A Morbidity Screening Tool for identifying fatigue, pain, upper limb dysfunction and lymphedema after breast cancer treatment: a validity study.
OBJECTIVE
This study aimed to investigate validity of a newly developed Morbidity Screening Tool (MST) to screen for fatigue, pain, swelling (lymphedema) and arm function after breast cancer treatment.


METHODS
A cross-sectional study included women attending reviews after completing treatment (surgery, chemotherapy and radiotherapy), without recurrence, who could read English. They completed the MST and comparator questionnaires: Disability of the Arm, Shoulder and Hand questionnaire (DASH), Chronic Pain Grade Questionnaire (CPGQ), Lymphedema and Breast Cancer Questionnaire (LBCQ) and Functional Assessment of Cancer Therapy questionnaire with subscales for fatigue (FACT F) and breast cancer (FACT B + 4). Bilateral combined shoulder ranges of motion were compared (upward reach; hand behind back) and percentage upper limb volume difference (%LVD =/>10% diagnosed as lymphedema) measured with the vertical perometer (400T).


RESULTS
613 of 617 participants completed questionnaires (mean age 62.3 years, SD 10.0; mean time since treatment 63.0 months, SD 46.6) and 417 completed objective testing. Morbidity prevalence was estimated as 35.8%, 21.9%, 19.8% and 34.4% for fatigue, impaired upper limb function, lymphedema and pain respectively. Comparing those self-reporting the presence or absence of each type of morbidity, statistically significant differences in comparator variables supported validity of the MST. Statistically significant correlations resulted between MST scores focussing on impact of morbidity, and comparator variables that reflect function and quality of life.


CONCLUSIONS
Analysis supports the validity of all four short-forms of the MST as providing indications of both presence of morbidity and impacts on participants' lives. This may facilitate early and appropriate referral for intervention.
School of Health Sciences, Queen Margaret University, Edinburgh, Queen Margaret University Drive, Musselburgh, East Lothian EH21 6UU, United Kingdom. Electronic address: cbulley@qmu.ac.uk.
Catherine
C
Bulley
School of Health Sciences, Queen Margaret University, Edinburgh, Queen Margaret University Drive, Musselburgh, East Lothian EH21 6UU, United Kingdom. Electronic address: fcoutts@qmu.ac.uk.
Fiona
F
Coutts
School of Health Sciences, Queen Margaret University, Edinburgh, Queen Margaret University Drive, Musselburgh, East Lothian EH21 6UU, United Kingdom. Electronic address: cblyth@qmu.ac.uk.
Christine
C
Blyth
Western General Hospital, Breast Unit, Crewe Road South, Edinburgh EH4 2XU, United Kingdom. Electronic address: Wilma.Jack@luht.scot.nhs.uk.
Wilma
W
Jack
Western General Hospital, Breast Unit, Crewe Road South, Edinburgh EH4 2XU, United Kingdom. Electronic address: Matthew.Barber@luht.scot.nhs.uk.
Udi
U
Chetty
Western General Hospital, Breast Unit, Crewe Road South, Edinburgh EH4 2XU, United Kingdom.
Matthew
M
Barber
School of Health Sciences, Queen Margaret University, Edinburgh, Queen Margaret University Drive, Musselburgh, East Lothian EH21 6UU, United Kingdom. Electronic address: ctan@qmu.ac.uk.
Chee Wee
CW
Tan
D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005221:Fatigue / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008209:Lymphedema / Q000209:etiology* / Q000503:physiopathology; D008403:Mass Screening; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D009017:Morbidity; D059352:Musculoskeletal Pain / Q000209:etiology* / Q000503:physiopathology; D010147:Pain Measurement; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D006113:United Kingdom; D034941:Upper Extremity / Q000503:physiopathology
Fatigue; Lymphedema; Morbidity; Pain; Upper limb function; Validity