Li-Ping Ge,1,2,* Lichen Tang,1,2,* WenJia Zuo,1 Changmin Zhou,3 Tianhao Gao,4 Yun Li,1 Cuixia Fu,1 Jiajia Qiu,1 Ping Li,1 Rongrong Lu,4 Li Chen,5 Yunzi Xue,6 Zhou Shen,6 Zhimin Shao,1,2 Genhong Di,1,2 Wei Feng7 

1Department of Breast Surgery, Fudan University Shanghai Cancer Center; Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai, 200032, People’s Republic of China; 2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People’s Republic of China; 3Department of Cancer Prevention, Fudan University Shanghai Cancer Center; Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai, 200032, People’s Republic of China; 4Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, People’s Republic of China; 5Department of Medical Ultrasound, Huashan Hospital, Fudan University, Shanghai, 200040, People’s Republic of China; 6Shanghai Yun Dong Rehabilitation Medical Clinic, Shanghai, 200031, People’s Republic of China; 7Department of Psychological Medicine, Fudan University Shanghai Cancer Center; Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai, 200032, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Wei Feng; Genhong Di, Email ffww06@163.com; dgh_2015@126.com

Background: Lymphedema and psychological distress, including anxiety and depression, are common in breast cancer patients post-surgery. This study aimed to assess the incidence and determinants of anxiety and depression in patients with acute lymphedema (ALE) following breast cancer surgery.
Methods: A retrospective study was conducted on 1613 breast cancer patients who underwent surgery at Fudan University Shanghai Cancer Center in 2018. ALE was defined as lymphatic fluid accumulation causing limb swelling and was classified by the difference in arm circumference. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale (HADS) at discharge. Descriptive statistics and logistic regression were used to identify psychological distress-related factors.
Results: Among the 1613 patients, 363 (22.5%) had ALE. Anxiety was observed in 31% and depression in 21% of patients. ALE significantly impacted anxiety in the multivariate analysis (OR = 1.57, 95% CI: [1.04– 2.38], P = 0.033). Multivariate analysis of ALE patients showed that longer hospital stays (OR = 0.51, 95% CI: [0.30– 0.88], P = 0.017) and invasive disease (OR = 0.39, 95% CI: [0.19– 0.78], P = 0.008) were associated with reduced anxiety; while lymph-vessel invasive disease was associated with increased anxiety (OR = 5.97, 95% CI: [1.15– 30.97], P = 0.034). ALE had no significant impact on depression in the multivariate analysis. However, menopause (OR = 0.72, 95% CI: [0.56– 0.94], P = 0.014) and longer hospitalization (OR = 1.30, 95% CI: [1.00– 1.68], P = 0.047) influenced depression in all patients. In the ALE group, lymph node surgery was the only significant factor for depression (OR = 8.67, 95% CI: [1.56– 48.23], P = 0.014) in the multivariate analysis.
Conclusion: Psychological stress, influenced by both surgical factors and emotional states, is associated with ALE development. Addressing both psychological and surgical factors is crucial for improving outcomes and quality of life in post-surgery breast cancer patients.

Keywords: breast cancer, psychological stress, anxiety, depression, acute lymphedema, invasive breast cancer, lymphatic invasive cancer