# Perceived Psychological and Physical Health as Predictors of Mortality and Quality of Life in Patients with Lymphedema: A Prospective Study Spanning Almost Two Decades

## TL;DR

This study shows that age, gender, and cancer are key factors affecting mortality and quality of life in lymphedema patients over nearly two decades.

## Contribution

The study provides novel longitudinal insights into biopsychosocial predictors of mortality and quality of life in lymphedema patients.

## Key findings

- Age, gender, and cancer significantly predicted mortality and quality of life.
- Anxiety and depression showed suppressor effects when predicting outcomes.
- 19.5% of participants were deceased at follow-up.

## Abstract

How does living with a chronic disease of the lymphatic system affect quality of life and mortality? Lymphedema is a chronic disease mostly affecting women and research is sparse. To this date, longitudinal studies evaluating biopsychosocial predictors for mortality and quality of life in lymphedema are largely missing. This study aims to identify possible predictors and could open innovative ways for treatment options.

Two hundred ninety-two patients with lymphedema partaking in a rehabilitation program in a lymphedema clinic were longitudinally assessed. The sample consisted of 86.2% women, aged between 18 and 83 years (M = 53.42, SD = 12.54), with a mean BMI (kg/m2) of 31.64 (SD = 8.26). Beginning with baseline assessment in 2002–2006, follow-up was evaluated 15–19 years later (N = 91). We assessed a variety of potential biopsychosocial predictors of mortality and quality of life (i.e., depression, anxiety, cancer). At follow-up, 19.5% of participants were deceased.

Age, gender, and cancer significantly predicted mortality (R2 = .27) and quality of life (R2 = .29). Anxiety and depression significantly predicted both quality of life and mortality when entered simultaneously. However, further analyses indicated suppressor effects and when entered separately, effects solely for depression or anxiety did not reach significance level.

Age, gender, and cancer were the main predictors of mortality and quality of life in patients with lymphedema. Psychological predictors of mortality and quality of life were mainly due to suppressor effects, thus calling for caution when analyzing the contribution of mental health indicators for clinical outcomes.

This study was preregistered with the German Clinical Trials Register (Identifier DRKS00024450) and Open Science Framework (https://doi.org/10.17605/OSF.IO/RHXQJ).