Arm morbidity and disability after breast cancer: new directions for care.
OBJECTIVE
To chart the incidence and course of three types of arm morbidity (lymphedema, pain, and range of motion [ROM] restrictions) in women with breast cancer 6-12 months after surgery and the relationship between arm morbidity and disability.


METHODS
Longitudinal mixed methods approach.


METHODS
Four sites across Canada.


METHODS
347 patients with breast cancer 6-12 months after surgery at first point of data collection.


METHODS
Incidence rates were calculated for three types of arm morbidity, correlations between arm morbidity and disability were computed, and open-ended survey responses were compiled and reviewed.


METHODS
Lymphedema, pain, ROM, and arm, shoulder, and hand disabilities.


RESULTS
Almost 12% of participants experienced lymphedema, 39% reported pain, and about 50% had ROM restrictions. Little overlap in the three types of arm morbidity was observed. Pain and ROM restrictions correlated significantly with disability, but most women did not discuss arm morbidity with healthcare professionals.


CONCLUSIONS
Pain and ROM restrictions are prevalent 6-12 months after surgery, but lymphedema is not. Pain and ROM restrictions are associated with disability.


CONCLUSIONS
Screening for pain and ROM restrictions should be part of breast cancer follow-up care. Left untreated, arm morbidity could have a long-term effect on quality of life. Additional research into the longevity of various arm morbidity symptoms and possible interrelationships also is required.
Thomas-Maclean
Roanne L
RL
Department of Sociology, University of Saskatchewan, Saskatoon, Canada. roanne.thomas@usask.ca
Hack
Thomas
T
Kwan
Winkle
W
Towers
Anna
A
Miedema
Baukje
B
Tilley
Andrea
A
D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm; D001943:Breast Neoplasms / Q000601:surgery*; D002170:Canada / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008197:Lymph Node Excision / Q000009:adverse effects*; D008209:Lymphedema / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D010146:Pain / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D011788:Quality of Life; D016059:Range of Motion, Articular; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects