Factors Predicting Treatment Adherence in Outpatients with Cancer-Related Edema: Decision Tree Analysis

Yudai Fujimoto,1,2 Yoshimi Yuri,2 Miki Fujii,1 Hironari Tamiya1,3 1Department of Rehabilitation, Osaka International Cancer Institute, Osaka, Japan; 2Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan; 3Department of Orthopaedic Surgery (Musculoskeletal Oncology Service), Osaka International Cancer Institute, Osaka, JapanCorrespondence: Yudai Fujimoto, Department of Rehabilitation, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan, Tel +81-6-6945-1181, Fax +81-6-6945-1900, Email yuudai.fujimoto@oici.jpPurpose: This study aimed to determine the combination of factors associated with continuity of care in outpatients with cancer-related edema six months after the initial visit.Patients and Methods: A total of 101 outpatients were divided into two groups: continuation (n=65) and non-continuation (n=36) groups. Details regarding age, body mass index, sex, affected extremities (upper or lower), site of edema (unilateral or bilateral), International Society of Lymphology (ISL) classification, presence of distant metastasis, and overall score on the lymphedema quality of life questionnaire (LYMQOL) were obtained before initial lymphedema care. In this study, we performed a decision tree analysis using a classification and regression tree (CART) to detect the combination of factors associated with the continuity of edema care for cancer-related edema.Results: Significant differences were observed in the site of edema (unilateral or bilateral) and distant metastasis between the two groups. In the decision tree using CART analysis, the factors selected to influence the possibility of continuation were the side of edema as the first layer, and body mass index of 23.0 and distant metastasis (with/without) as the second layer. Outpatients with unilateral edema and a body mass index higher than 23.0 were most likely to be able to continue care. In contrast, outpatients with bilateral edema and distant metastasis had greater difficulty in continuing care.Conclusion: In this study, factors that were suggested to influence the continuity of cancer-related edema care were the side with edema, body mass index higher than 23.0, and distant metastasis. This information may be helpful for developing care strategies and improving patient adherence.Keywords: cancer-related edema, continuation, decision tree analysis, outpatient, predicted factor