five or six problems (P .0002) (5). Passik et al. (62), in a
study of 69 women being treated for breast cancer treatmentrelated
lymphedema, found that 25% of lymphedema patients
experienced pain and that lymphedema was associated with distress,
decreased functioning, and decreased sexual desire. Although
patients with arm edema had high levels of psychological
distress and of sexual and social dysfunction as measured by the
Brief Symptom Inventory (63), no linear relationship between
severity of edema and levels of distress was identified (62). In a
group of 76 patients who had been treated for early-stage breast
cancer with wide excision and axillary dissection, the presence
of arm edema had a stronger association with psychological
functioning and perceptions of body image in younger patients
(60 years old) and for patients treated more than 5 years earlier
than in older patients and those treated less than 5 years earlier
(58).
Psychological dysfunction secondary to lymphedema has also
been described in case–control studies. Tobin et al. (55) conducted
a series of case–control studies with 100 subjects to
identify the degree of psychological dysfunction experienced by
patients with lymphedema. Patients with lymphedema had significantly
more anxiety and depression based on the Clinical
Interview Scale, a semistructured standard mental state examination
(64); they also experienced poorer adjustment to their
illness, as measured by the Psychosocial Adjustment to Illness
Scale (65), in the areas of vocational, domestic, and social environments
as well as sexual relationships and psychological
distress (55). This impaired psychosocial adjustment was not
consistently related to the amount of edema; in fact, it persisted
after a significant reduction in edema following 6 months of
individualized lymphedema treatment in the majority of patients
(81%) (55).
five or six problems (P .0002) (5). Passik et al. (62), in astudy of 69 women being treated for breast cancer treatmentrelatedlymphedema, found that 25% of lymphedema patientsexperienced pain and that lymphedema was associated with distress,decreased functioning, and decreased sexual desire. Althoughpatients with arm edema had high levels of psychologicaldistress and of sexual and social dysfunction as measured by theBrief Symptom Inventory (63), no linear relationship betweenseverity of edema and levels of distress was identified (62). In agroup of 76 patients who had been treated for early-stage breastcancer with wide excision and axillary dissection, the presenceof arm edema had a stronger association with psychologicalfunctioning and perceptions of body image in younger patients(60 years old) and for patients treated more than 5 years earlierthan in older patients and those treated less than 5 years earlier(58).Psychological dysfunction secondary to lymphedema has alsobeen described in case–control studies. Tobin et al. (55) conducteda series of case–control studies with 100 subjects toidentify the degree of psychological dysfunction experienced bypatients with lymphedema. Patients with lymphedema had significantlymore anxiety and depression based on the ClinicalInterview Scale, a semistructured standard mental state examination(64); they also experienced poorer adjustment to theirillness, as measured by the Psychosocial Adjustment to IllnessScale (65), in the areas of vocational, domestic, and social environmentsas well as sexual relationships and psychologicaldistress (55). This impaired psychosocial adjustment was notconsistently related to the amount of edema; in fact, it persistedafter a significant reduction in edema following 6 months ofindividualized lymphedema treatment in the majority of patients(81%) (55).
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