The association between allostatic load and lymphedema in breast cancer survivors

TL;DR

This study found that higher allostatic load at diagnosis is linked to increased odds of developing lymphedema in breast cancer survivors.

Contribution

The study introduces a novel association between allostatic load and breast cancer-related lymphedema.

Findings

High allostatic load was associated with a 28% increased odds of developing lymphedema.

A 1-unit increase in allostatic load was linked to a 10% higher odds of lymphedema.

No significant association was found between allostatic load and lymphedema severity.

Abstract

Allostatic load, a measure of physiological dysregulation secondary to chronic exposure to socioenvironmental stressors, is associated with 30-day postoperative complications and mortality in patients with breast cancer. This study aimed to examine the association between allostatic load (AL) at diagnosis and development of breast cancer-related lymphedema (BCRL).

Patients aged 18 years or older who received surgical treatment for stage I-III breast cancer between 2012 and 2020 were identified from The Ohio State University Cancer Registry. AL was calculated using biomarkers from the cardiovascular, metabolic, renal, and immunologic systems. A high AL was defined as AL > median. Logistic regression analyses examined the association between AL and BRCL, adjusting for sociodemographic, clinical, and treatment factors.

Among 3,609 patients, 18.86% (n = 681) developed lymphedema. A higher proportion of patients with lymphedema were Black (11.89% vs. 7.38%, p < 0.0001), Medicaid insured (12.19% vs. 6.97%, p < 0.0001), had stage 3 disease (7.05% vs. 1.57%, p < 0.0001), and had a high AL (53.63% vs. 46.90%, p = 0.0018). In adjusted analysis, high AL was associated with higher odds of developing lymphedema than low AL (OR 1.281 95% CI 1.06–1.55). Moreover, a 1-unit increase in AL was associated with 10% higher odds of lymphedema (OR 1.10, 95% CI 1.04–1.16). There was no statistically significant association between AL and severity of lymphedema (OR 1.02, 95% CI 0.82–1.23).

In this retrospective cohort of breast cancer survivors, high AL at diagnosis was associated with higher odds of developing lymphedema. Future research should elucidate the pathways by which AL influences lymphedema.

The online version contains supplementary material available at 10.1007/s00520-025-09362-4.

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