Anna Towers

Arm morbidity and disability after breast cancer: new directions for care.

PURPOSE/OBJECTIVES 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. DESIGN Longitudinal mixed methods approach. SETTING Four sites across Canada. SAMPLE 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. MAIN RESEARCH VARIABLES Lymphedema, pain, ROM, and arm, shoulder, and hand disabilities. FINDINGS 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. IMPLICATIONS FOR NURSING 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.

Predictors of arm morbidity following breast cancer surgery

Objective: Arm morbidity post‐breast cancer surgery is increasingly being recognized as a chronic problem for some women following breast cancer surgery. The purpose of this study was to examine demographic, disease, and treatment‐related predictors of a comprehensive array of chronic arm morbidity (pain, lymphedema, functional disability, and range of motion) post‐breast cancer surgery.

Breast Cancer Survivorship and Work Disability

Breast cancer survivors can anticipate a number of years of paid labor market participation. Therefore, the link between breast cancer survivorship and productivity deserves serious consideration. The hypothesis guiding this study is that arm disability, particularly pain and range of motion limitations, are important explanatory variables in survivors’ loss of productivity. The study investigates the association between productivity and arm disability over time. The longitudinal data are drawn from survivors in four geographical locations in Canada. Regression results indicate that survivors with arm pain, 2.5 to 3 years postsurgery, are almost 8 times more likely to experience a loss in productivity compared to those survivors without pain, and those with some range of motion limitations are 4 times more likely to experience productivity loss 2.5 to 3 years postsurgery compared to their counterparts without limitations. More than 40% of survivors begin to or continue to experience productivity loss as long as 30 to 36 months after surgery and that the loss in productivity is primarily due to two forms of arm disability: pain and range-of-motion limitations. These findings highlight the importance of rehabilitation programming for breast cancer survivors.

Loss, adaptation and new directions: The impact of arm morbidity on leisure activities following breast cancer

The impact of arm morbidity on leisure and quality of life is an understudied area in cancer survivorship. The purpose of this study was to qualitatively describe the impact of breast cancer-related arm morbidity on leisure participation in Canadian women. A grounded theory approach was used to generate thematic categories and a model. Drawing on participants from a larger cohort study (n = 740), 40 women with arm morbidity symptoms were purposively sampled and interviewed. Three themes emerged: a sense of loss, adapting participation, and new directions. Women with arm morbidity may experience an abrupt loss of previously enjoyed leisure activities and engage in a process of adapting to discover new meanings and directions. Comprehensive, person-centred cancer survivorship programs may assist with adaptation to arm morbidity.

Accuracy and usefulness of the Palliative Prognostic Index in a community setting

PURPOSE In a community setting characterised by scarce inpatient palliative care resources, a precise prognosis could help determine which patients should be prioritised for end-of-life admission. AIM The aim of this study was to assess the validity of the Palliative Prognostic Index (PPI) and to determine whether it is a helpful tool for nurses to administer as part of the admission protocol in the palliative care service of a community hospital. RESULTS The PPI was a moderately accurate prognostic tool when assessing the frequency of 14-day overstay; 81% of patients died within 14 days of their expected prognosis. Based on sensitivity and specificity, the accuracy of the prognoses was acceptable for the 6-week prognosis group (80%), and poor for the 3-week prognostic group (53%). The tool was easy to administer by the admission nurse receiving referrals. CONCLUSION A nurse-administered and minimally-invasive prognostic tool was helpful in this context.