Validation of Korean Version of ‘Questionnaire to Characterize Lymphedema in Women Treated for Breast Cancer’

Objective: Lymphedema is one of the common complications that compromise the quality of life after the treatment of breast cancer. Bio-impedance, perometer, circumferential upper limb measurement and self-report are known as an appropriate tool to assess the lymphedema. Self-report method is simple, less expensive, accurate measure. Since the Korean version of lymphedema questionnaire is absent, the investigation of the reliability and validity of Korean version of ‘Questionnaire to Characterize Lymphedema in Women Treated for Breast Cancer is required.

Methods: The cross-culture translation of ‘Questionnaire to Characterize Lymphedema in Women Treated for Breast Cancer’ was done by guideline by Dorcas. The translated questionnaire was applied to 91 breast cancer patients (mean age=48.4±8.9) before treatment. Questionnaire assessment of degree and presence of the lymphedema was compared with measurement of circumference, at above and below 10 cm of both epicondyles. Lymphedema was categorized as no lymphedema (circumference difference less than or equal to 1 cm), mild lymphedema (circumference difference larger than 1 cm to less than or equal to 2 cm), and moderate/severe lymphedema (circumference difference larger than 2 cm). The questionnaire composed of 2 major questions. Question number 1 asked patients whether they feel a difference between upper extremities. Question number 2 asked how they notice the difference between their arms, forearms, and hands. Questionnaire was analyzed with 2 methods. On method 1, the summation of score equal or larger than 4 was considered moderate/severe (the score was assigned as - very slight, you are the only person who would notice this: 1, noticeable to people who knows you well, but not to strangers: 2, Very noticeable: 3). On method 2, any sites ‘noticeable to people who knows you well but not to strangers’ was considered moderate/severe. If the summation of scores were 0, when the patient chose the question number 1 as ‘no’, the patient was considered as no lymphedema. The follow up questionnaire was done after the lymphedema treatment when they visited an outpatient.

Results: Total of 46 patients followed up with questionnaire. Weighted kappa analysis was used to confirm the reliability and validity of Questionnaire compared with actual measurement. On initial questionnaire method 1, kappa was 0.717. On method 2, kappa was 0.752. On follow up questionnaire, kappa was 0.586 by method 1. On method 2, kappa was 0.622.

Conclusion: The Korean version of ‘Questionnaire to Characterize Lymphedema in Women Treated for Breast Cancer’ showed validity and reliability in women treated for breast cancer. It showed excellent agreement with actual measurement before and after the treatment. The method 2 was more agreeable to the actual measurement, before and after the treatment.