title: Upper-body morbidity after breast cancer: incidence and evidence for evaluation, prevention, and management within a prospective surveillance model of care.
abstract: The purpose of this paper is to review the incidence of upper-body morbidity (arm and breast symptoms, impairments, and lymphedema), methods for diagnosis, and prevention and treatment strategies. It was also the purpose to highlight the evidence base for integration of prospective surveillance for upper-body morbidity within standard clinical care of women with breast cancer. Between 10% and 64% of women report upper-body symptoms between 6 months and 3 years after breast cancer, and approximately 20% develop lymphedema. Symptoms remain common into longer-term survivorship, and although lymphedema may be transient for some, those who present with mild lymphedema are at increased risk of developing moderate to severe lymphedema. The etiology of morbidity seems to be multifactorial, with the most consistent risk factors being those associated with extent of treatment. However, known risk factors cannot reliably distinguish between those who will and will not develop upper-body morbidity. Upper-body morbidity may be treatable with physical therapy. There is also evidence in support of integrating regular surveillance for upper-body morbidity into the routine care provided to women with breast cancer, with early diagnosis potentially contributing to more effective management and prevention of progression of these conditions.
authors.affiliation: Queensland University of Technology, Institute of Health and Biomedical Innovation, School of Public Health, Brisbane, Australia. sc.hayes@qut.edu.au
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Hayes
authors.forename: Karin
authors.initials: K
authors.lastname: Johansson
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Stout
authors.forename: Robert
authors.initials: R
authors.lastname: Prosnitz
authors.forename: Jane M
authors.initials: JM
authors.lastname: Armer
authors.forename: Sheryl
authors.initials: S
authors.lastname: Gabram
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Schmitz
mesh_terms: D000328:Adult; D000368:Aged; D000570:American Cancer Society; D001943:Breast Neoplasms / Q000401:mortality / Q000534:rehabilitation / Q000601:surgery*; D003226:Congresses as Topic; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008209:Lymphedema / Q000453:epidemiology* / Q000209:etiology / Q000534:rehabilitation; D008408:Mastectomy / Q000009:adverse effects / Q000379:methods / Q000534:rehabilitation; D008875:Middle Aged; D017146:Models, Organizational; D018908:Muscle Weakness / Q000453:epidemiology / Q000209:etiology / Q000534:rehabilitation; D010146:Pain / Q000453:epidemiology* / Q000209:etiology / Q000534:rehabilitation; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control*; D011322:Primary Prevention / Q000379:methods; D011446:Prospective Studies; D011788:Quality of Life; D016059:Range of Motion, Articular / Q000502:physiology; D012720:Severity of Illness Index; D013997:Time Factors; D034941:Upper Extremity / Q000503:physiopathology