Objective Severity, Pain and Range-of-Motion Limitation in Breast Cancer-Related Upper-Limb Lymphedema: Associations with Patient-Reported Burden

Background/Objectives: Breast cancer-related upper-limb lymphedema (BCRL) can impair arm function and quality of life, while objective measures may not fully reflect patient-perceived burden. This study examined associations of objective severity, pain intensity, and shoulder range-of-motion (ROM) limitation with disability and lymphedema-specific quality of life in women with BCRL. Methods: This cross-sectional analysis included 110 women with clinically diagnosed BCRL. Objective severity was assessed using International Society of Lymphology stage, circumferential measurements, and water displacement volumetry. Pain was evaluated with a visual analog scale. Disability was assessed using the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), and lymphedema-specific quality of life using the Quality of Life Measure for Limb Lymphedema-Arm (LYMQOL-Arm). Analyses included nonparametric comparisons, Spearman correlations, and exploratory multivariable regression. Results: Higher lymphedema stage was associated with greater circumferential and volumetric differences and worse QuickDASH, LYMQOL function, and LYMQOL appearance scores. Objective severity measures correlated with QuickDASH, LYMQOL function, and LYMQOL appearance, but not with pain or LYMQOL symptoms. Shoulder ROM limitation was associated with higher pain, worse QuickDASH, higher LYMQOL function, appearance, and symptom scores, and lower global quality of life. In regression analyses, pain intensity, volumetric difference, and shoulder ROM limitation remained associated with QuickDASH, whereas pain intensity was the main factor associated with global quality of life. Conclusions: Objective severity measures mainly reflected anatomical, functional, and appearance-related burden but did not fully capture pain, symptoms, or global quality of life. Multidimensional assessment combining limb measurements, pain evaluation, shoulder mobility assessment, and patient-reported outcomes may support a more comprehensive clinical evaluation of women with BCRL.