Trajectories of lymphedema risk perception and their predictors in postoperative breast cancer survivors.

BACKGROUND

Risk perception is considered an important component of patients' self-management in breast cancer-related lymphedema (BCRL). However, existing evidence is largely cross-sectional and provides limited understanding of how risk perception evolves over time in the early postoperative period.

OBJECTIVE

This study aimed to describe the level of lymphedema risk perception at discharge and to explore its change trajectories during the first 6 months after surgery in patients with breast cancer.

METHODS

Participants were recruited from two tertiary grade A hospitals in China and completed a baseline survey (questionnaires on demographic and clinical characteristics, lymphedema risk perception, health literacy, communication patterns, and perceived social support) and follow-up assessments (Lymphedema Risk Perception Questionnaire) at the 1st, 3rd, and 6th months postoperatively.

RESULTS

Among 225 patients completing baseline, 185 (82.3%) completed the 6-month follow-up. Risk perception showed moderate overall levels with an initial rise followed by decline. Three distinct trajectories emerged: high-gradually declining group, moderate-peaked group, and low-peaked group. Key predictors included education, health education exposure, treatment type, surgery, disease stage, health literacy, communication patterns, and social support.

CONCLUSION

This study identified the change trajectories and latent classes of lymphedema risk perception within 6 months after surgery in breast cancer patients and revealed the predictive effects of demographic, clinical, and psychosocial factors on these trajectories.

IMPLICATIONS FOR CANCER SURVIVORS: Breast cancer survivors should tailor their self-management strategies based on their BCRL risk perception trajectories. Those in the low-peaked group are advised to actively participate in lymphedema-related health education and enhance health literacy to improve risk awareness timely. The moderate-peaked group needs to reinforce knowledge and self-monitoring to maintain stable perception. The high-gradually declining group needs to maintain appropriate vigilance through regular self-monitoring and avoid risk perception fatigue. These suggestions are intended to provide risk perception trajectory-based stratified self-management support for patients, while further research is needed to determine their impact on long-term clinical outcomes.