1219 - A Case of Discordant Physiologic and Patient-Reported Outcomes in Leg Lymphedema After Cancer Treatment

Case Diagnosis: A 48-year-old female with Stage 1a endometrial cancer, status post hysterectomy and bilateral sentinel lymph node biopsy, who developed bilateral Stage 1 lower extremity lymphedema (LEL).

Case Description: The patient’s cancer was successfully treated without radiation or chemotherapy. Seven months later, she was diagnosed with LEL, right greater than left. She was enrolled in an ongoing observational clinical trial to develop relevant MRI metrics of LEL (NCT05242900). Bedside measures (e.g., bioimpedance, limb volume) and MRI metrics (e.g., calf tissue sodium content, subcutaneous adipose tissue volume) were obtained alongside validated patient-reported outcome measures (PROMs) at the time of diagnosis. Following six sessions of complete decongestive therapy (CDT), repeat objective measures demonstrated stability or modest improvement (e.g., ~9% reduction in limb volume, ~34% reduction in subcutaneous adipose tissue volume). In contrast, PROMs demonstrated marked worsening across multiple scales, such as the Lower Extremity Functional Scale, which demonstrated a 60% reduction in function.

Discussions: This paradox illustrates the complexity of lymphedema management in cancer survivorship. Despite stable or improved bedside and MRI findings, the patient reported worsening function and quality of life, underscoring the value of PROMs in capturing aspects of disease burden not reflected in objective metrics, and which may require further attention beyond CDT. Potential contributors to this discordance include medical comorbidities, psychosocial stressors, and evolving expectations after cancer treatment.

Conclusions: This case highlights the importance of integrating PROMs with objective metrics in evaluating lymphedema interventions for a more complete understanding of treatment impact in LEL. For physiatrists and therapists, collaborative interpretation of both physiologic and patient-centered measures is essential to guide rehabilitation and optimize cancer survivorship care.