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.