title: A longitudinal analysis of chronic arm morbidity following breast cancer surgery.
abstract: Arm morbidity (AM) arising from breast cancer (BC) treatment can detrimentally impact quality of life; often limiting a survivor's ability to participate in valued activities. The present study explored (a) the developmental time course of AM [restricted range of motion (ROM), pain, and arm volume changes], negative affect, and perceived disability in the immediate years post-surgery, and (b) the mediating role of perceived disability on the relationship between AM and negative affect over time. In this 5-year longitudinal study, BC survivors from four Canadian oncology clinics (n = 431) completed five annual clinical assessments, where differences in ROM (shoulder abduction, external rotation) and arm volume between the affected and non-affected arm were measured. The profile of mood states (POMS), disability of arm, shoulder, hand, and McGill Pain Questionnaire-Short form were completed. Results from general linear modeling showed that AM, negative affect, and perceived disability were greatest 1-year post-surgery, declined, and with the exception of arm volume changes, were significantly lower 5 years later. Negative affect was significantly associated with restrictions in shoulder abduction and external rotation (average r = -0.15; p < 0.05) and present arm pain (average r = 0.28, p < 0.01) at most assessments. The mediating role of perceived disability on the relationship between AM and negative affect was statistically significant in a majority of assessments. Perceived disability is the underlying factor driving the relationship between AM and mood disturbance over time. Rehabilitative therapy to improve survivors' functional well-being might mitigate the negative impacts of AM on emotional health.
authors.affiliation: Department of Supportive Care, University Health Network, Toronto, ON, M5G 2C4, Canada. vboquire@uhnresearch.ca.
authors.forename: Virginia M
authors.initials: VM
authors.lastname: Boquiren
authors.affiliation: College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.|I.H. Asper Clinical Research Institute, CR3018, 369 Taché Avenue, Winnipeg, MB, R2H 2A6, Canada.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Hack
authors.affiliation: School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Roanne L
authors.initials: RL
authors.lastname: Thomas
authors.affiliation: Department of Oncology, Faculty of Medicine, McGill University, Montreal, QC, Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Towers
authors.affiliation: British Columbia Cancer Agency, Surrey, BC, Canada.
authors.forename: Winkle B
authors.initials: WB
authors.lastname: Kwan
authors.affiliation: Horizon Health Network, Saint John, NB, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Tilley
authors.affiliation: Department of Sociology, University of Saskatchewan, Saskatoon, SK, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Quinlan
authors.affiliation: Department of Family Medicine, Dalhousie University, Halifax, NS, Canada.
authors.forename: Baukje
authors.initials: B
authors.lastname: Miedema
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000503:physiopathology*; D001943:Breast Neoplasms / Q000601:surgery*; D002170:Canada / Q000453:epidemiology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008209:Lymphedema / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D010147:Pain Measurement; D015995:Prevalence; D011788:Quality of Life; D016059:Range of Motion, Articular; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology
keywords: Arm morbidity; Breast cancer; Pain; Perceived disability