title: Arm morbidity and disability after breast cancer: new directions for care.
abstract: 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.
authors.affiliation: Department of Sociology, University of Saskatchewan, Saskatoon, Canada. roanne.thomas@usask.ca
authors.forename: Roanne L
authors.initials: RL
authors.lastname: Thomas-Maclean
authors.forename: Thomas
authors.initials: T
authors.lastname: Hack
authors.forename: Winkle
authors.initials: W
authors.lastname: Kwan
authors.forename: Anna
authors.initials: A
authors.lastname: Towers
authors.forename: Baukje
authors.initials: B
authors.lastname: Miedema
authors.forename: Andrea
authors.initials: A
authors.lastname: Tilley
mesh_terms: 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