title: Late morbidity after treatment of breast cancer in relation to daily activities and quality of life: a systematic review.
abstract: OBJECTIVE
  Breast cancer treatment may result in long-term upper limb morbidity: reduced range of motion of the shoulder, muscle weakness of the arm and hand, lymph edema, pain and numbness. Relationship of this late morbidity with activities of daily life (ADL) and quality of life (QOL) is infrequently described and the strength of this relationship is not clear.
  
  
  METHODS
  A systematic review was performed to evaluate the results of studies, analyzing late morbidity of breast cancer treatment in relationship with ADL and/or QOL. A literature search over the last 20 years (1980-2000) was performed in the databases MEDLINE, EMBASE, PSYCHLIT and CANCERLIT. Methodological quality of selected articles was assessed and additional, aspects of treatment related late morbidity and the relationship to ADL and/or QOL were summarized.
  
  
  RESULTS
  From the 1642 yielded articles 15 fulfilled our primary selection criteria. Only six articles could be selected due to the inappropriate methodological quality. There was high variation in prevalence of pain (12-51%), impairments in range of motion (2-51%), edema (6-43%) and decreased muscle strength (17-33%). Four articles reported significant relationships between late morbidity of the upper limb and perceived disabilities in ADL/QOL. The strength of these relationships was rather low.
  
  
  CONCLUSIONS
  Few studies investigated the relationship between late morbidity of the upper limb after treatment of early breast cancer and ADL/QOL. Significant relationship between late morbidity and restrictions of daily activities and poorer QOL was reported, however, the strength of this relationship was rather low.
authors.affiliation: Department of Surgery, University Hospital Groningen, P.O. Box 30001, NL-9700 RB, Groningen, The Netherlands. j.s.rietman@rev.azg.nl
authors.forename: J S
authors.initials: JS
authors.lastname: Rietman
authors.forename: P U
authors.initials: PU
authors.lastname: Dijkstra
authors.forename: H J
authors.initials: HJ
authors.lastname: Hoekstra
authors.forename: W H
authors.initials: WH
authors.lastname: Eisma
authors.forename: B G
authors.initials: BG
authors.lastname: Szabo
authors.forename: J W
authors.initials: JW
authors.lastname: Groothoff
authors.forename: J H B
authors.initials: JH
authors.lastname: Geertzen
mesh_terms: D000203:Activities of Daily Living; D001132:Arm / Q000503:physiopathology*; D001943:Breast Neoplasms / Q000601:surgery*; D004487:Edema / Q000453:epidemiology; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects*; D018482:Muscle, Skeletal / Q000503:physiopathology; D009426:Netherlands / Q000453:epidemiology; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D015995:Prevalence; D011788:Quality of Life; D016059:Range of Motion, Articular