Mild symptoms matter: Results from a prospective, longitudinal study on the relationship between symptoms, lymphedema and health-related outcomes post-gynecological cancer

To describe lower-limb symptoms pre- through to 2-years post-surgery following newly diagnosed gynecological cancer; to explore relationships between lower-limb symptoms, lower-limb lymphedema, body image, quality of life, anxiety and depression; and to determine whether lower-limb symptoms predict lower-limb lymphedema. Fourteen lower-limb symptoms, lymphedema, body image, anxiety, depression, and quality of life were prospectively collected in 408 women with gynecological cancer pre-surgery, and at 6-, 12-, and 24-months post-surgery. Point prevalence and cumulative incidence were calculated for symptoms. Cross-sectional relationships were explored between symptoms, lower-limb lymphedema and health-related outcomes at all timepoints, while regression analyses were used to assess the predictive relationships between lower-limb symptoms at 6-months post-surgery, and lymphedema at 12- and 24-months post-surgery. Participants were on average 59 (SD: 11) years of age, and 58 %, 28 %, 9 % and 5 % were diagnosed with endometrial, ovarian, cervical, and vulvar/vaginal cancer, respectively. Prevalence of any given lower limb symptom among all cancer types ranged between 11 and 59 %, with the most prevalent symptoms being pain, stiffness, and aching (prevalence >40 % across all time-points). The presence of symptoms was associated with higher anxiety and depression, poorer overall quality of life and body image (p 1.3). Self-reported symptoms are associated with adverse health-related outcomes. Assessment and management of symptoms, irrespective of symptom severity, has potential for improving health outcomes, including lymphedema, in those following gynecological cancer. •The most prevalent lower limb symptoms were pain, stiffness, and aching (prevalence >40 %).•Lower-limb symptoms were associated with higher anxiety and depression, poorer overall quality of life and body image.•Symptoms increase the odds of developing lymphedema, irrespective of symptom severity.