Purpose

Lower extremity lymphedema (LEL), which causes ankle, leg, and feet swelling, poses a significant challenge for endometrial cancer survivors, impacting physical functioning and psychological well-being. Inconsistent LEL diagnostic methods result in wide-ranging LEL incidence estimates.

Methods

We calculated the cumulative incidence of LEL based on survivor-reported Gynecologic Cancer Lymphedema Questionnaire (GCLQ) responses in addition to survivor- and nurse-reported leg circumference measurements among a pilot sample of 50 endometrial cancer survivors (27 White, 23 Black) enrolled in the ongoing population-based Carolina Endometrial Cancer Study.

Results

Self-leg circumference measurements were perceived to be difficult and were completed by only 17 survivors. Diagnostic accuracy testing measures (sensitivity, specificity, positive and negative predictive value) compared the standard nurse-measured \(\ge\)10% difference in leg circumference measurements to GCLQ responses. At a mean of ~11 months post-diagnosis, 54% of survivors met established criteria for LEL based on \(\ge\)4 GCLQ cutpoint while 24% had LEL based on nurse-measurement. Percent agreement, sensitivity, and specificity approximated 60% at a threshold of \(\ge\)5 GCLQ symptoms. However, Cohen’s kappa, a measure of reliability that corrects for agreement by chance, was highest at \(\ge\)4 GCLQ symptoms (κ = 0.27).

Conclusion

Our findings emphasize the need for high quality measurements of LEL that are feasible for epidemiologic study designs among endometrial cancer survivors. Future studies should use patient-reported survey measures to assess lymphedema burden and quality of life outcomes among endometrial cancer survivors.

中文翻译：

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子宫内膜癌幸存者的淋巴水肿自我评估

目的

下肢淋巴水肿 (LEL) 会导致脚踝、腿部和足部肿胀，对子宫内膜癌幸存者构成重大挑战，影响身体机能和心理健康。不一致的 LEL 诊断方法导致 LEL 发生率估计值范围广泛。

方法

我们根据幸存者报告的妇科癌症淋巴水肿问卷 (GCLQ) 反应以及幸存者和护士报告的腿围测量值，计算了 LEL 的累积发生率，该样本包括 50 名子宫内膜癌幸存者（27 名白人，23 名黑人）。正在进行的基于人群的卡罗莱纳子宫内膜癌研究。

结果

自我测量腿围被认为是困难的，只有 17 名幸存者完成了。诊断准确性测试措施（敏感性、特异性、阳性和阴性预测值）将标准护士测量的腿围测量值 10% 差异与 GCLQ 反应进行了比较。诊断后平均约 11 个月，54% 的幸存者符合基于\(\ge\) 4 GCLQ 切点的既定 LEL 标准，而 24% 的幸存者具有基于护士测量的 LEL。在\(\ge\) 5 个 GCLQ 症状的阈值下，一致性百分比、敏感性和特异性接近 60% 。然而，Cohen 的 kappa（一种校正偶然一致性的可靠性度量）在\(\ge\) 4 GCLQ 症状时最高 (κ = 0.27)。

结论

我们的研究结果强调需要对 LEL 进行高质量的测量，这对于子宫内膜癌幸存者的流行病学研究设计是可行的。未来的研究应使用患者报告的调查措施来评估子宫内膜癌幸存者的淋巴水肿负担和生活质量结果。