler CL, Fish L, Greene PG. The relationship of per¬ceived self-efficacy to quality of life in chronic obstructive pulmo-nary disease. Health Psychol 2002; 21(6): 610–14.
Giese-Davis J, Koopman C, Butler LD, Classen C, Morrow GR, Spiegel D. Self-efficacy with emotions predicts higher quality of life in primary breast cancer patients. In: Brady M (Chair), Self efficacy and cancer: Theory, assessment, and treatment. Symposium conducted at the meetin of the Society of Behav-ioral Medicine, San Diego, CA: American Psychological Asso-ciation; 1999.
Merluzzi TV, Nairn MA. An exploration of self-efficacy and longevity in persons with cancer. 20th annual meeting of the Society of Behavioral Medicine; 1999; San Diego, Cali¬fornia: American Psychological Association; 1999.
Ganz PA, Guadagnoli E, Landrum MB, Lash TL, Rakowski W, Silliman RA. Breast Cancer in Older Women: Quality of Life and Psychosocial Adjustment in the 15 Months Af¬ter Diagno-sis. J Clin Oncol 2003; 21(21): 4027–33.
Mols F, Vingerhoets AJ, Coebergh JW, van de Poll-Franse LV. Quality of life among long-term breast cancer survivors: A sys-tematic review. Eur J Cancer 2005; 41(17): 2613–9.
Brady MJ, Cella DF, Mo F, Bonomi AE, Tulsky DS, Lloyd SR, et al. Reliability and validity of the Functional Assessment of Cancer Therapy-Breast quality-of-life instrument. J Clin On-col 1997; 15(3): 974–86.
Broadbent E, Petrie K, Main J, Weinman J. The brief illness per-ception questionnaire. J Psychosom Res 2006; 60(6): 631–7.
Broadbent E, Wilkesa C, Koschwaneza H, Weinmanb J, Nor¬ton S, Petrie KJ. A systematic review and meta-analysis of the Brief Illness Perception Questionnaire. Psychol Health 2015; 30(11): 1361–85.
Lovibond PF, Lovibond SH. The structure of negative emo¬tional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety In¬ventories. Behav Res Ther 1995; 33(3): 335–43.
Jovanović V, Gavrilović-Jerković V, Žuljević D, Brdarić D. Psycho-metric evaluation of the depression anxiety stress Scales -21 (DASS-21) in a Serbian student sample. Psi¬hologija 2014; 47(1): 93–112. (Serbian)
Schwarzer R, Jerusalem M. Generalized Self-Efficacy scale. In: Weinman J, Wright S, Johnston M, editors. Measures in health psychology: A user's portfolio. Causal and control beliefs. Windsor, U. K.: NFER-NELSON; 1995. p. 35–7
Scholz U, Gutiérrez-Doña B, Sud S, Schwarzer R. Is general self-efficacy a universal construct?, Psychometric findings from 25 countries. Eur J Psychol Assess 2002; 18(3): 242–51.
Chachaj A, Małyszczak K, Pyszel K, Lukas J, Tarkowski R, Pu-dełko M, et al. Physical and psychological impairments of women with upper limb lymphedema following breast cancer treatment. Psychooncology 2010; 19(3): 299–305.
Pain SJ, Vowler S, Purushotham AD. Is physical function a more appropriate measure than volume excess in the as¬sessment of breast cancer-related lymphoedema (BCRL)?. Eur J Cancer 2003; 39(15): 2168–72.
Pereira de Godoy JM, Braile DM, de Fatima Godoy M, Longo O Jr. Quality of life and peripheral lymphedema. Lym¬phology 2002; 35(2): 72–5.
Kim SJ, Yi CH, Kwon OY. Effect of complex decongestive therapy on edema and the quality of life in breast cancer pa-tients with unilateral leymphedema. Lymphology 2007; 40(3): 143–51.
Kim SJ. The long term effects of complex decongestive physi-cal therapy on lower extremity secondary lymphoe¬dema and quality of life. J Phys Ther Sci 2011; 23(1): 155–9.
Buragadda S, Alhusaini A, Melam GR, Arrora N. Effect of complete decongestive therapy and home program on health- related quality of life in post mastectomy lymphe¬dema pa-tients. J Phys Ther Sci 2015; 27(9): 2743–8.
Ashley L, Marti J, Jones H, Velikova G, Wright E. Illness per-ceptions within 6 months of cancer diagnosis are an inde-pendent prospective predictor of future health-related quality of life 15 months post-diagnosis. Psychooncology 2015; 24(11): 1463–70.
Reich M, Lesur A, Perdrizet-Chevallier C. Depression, qual¬ity of life and breast cancer: A review of the literature. Breast Can-cer Res Treat 2008; 110(1): 9–17.
Mosher CE, Duhamel KN, Egert J, Smith MY. Self-efficacy for coping with cancer in a multiethnic sample of breast cancer patients: Associations with barriers to pain man¬agement and distress. Clin J Pain 2010; 26(3): 227–34.
Yeung NC, Lu Q. Affect as a mediator between self-efficacy and quality of life among Chinese cancer survivors in China. Eur J Cancer Care (Engl) 2014; 23(1): 149–55.
