Louise Koelmeyer

The Role of Information Sources and Objective Risk Status on Lymphedema Risk-Minimization Behaviors in Women Recently Diagnosed With Breast Cancer

PURPOSE/OBJECTIVES to assess the role of education sources and objective risk status on knowledge and practice of lymphedema risk-minimization behaviors among women recently diagnosed with breast cancer. RESEARCH APPROACH prospective survey. SETTING a hospital in Sydney, Australia. PARTICIPANTS 106 women recently diagnosed with breast cancer at increased risk for developing lymphedema following lymph node dissection. METHODOLOGIC APPROACH a questionnaire administered at the time of surgery and three months after surgery measured demographics, lymphedema knowledge, lymphedema information sources used, and adherence to risk-minimization recommendations. MAIN RESEARCH VARIABLES lymphedema knowledge, source of information used, objective lymphedema risk, and adherence to risk-minimization behaviors. FINDINGS knowledge was high and increased over time. Lymphedema information from the clinic (e.g., brochures, nursing staff) was the most cited source. Adherence to recommendations was moderate; nonadherence was mostly for behaviors requiring regular enactment. Regression analysis revealed that only receipt of information from nursing staff and lymphedema knowledge three months after surgery were significant predictors of risk-minimization behaviors. CONCLUSIONS exposing women to lymphedema risk information at the time of breast cancer diagnosis facilitates increased awareness and enactment of risk-minimization behaviors. Nursing staff play a key role in disseminating this information and in convincing women to perform the recommendations. INTERPRETATION provision of lymphedema education by breast clinic staff is critical to ensure that women realize the importance of early detection and treatment. Reminder booster sessions by nursing staff may be beneficial particularly for longer-term knowledge retention and adherence to recommended behaviors.

Factors Affecting the Preoperative and Postoperative Extracellular Fluid in the Arm on the Side of Breast Cancer: A Cohort Study

BACKGROUND To explore what factors affect volume of extracellular fluid (ECF) in the arm on the side of surgery pre- and postoperatively and to determine the value of knowing preoperative ECF volume for diagnosis of lymphedema postoperatively. METHODS AND RESULTS Women (N=516) with early breast cancer were assessed preoperatively and within 4 weeks postoperatively. Baseline measures included inter-arm ECF ratio, side of cancer, number of nodes involved, and other individual characteristics. Postoperative assessment included inter-limb ECF ratio and details from surgery. The postoperative ECF ratio was categorized as to whether it exceeded previously established thresholds, and the change in ECF was categorized as to whether it exceeded 0.1. Linear regression identified which factors explained the variance for preoperative ECF ratio and the change in ratio. Chi square analysis compared whether women categorized using thresholds were the same as those whose ratio increased >0.1 postoperatively. Postoperative ECF ratio was significantly higher than the preoperative ratio (p<0.001). Women whose ECF ratio exceeded previously established thresholds were not the same as those whose ratio increased >0.1 postoperatively (p<0.001). Only the side of surgery explained the preoperative ECF measure; extent of surgery and actual weight explained the change in ECF ratio. CONCLUSION The ECF ratio preoperatively is not affected by nodal involvement. The change in ECF ratio is affected by the extent of surgery and body mass. Change from preoperative ECF ratio did identify more women at risk for lymphedema than reliance postoperatively on thresholds, supporting preoperative measures.

Financial cost of lymphedema borne by women with breast cancer

Our study examines the financial cost of lymphedema following a diagnosis of breast cancer and addresses a significant knowledge gap regarding the additional impact of lymphedema on breast cancer survivors.

“You’re naked, you’re vulnerable”: Sexual well-being and body image of women with lower limb lymphedema

Lower-limb lymphedema is an incurable illness manifesting as visible swelling enlarging the leg(s) and/or feet, buttocks, and genitals. This study used semi-structured interviews and thematic analysis to explore sexual well-being among women with primary (congenital) lymphedema (n=11) or secondary lymphedema associated with gynecological cancer (n=8). Five themes (subthemes) summarized womens responses, with Attractiveness and Confidence (Publicly Unattractive, Privately Unconfident, Lymphedema or Aging?) describing womens central concern. These body image-related concerns accounted for sexual well-being in association with Partner Support (Availability of Support, Languages of Support, Fears About Support) and the degree of Functional Interruptions (Lymphedema in Context, Enduring Impacts, Overcoming Interruptions). Successful Lymphedema Coping (Control, Acceptance) and self-perceived ability to fulfill a valued Sexual Role also affected sexual well-being. Few differences between women with primary versus secondary lymphedema were evident. Lymphedema clinicians should screen for sexual concerns and have referral options available.

The effect of monitoring ‘processing style’ on post‐surgical neuropathic pain in women with breast cancer

Pain is a commonly reported symptom following surgery that is more likely to occur in individuals psychologically distressed prior to surgery. Monitoring processing style, a cognitive tendency to focus on health‐related threats, has been associated with increased reporting of somatic symptoms, but no studies have specifically addressed the link between this cognitive style and pain. This prospective clinical study aimed to investigate whether monitoring processing style predicted post‐surgical pain in women undergoing breast surgery, controlling for pre‐surgical psychological distress.

Patterns of lymphatic drainage after axillary node dissection impact arm lymphoedema severity: A review of animal and clinical imaging studies

Upper extremity lymphoedema after axillary node dissection is an iatrogenic disease particularly associated with treatment for breast or skin cancer. Anatomical studies and lymphangiography in healthy subjects identified that axillary node dissection removes a segment of the lymphatic drainage pathway running from the upper limb to the sub-clavicular vein, creating a surgical break. It is reasonable to infer that different patterns of lymphatic drainage may occur in the upper limb following surgery and contribute to the various presentations of lymphoedema from none to severe. Firstly, we reviewed animal imaging studies that investigated the repair of lymphatic drainage pathways from the limb after lymph node dissection. Secondly, we examined clinical imaging studies of lymphatic drainage pathways after axillary node dissection, including lymphangiography, lymphoscintigraphy and indocyanine green fluorescence lymphography. Finally, based on the gathered data, we devised a set of general principles for the restoration of lymphatic pathways after surgery. Lymphoscintigraphy shows that restoration of the original lymphatic pathway to the axilla after its initial disruption by nodal dissection was not uncommon and may prevent lymphoedema. We found that regenerated lymphatic vessels and dermal backflow (the reflux of lymph to the skin) contributed to either restoration of the original pathway or rerouting of the lymphatic pathway to other regional nodes. Variation in the lymphatic drainage pathway and the mechanisms of fluid drainage itself are the foundation of new lymphatic drainage patterns considered to be significant in determining the severity with which lymphoedema develops.

Reducing Body Image–Related Distress in Women With Breast Cancer Using a Structured Online Writing Exercise: Results From the My Changed Body Randomized Controlled Trial

Purpose Breast cancer treatment adverse effects result in one in three survivors experiencing body image-related distress (BID) that negatively impacts on a womans ability to recover after cancer and into survivorship. My Changed Body (MyCB) is a Web-based psychological intervention to alleviate BID and improve body appreciation in survivors of breast cancer (BCSs) through a single-session, self-compassion focused writing activity. This randomized controlled trial evaluated the impact of MyCB on BID and body appreciation in BCSs. The moderating effect of lymphedema status (affected or unaffected) and appearance investment (self-importance placed on personal appearance) and the mediating effect of self-compassion were evaluated. Patients and Methods Women (disease-free stage I to III BCSs who had experienced at least one negative event related to bodily changes after breast cancer) were randomly assigned to MyCB (n = 149) or an expressive writing control arm (n = 155). Primary outcomes were reduction in BID and improvement in body appreciation 1 week after intervention. Secondary outcomes included psychological distress (depression and anxiety) and self-compassion. Follow-up assessments occurred 1 week, 1 month, and 3 months after writing. Results Compliance with the MyCB intervention was 88%, and attrition was 9.2%. Intent-to-treat linear mixed models indicated that participants who received MyCB reported significantly less BID ( P = .035) and greater body appreciation ( P = .004) and self-compassion ( P < .001) than expressive writing participants. Intervention effects on BID were moderated by lymphedema status ( P = .007) and appearance investment ( P = .042). Self-compassion mediated effects on both primary outcomes. Therapeutic effects were maintained at 1 month (BID and body appreciation) and 3 months (body appreciation) after intervention. Significant reductions in psychological distress (1-month depression, P = .001; 1-week and 1-month anxiety, P = .007) were evident for MyCB participants with lymphedema. Conclusion This study supports the efficacy of MyCB for reducing BID and enhancing body appreciation among BCSs.

Monitoring processing style and pre-surgical distress predict reported neuropathic pain in women with breast cancer

Background: Many psycho-oncology studies use posttraumatic growth (PTG) measures designed for general trauma experiences, and as such they may not take into account life changes associated with a health-related context. Method: Study 1, a thematic analysis of written narratives (N = 209), emphasised cancer survivors’ newfound compassion. Study 2, with 504 prostate cancer survivors, measured the Posttraumatic Growth Inventory including five additional items derived from Study 1 to represent increased compassion. Findings: A Principal Components Analysis revealed a six-component structure after deleting eight items. Components related to compassion, new possibilities, relating to others, personal strength, appreciation of life, and spiritual change. Compassion accounted for 48.9% of variance, with the overall model accounting for 79.9% of variance. Strong factorability, internal consistency, and convergent validity were demonstrated. Discussion: The salience of newfound compassion after cancer was demonstrated. This research has important implications for accurately assessing the post-diagnosis trajectory of adjustment after cancer.Special Issue: Abstracts supplement: “Well-being, quality of life and caregiving” : 27th Conference of the European health psychology society, Bordeaux, France, 16th – 20th July 2013Background: Self-affirmation (i.e., focusing on a valued aspect of the self-concept) can promote health behaviour change. This study aimed to see if self-affirmation increased physical activity (PA) regardless of threat level presented in health messages. Methods: Sixty-eight participants were randomly allocated to condition in a 2 (self-affirmation, no affirmation) x 2 (high threat, low threat) between-participants design. Participants completed the Godin Leisure-Time Exercise Questionnaire at baseline and one week later to assess PA. Findings: A two-way ANCOVA with affirmation condition and threat level as predictor variables, controlling for baseline PA, was performed on follow up PA. Baseline PA was a significant predictor (F(1,63) = 399.63, p<0.001) and the main effect of affirmation condition approached significance (F(1,63) = 3.55, p=0.06). There were no other significant effects. Discussion: This study provides further evidence that self-affirmation can increase PA, but found no interaction between self-affirmation and threat level presented in health messages.Background: Contemporary alcohol research suggests that implicit attitudes are important predictors of drinking behaviour and there is growing interest surrounding factors influencing them. Research suggests that evaluative conditioning (EC) influences implicit attitudes and at a population level the most obvious and prolific use of EC is advertising. Methods: Participants (n= 51, mean age= 22.43) completed alcohol- and chocolate-related Implicit Association Tests (IAT) before viewing an advertisement for either chocolate or beer. Participants then completed post-test IATs before being provided with chocolate and beer products and asked to consume as much as they wanted. Findings: Viewing a beer advertisement produced a significant positive shift in alcohol-related implicit attitudes from pre- to post-test. No other significant effects on implicit attitudes or behaviour were found. Discussion: Alcohol advertisements are effective in changing alcohol-related implicit attitudes; however the influence on behaviour requires further investigation. Implications for the manipulation of alcohol-related implicit attitudes are discussed.Background: Recent research has highlighted the importance of automatic processes in predicting impulsive health risk behaviour. This has led to the creation of health behaviour models such as the Prototype Willingness Model (PWM) which take into account dual processes when predicting health behaviour. The current research argues that individuals are more likely to engage in impulsive drinking behaviour on a weekend as opposed to a weekday as there are fewer constraints placed upon drinking behaviour. Methods: Participants (n= 61, mean age= 22) completed an alcohol Implicit Association Test as well as a questionnaire assessing variables on the PWM and drinking behaviour. Findings: More positive alcohol-related automatic cognitions were significantly related to increased levels of both frequency and quantity of self-reported weekend drinking behaviour but were not significantly related to weekday drinking behaviour. Discussion: Automatic processes successfully predicted drinking behaviour when there were fewer constraints placed upon individuals.Background: The Prototype Willingness Model (PWM) suggests that there are two separate antecedents to behaviour: intention and willingness. Whereas intention is suggested to be rational and deliberative, willingness is more automatic and impulsive. The current study used a cross-cultural sample in order to examine the differing predictive power of the PWM for drinking behaviour. Methods: A sample of 193 individuals from Australia (n=108) and Singapore (n=85) completed a questionnaire measuring alcohol consumption and variables on the PWM. Findings: Willingness to drink significantly predicted alcohol consumption in Singaporeans. Both willingness and intention to drink significantly predicted frequency of alcohol consumption Discussion: The antecedents of the PWM differentially predict alcohol consumption in culturally different samples. Implications for health interventions aimed to reduce drinking across cultures are discussed.Background. Parenting has been associated with child weight status. This study aims to evaluate the effects on parenting skills and BMI-SDS of the BBOFT+ overweight prevention program, compared to care-as-usual (CAU). Method. In a cluster-randomized trial, 2500 parents participated. Parent-reported weight and length were used. Parenting was measured with subscales control and reinforcement of the parenting strategies for eating and activity scale (PEAS) and the warmth subscale from the Child Rearing Questionnaire. Results. The first univariate analyses show that at age 15 months, no statistically significant differences in BMI- SDS, parental control, reinforcement or warmth were found between the BBOFT+ and the CAU group. Further cluster analyses need to be conducted. Results from age 36 months will be presented during the conference, which will include all subscales of the PEAS and an assessment of parenting styles. Conclusion. The intervention does not seem to have an effect on BMI-SDS or parenting.Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. 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Elevated extracellular fluid in the "at risk" arm from taxane-based chemotherapies in women treated for early breast cancer.

126 Background: Taxane-based regimes has improved survival in early breast cancer and now is used routinely. A common side effect is oedema which potentially increases the risk of lymphoedema in the arm after surgery. This has not been assessed prospectively. The aim of this study was to determine the effect of taxane-based regimens on extracellular fluid (ECF) in the arm on the side of surgery. METHODS Women (n=441) aged 56.8 (SD 11.2) years enrolled prior to surgery for early breast cancer and were reassessed within 1 month and 6, 12, and 18 months following surgery. Assessment included bioimpedance spectroscopy which quantifies ECF in each arm and used to derive the ECF ratio. Based on the ECF ratio, women were categorised as having, or not, swelling preferentially in their at risk arm at each time point and having no taxane-based chemotherapy (n=269), paclitaxel (n=73) or docetaxel chemotherapy (n=88). RESULTS Pre-surgery, the ECF ratio was not significantly different in women who later did or did not receive taxane-based chemotherapy. Following surgery but prior to commencing chemotherapy, 45 (11%) women had increased ECF in their at-risk arm. Both taxane-based chemotherapies and elevated postoperative arm swelling were associated with swelling at each follow-up timepoint (Table). CONCLUSIONS In addition to pre-existing swelling, both taxel chemotherapies were associated with swelling preferentially in the at-risk arm between 6 and 18 months following surgery. Strategies to prevent or minimise this swelling need to be developed. [Table: see text].