Aim This study aimed to compare the pain and lymphedema characteristics of women with breast cancer-related lymphedema (BCRL) with and without type 2 diabetes mellitus (T2DM). Methods A case–control study was conducted with 105 breast cancer survivors diagnosed with unilateral BCRL, divided into T2DM (n = 51) and non-T2DM (n = 54) groups. For pain characteristics, Visual Analog Scale (VAS) and Self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) were used. In addition, circumference measurement, the Lymphedema Life Impact Scale (LLIS), and Lymphedema Quality of Life Questionnaire (LYMQOL) were applied to determine the severity of lymphedema and its impact on quality of life. Statistical analysis was performed using t-tests, Mann–Whitney U tests, and Chi-square tests. Results T2DM patients exhibited significantly higher pain intensity (VAS) (p <InlineEquation ID="IEq1"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="520_2025_9728_Article_IEq1.gif" Format="GIF" Height="11" Rendition="HTML" Resolution="72" Type="Linedraw" Width="17" /> </InlineMediaObject> <EquationSource Format="TEX">$<$</EquationSource> <EquationSource Format="MATHML"><math> <mo><</mo> </math></EquationSource> </InlineEquation> 0.001, t =   ‒ 4.148), neuropathic symptoms (S-LANSS ≥ 12 in 72.5% vs. 18.5%) (p <InlineEquation ID="IEq2"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="520_2025_9728_Article_IEq1.gif" Format="GIF" Height="11" Rendition="HTML" Resolution="72" Type="Linedraw" Width="17" /> </InlineMediaObject> <EquationSource Format="TEX">$<$</EquationSource> <EquationSource Format="MATHML"><math> <mo><</mo> </math></EquationSource> </InlineEquation> 0.001, t = ‒ 6.435), and poorer quality of life metrics (LLIS-physical concerns, LLIS-psychococial concerns, LYMQOL-function, LYMQOL-appearance, LYMQOL-symptoms, LYMQOL-mood, LYMQOL-total) compared to the non-T2DM group (p1 <InlineEquation ID="IEq3"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="520_2025_9728_Article_IEq1.gif" Format="GIF" Height="11" Rendition="HTML" Resolution="72" Type="Linedraw" Width="17" /> </InlineMediaObject> <EquationSource Format="TEX">$<$</EquationSource> <EquationSource Format="MATHML"><math> <mo><</mo> </math></EquationSource> </InlineEquation> 0.001, t1 = ‒ 3.661; p2 = 0.016, t2 = ‒ 2.461; p3 = 0.004, t3 = ‒ 2.963; p4 <InlineEquation ID="IEq4"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="520_2025_9728_Article_IEq1.gif" Format="GIF" Height="11" Rendition="HTML" Resolution="72" Type="Linedraw" Width="17" /> </InlineMediaObject> <EquationSource Format="TEX">$<$</EquationSource> <EquationSource Format="MATHML"><math> <mo><</mo> </math></EquationSource> </InlineEquation> 0.001, z = ‒ 3.483; p5 <InlineEquation ID="IEq5"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="520_2025_9728_Article_IEq1.gif" Format="GIF" Height="11" Rendition="HTML" Resolution="72" Type="Linedraw" Width="17" /> </InlineMediaObject> <EquationSource Format="TEX">$<$</EquationSource> <EquationSource Format="MATHML"><math> <mo><</mo> </math></EquationSource> </InlineEquation> 0.001, t5 = ‒ 3.891; p6 = 0.018, t6 = ‒ 2.396; p7 = 0.001, t7 = ‒ 3.544). Lymphedema severity (p <InlineEquation ID="IEq6"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="520_2025_9728_Article_IEq1.gif" Format="GIF" Height="11" Rendition="HTML" Resolution="72" Type="Linedraw" Width="17" /> </InlineMediaObject> <EquationSource Format="TEX">$<$</EquationSource> <EquationSource Format="MATHML"><math> <mo><</mo> </math></EquationSource> </InlineEquation> 0.001), volume (p <InlineEquation ID="IEq7"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="520_2025_9728_Article_IEq1.gif" Format="GIF" Height="11" Rendition="HTML" Resolution="72" Type="Linedraw" Width="17" /> </InlineMediaObject> <EquationSource Format="TEX">$<$</EquationSource> <EquationSource Format="MATHML"><math> <mo><</mo> </math></EquationSource> </InlineEquation> 0.001, z = ‒ 3.716) and duration (p <InlineEquation ID="IEq8"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="520_2025_9728_Article_IEq1.gif" Format="GIF" Height="11" Rendition="HTML" Resolution="72" Type="Linedraw" Width="17" /> </InlineMediaObject> <EquationSource Format="TEX">$<$</EquationSource> <EquationSource Format="MATHML"><math> <mo><</mo> </math></EquationSource> </InlineEquation> 0.001, z = ‒ 3.716) were also significantly higher in the T2DM group. Despite these differences, the place of onset of lymphedema, LLIS functional concerns and LYMQOL 21st question (How much lymphedema affects overall quality of life on a scale from 0: not at all to 10: a great deal) were similar in both groups (p > 0.05). Conclusion T2DM significantly amplifies pain and worsens lymphedema-related outcomes in BCRL patients, underscoring the need for targeted, multidisciplinary interventions that address metabolic, physical, and psychosocial factors. Although lymphedema severity, duration, and volume were significantly higher in the T2DM group, these factors may have also contributed to the reduced functional status and quality of life outcomes independently of T2DM. Future research should explore the long-term relationship between T2DM, pain, and lymphedema to develop comprehensive care strategies for this population.

Pain and lymphedema characteristics of women with breast cancer-related lymphedema with and without type 2 diabetes mellitus

期刊论文
发表日期：

2025年7月8日

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Esra Uzelpasaci,
Aysel Ozge Kemer,
Ozgu Inal Ozün,
Aysegül Yaman

摘要

Aim

This study aimed to compare the pain and lymphedema characteristics of women with breast cancer-related lymphedema (BCRL) with and without type 2 diabetes mellitus (T2DM).

Methods

A case–control study was conducted with 105 breast cancer survivors diagnosed with unilateral BCRL, divided into T2DM (n = 51) and non-T2DM (n = 54) groups. For pain characteristics, Visual Analog Scale (VAS) and Self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) were used. In addition, circumference measurement, the Lymphedema Life Impact Scale (LLIS), and Lymphedema Quality of Life Questionnaire (LYMQOL) were applied to determine the severity of lymphedema and its impact on quality of life. Statistical analysis was performed using t-tests, Mann–Whitney U tests, and Chi-square tests.

Results

T2DM patients exhibited significantly higher pain intensity (VAS) (p $<$ $<$ 0.001, t = ‒ 4.148), neuropathic symptoms (S-LANSS ≥ 12 in 72.5% vs. 18.5%) (p $<$ $<$ 0.001, t = ‒ 6.435), and poorer quality of life metrics (LLIS-physical concerns, LLIS-psychococial concerns, LYMQOL-function, LYMQOL-appearance, LYMQOL-symptoms, LYMQOL-mood, LYMQOL-total) compared to the non-T2DM group (p₁ $<$ $<$ 0.001, t₁ = ‒ 3.661; p₂ = 0.016, t₂ = ‒ 2.461; p₃ = 0.004, t₃ = ‒ 2.963; p₄ $<$ $<$ 0.001, z = ‒ 3.483; p₅ $<$ $<$ 0.001, t₅ = ‒ 3.891; p₆ = 0.018, t₆ = ‒ 2.396; p₇ = 0.001, t₇ = ‒ 3.544). Lymphedema severity (p $<$ $<$ 0.001), volume (p $<$ $<$ 0.001, z = ‒ 3.716) and duration (p $<$ $<$ 0.001, z = ‒ 3.716) were also significantly higher in the T2DM group. Despite these differences, the place of onset of lymphedema, LLIS functional concerns and LYMQOL 21st question (How much lymphedema affects overall quality of life on a scale from 0: not at all to 10: a great deal) were similar in both groups (p > 0.05).

Conclusion

T2DM significantly amplifies pain and worsens lymphedema-related outcomes in BCRL patients, underscoring the need for targeted, multidisciplinary interventions that address metabolic, physical, and psychosocial factors. Although lymphedema severity, duration, and volume were significantly higher in the T2DM group, these factors may have also contributed to the reduced functional status and quality of life outcomes independently of T2DM. Future research should explore the long-term relationship between T2DM, pain, and lymphedema to develop comprehensive care strategies for this population.