A new study from researchers with The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) has found that nearly one-third of older adult female survivors of colorectal, endometrial, and ovarian cancer have quality of life-impacting challenges with physical activity due to chronic swelling (lymphedema) in the lower extremities. This is the first study to assess lower lymphedema in colon cancer survivors to assess their levels of physical functioning and their ability to perform activities of daily living.
“Survivors of cancer continue to live longer thanks to early detection and more effective treatment, but long-term quality of life has become even more critical as a result. Studies show that when a person has limited physical ability it impacts both mental and physical health – and that impact layers over time to be even more challenging as individuals age,” said Electra Paskett, senior author of the study and associate director of population sciences and community outreach at the OSUCCC – James.
The findings, reported in the journal Jama Oncology underscore the importance of regularly assessing whether older cancer survivors are developing lymphedema in their lower extremities in order to provide early interventions that can help preserve physical ability and independence of this cohort patients. Currently, there are no clinical guidelines for these assessments for older cancer survivors.
For the study, the researchers enrolled 900 women diagnosed with colorectal, endometrial, and ovarian cancer with an average age of 78.5 (with a range of 5.9 years) and the average time since was 8.75 years (ranging from 1.42 to 20.23 years). Of the 900 women, 292 reported lower extremity lymphedema (LEL), a rate of 32.4%. There were minor variations of rates of LEL depending on which cancer each women had been diagnosed with. Colorectal cancer survivors in the study showed the highest rate of LEL at 36.5% (38 of 104 women), followed by survivors of endometrial cancer at 32.5% (122 of 375) and 31.4% of colorectal cancer survivors (132 of 421).
While severe cases of lymphedema can lead to the loss of a limb due to infections that can be caused by the disease, most symptoms include swelling of the affected limb, heaviness, pain, and discomfort. The chronic disease is also associated with decreased mobility in legs and arms. For this reason, the researchers also looked to see how the development of lymphedema affected cancer survivors’ quality of life.
To do this the team compared those cancer survivors with LEL in the cohort with those who hadn’t developed the condition and assessed their physical functioning and activities of daily living limitations. Unsurprisingly, the women with LEL showed decreased physical functioning and more limitations in their activities of daily living compared with those without the condition. The decrease in physical functioning was also highest among colorectal cancer survivors, who also needed more help with their activities of daily living.
“Our data call attention to a significant and important challenge for a large portion of female cancer survivors that deserves meaningful attention and action from the medical community as part of long-term survivorship care,” Paskett said. “It isn’t just about surviving cancer; people deserve to thrive in life post-cancer. Our findings suggest an urgent need to identify and implement interventions—especially among older survivors of cancer—to reduce lower extremity lymphedema symptoms, improve physical functioning, and maintain or improve affected individuals’ ability to maintain independent living and quality of life.”