Abstract：
BACKGROUND: Upper limb lymphedema (ULL) is a common and deliberating complication for breast cancer survivors (BCSs). Breast cancer survivors with ULL reported a wide range of symptoms. However, little is known about symptom patterns and interrelationships among them. This study was designed to explore symptom clusters and construct symptom networks of ULL-related symptoms among BCSs and to identify the core symptoms.
METHODS: This study is a secondary data analysis using datasets from three cross-sectional studies of BCSs in China. A total of 341 participants with maximum interlimb circumference ≥2 cm and complete responses in Part I of the Breast Cancer and Lymphedema Symptom Experience Index were included. Symptom clusters were identified through principal component analysis, and multiple linear regression analysis was employed to explore factors associated with severity of overall ULL-related symptoms. A contemporaneous network with 20 frequently reported symptoms were constructed after controlling for covariates.
RESULTS: Three symptom clusters, including lymph stasis symptom cluster, nerve symptom cluster, and movement limitation symptom cluster, were identified. Postsurgery time, axillary lymph node dissection, and radiotherapy were associated with the severity of ULL-related symptoms. Tightness (rs = 1.379; rscov = 1.097), tingling (rs = 1.264; rscov = 0.925), and firmness (rs = 1.170; rscov = 0.923) were the most central symptoms in both networks with and without covariates.
CONCLUSIONS: Breast cancer survivors with ULL experienced severe symptom burden. Tightness, tingling, and firmness were core symptoms of ULL among BCSs. Our findings demonstrated that the assessment and targeted intervention of specific core symptoms might help to relive effectively the burden of ULL-related symptom among BCSs.
METHODS: This study is a secondary data analysis using datasets from three cross-sectional studies of BCSs in China. A total of 341 participants with maximum interlimb circumference ≥2 cm and complete responses in Part I of the Breast Cancer and Lymphedema Symptom Experience Index were included. Symptom clusters were identified through principal component analysis, and multiple linear regression analysis was employed to explore factors associated with severity of overall ULL-related symptoms. A contemporaneous network with 20 frequently reported symptoms were constructed after controlling for covariates.
RESULTS: Three symptom clusters, including lymph stasis symptom cluster, nerve symptom cluster, and movement limitation symptom cluster, were identified. Postsurgery time, axillary lymph node dissection, and radiotherapy were associated with the severity of ULL-related symptoms. Tightness (rs = 1.379; rscov = 1.097), tingling (rs = 1.264; rscov = 0.925), and firmness (rs = 1.170; rscov = 0.923) were the most central symptoms in both networks with and without covariates.
CONCLUSIONS: Breast cancer survivors with ULL experienced severe symptom burden. Tightness, tingling, and firmness were core symptoms of ULL among BCSs. Our findings demonstrated that the assessment and targeted intervention of specific core symptoms might help to relive effectively the burden of ULL-related symptom among BCSs.
摘要：
背景：上肢淋巴水肿（ULL）是乳腺癌幸存者（BCSs）的常见并发症。患有ULL的乳腺癌幸存者报告了广泛的症状。然而,对症状模式和它们之间的相互关系知之甚少。本研究旨在探索症状群，构建BCS中与ULL相关症状的症状网络，并识别核心症状。
方法：本研究是使用来自中国BCS的三个横断面研究的数据集进行的二次数据分析。共纳入341名参与者，其最大肢间周长≥2cm，并且在乳腺癌和淋巴水肿症状经验指数的第一部分中完全缓解。通过主成分分析确定症状簇，并采用多元线性回归分析探讨与整体ULL相关症状严重程度相关的因素.在控制协变量后，构建了具有20个频繁报告症状的同期网络。
结果：三个症状群，包括淋巴淤滞症状群，神经症状群，和运动受限症状群，已确定。术后时间,腋窝淋巴结清扫术,放疗与ULL相关症状的严重程度相关.紧密度（rs=1.379；rscov=1.097），刺痛（rs=1.264；rscov=0.925），和硬度（rs=1.170;rscov=0.923）是有和没有协变量的两个网络中最主要的症状。
结论：患有ULL的乳腺癌幸存者经历了严重的症状负担。紧密度,刺痛,坚定是BCS中ULL的核心症状。我们的研究结果表明，对特定核心症状的评估和有针对性的干预可能有助于有效地减轻BCS中ULL相关症状的负担。
方法：本研究是使用来自中国BCS的三个横断面研究的数据集进行的二次数据分析。共纳入341名参与者，其最大肢间周长≥2cm，并且在乳腺癌和淋巴水肿症状经验指数的第一部分中完全缓解。通过主成分分析确定症状簇，并采用多元线性回归分析探讨与整体ULL相关症状严重程度相关的因素.在控制协变量后，构建了具有20个频繁报告症状的同期网络。
结果：三个症状群，包括淋巴淤滞症状群，神经症状群，和运动受限症状群，已确定。术后时间,腋窝淋巴结清扫术,放疗与ULL相关症状的严重程度相关.紧密度（rs=1.379；rscov=1.097），刺痛（rs=1.264；rscov=0.925），和硬度（rs=1.170;rscov=0.923）是有和没有协变量的两个网络中最主要的症状。
结论：患有ULL的乳腺癌幸存者经历了严重的症状负担。紧密度,刺痛,坚定是BCS中ULL的核心症状。我们的研究结果表明，对特定核心症状的评估和有针对性的干预可能有助于有效地减轻BCS中ULL相关症状的负担。
