Perceptions of upper-body problems during recovery from breast cancer treatment

Despite improved recognition recently, restrictions in upper-body movement continue to cause impairment and distress for many women long after breast cancer treatment. The purpose of this research is to investigate this issue through the perceptions of breast cancer survivors in the context of their everyday lives. Twenty-four women recruited from a private breast clinic in south-eastern Queensland, Australia, participated in a qualitative study. Discussion groups comprised women treated for breast cancer within the previous 18 months. Discussions centred on experiences of physical difficulties, follow-up support, arm lymphoedema and exercise therapy during the womens recoveries. Returning to normal activities for women after breast surgery was felt to take longer than either the womens or their physicians expectations. Many women reported difficulties in upper-body tasks, which worsened simple everyday responsibilities. The physical impact leads to psychological strain, as the women are constantly reminded of their illness and the possibility they may never return to their full capacity. These upper-body difficulties may include discomfort while driving and sleeping, posture disturbances, reduced employability in physical work, and decreased ability to do housework and gardening. Having lymphoedema or the threat of developing it was very distressing for most women. The potential preventive role of physiotherapy-led exercises to prevent further decline and improve function was strongly emphasised during these discussions. Clinicians need to recognise that it is very common for women with breast cancer to experience upper-body morbidity long after their treatment, and consequently every effort to enhance recovery and avoid further deterioration in function is required.     

Experiences and management of breast cancer‐related lymphoedema: a comparison between South Africa and the United States of America

WANCHAI A., STEWART B.R. & ARMER J.M. (2011) Experiences and management of breast cancer‐related lymphoedema: a comparison between South Africa and the United States of America. International Nursing Review 59 , 117–124 Purpose: Approximately one third of breast cancer survivors are estimated to develop lymphoedema. This study was conducted in the midwestern region of the USA and in Western Cape, South Africa. The purpose of this study was to compare and contrast lymphoedema experiences and lymphoedema managements between breast cancer survivors from the two countries . Methods: Using a qualitative research design, data were collected from 29 women with a history of breast cancer‐related lymphoedema (18 women from the USA and 11 women from South Africa ) who consented to semi‐structured interviews. Findings: Six themes regarding effects of lymphoedema emerged from the study including difficulties with daily activities, unmet lymphoedema preparations, facing public curiosity, time‐consuming wrapping, trouble with fitted clothes and a reminder of breast cancer. Four themes regarding lymphoedema management included compression garments, physical activities and faith, as well as other strategies such as compression pumps or antibiotics for infection. Conclusion: Experiences about lymphoedema and its management for breast cancer survivors from both countries were somewhat similar and somewhat different. Collaboration between healthcare providers from both countries should be planned to develop culturally appropriate lymphoedema symptom management interventions for each country.     

Impingement pain affects kinematics of breast cancer survivors in work-related functional tasks

BackgroundBreast cancer survivors may encounter upper limb morbidities post-surgery. It is currently unclear how these impairments affect arm kinematics, particularly during functional task performance. This investigation examined upper body kinematics during functional tasks for breast cancer survivors and an age-matched control group.MethodsFifty women (aged 35–65) participated: 25 breast cancer survivors who had undergone mastectomy and 25 age-range matched controls. Following basic clinical evaluation, including shoulder impingement tests, motion of the torso and upper limbs were tracked during six upper limb-focused functional tasks from which torso, scapular, and thoracohumeral angles were calculated. Between-group differences were evaluated with independent t-tests (p < .05). The breast cancer group was then divided based upon impingement tests and differences between the three new groups were tested with one-way ANOVAs (p < .05).FindingsBreast cancer survivors had higher disability scores, lower range of motion, and lower performance scores. The largest kinematic differences existed between the breast cancer survivors with impingement pain and the two non-pain groups. During overhead tasks, right peak scapular upward rotation was significantly reduced (d = 0.80–1.11) in the breast cancer survivors with impingement pain. This group also demonstrated trends of decreased peak humeral abduction and internal rotation at extreme postures (d = 0.54–0.78). These alterations are consistent with kinematics considered high risk for rotator cuff injury development.InterpretationImpingement pain in breast cancer survivors influences functional task performance and may be more important to consider than self-reported disability when evaluating pain and potential injury development.     

Survivorship care in breast cancer: Perceptions of patients and primary care physicians

Objective

To compare the perceptions of breast cancer survivors and primary care physicians (PCPs) about PCPs’ ability to deliver survivorship care in breast cancer.

Design

Mailed survey.

Setting

British Columbia.

Participants

A total of 1065 breast cancer survivors who had completed treatment of nonmetastatic breast cancer within the previous year, and 587 PCPs who had patients with nonmetastatic breast cancer discharged to their care within the preceding 18 months.

Main outcome measures

Breast cancer survivors’ and PCPs’ confidence ratings of PCPs’ ability to deliver the following aspects of care: screening for recurrence; managing osteoporosis, lymphedema, endocrine therapy, menopausal symptoms, and anxiety about or fear of recurrence; and providing nutrition and exercise counseling, sex and body image counseling, and family counseling. Response options for each question included low, adequate, or good. Responses were summarized as frequencies and compared using χ² tests.

Results

Response rates for breast cancer survivors and PCPs were 47% and 59%, respectively. Responses were statistically different in all categories (P < .05). Both groups were most confident in the ability of PCPs to screen for recurrence, but breast cancer survivors were 10 times as likely to indicate low confidence (10% of breast cancer survivors vs 1% of PCPs) in this aspect of care. More breast cancer survivors (23%) expressed low confidence in PCPs’ ability to provide counseling about fear of recurrence compared with PCPs (3%). Aspects of care in which both breast cancer survivors and PCPs were most likely to express low confidence included sex and body image counseling (35% of breast cancer survivors vs 26% of PCPs) and family counseling (33% of breast cancer survivors vs 24% of PCPs). Primary care physicians (24%) described low confidence in their ability to manage lymphedema.

Conclusion

Breast cancer survivors and PCPs are reasonably confident in a PCP-based model of survivorship care. Primary care physicians are confident in their ability to manage physical effects related to breast cancer, with the exception of lymphedema. Low confidence ratings among both groups in psychosocial aspects of care suggest an area for improvement.     

Breast and Prostate Cancer Survivors in a Diabetic Cohort: Results from the Living With Diabetes Study

Objective

Diabetes is more common in cancer survivors than in the general population. The objective of the present study was to determine cancer frequency in a cohort of patients with diabetes and to examine demographic, clinical, and quality of life differences between cancer survivors and their cancer-free peers to inform better individualized care.

Methods

Self-reported survey data from 3,466 registrants with type 2 diabetes from Australia’s National Diabetes Services Scheme (NDSS) were analyzed to compare relevant variables between cancer survivors and cancer-free patients. Analyses were focused on breast and prostate cancer to reflect the most common cancers in women and men, respectively.

Results

Five percent of diabetic women reported a history of breast cancer and 4.2% of men reported a history of prostate cancer. Diabetic patients with a history of breast or prostate cancer were older at time of survey and diabetes diagnosis, less likely to report metformin use (women), and more likely to have two or more comorbidities than their cancer-free peers. More diabetic prostate cancer survivors also reported problems with mobility and performing usual tasks. However, cancer-free diabetic subjects reported a lower diabetes-dependent quality of life than diabetic cancer survivors. There was no association between cancer survivorship and duration of diabetes, indices of glycemic control, obesity, or diabetic complications.

Conclusions

Cancer survivors comprise a significant minority of diabetic patients that are particularly vulnerable and may benefit from interventions to increase screening and treatment of other comorbidities and promote a healthy lifestyle.     

The comparative effectiveness of a team-based versus group-based physical activity intervention for cancer survivors

Purpose

Physical activity benefits cancer survivors, but the comparative effectiveness of a team-based delivery approach remains unexplored. The hypothesis tested was that a team-based physical activity intervention delivery approach has added physical and psychological benefits compared to a group-based approach. A team-based sport accessible to survivors is dragon boating, which requires no previous experience and allows for diverse skill levels.

Methods

In a non-randomized trial, cancer survivors chose between two similarly structured 8-week programs, a dragon boat paddling team (n?=?68) or group-based walking program (n?=?52). Three separate intervention rounds were carried out in 2007–2008. Pre–post testing measured physical and psychosocial outcomes.

Results

Compared to walkers, paddlers had significantly greater (all p?Conclusions These hypothesis-generating findings suggest that a short-term, team-based physical activity program (dragon boat paddling) was associated with increased cohesion and adherence/attendance. Improvements in physical fitness and psychosocial benefits were comparable to a traditional, group-based walking program. Compared to a group-based intervention delivery format, the team-based intervention delivery format holds promise for promoting physical activity program adherence/attendance in cancer survivors.     

Measurement of objective shoulder function following breast cancer surgery: a scoping review protocol

Background: Decreased shoulder function is frequently experienced by breast cancer survivors following surgery, and it is associated with both decreased ability to perform daily living tasks and decreased overall quality of life, even several years post-surgery. Shoulder function is often measured with self-reported questionnaires. If objective measurements are taken, they are frequently restricted to range of motion measurement in the cardinal planes of movement. It is not known to what extent shoulder motion in more functional tasks has been investigated.

Objectives: This review aims to determine what is known about the objectively evaluated shoulder function following breast cancer and to determine what are the most frequently used methods for evaluation.

Methods: This protocol outlines the steps that will be taken to conduct a high quality scoping review on the objective measurement of shoulder function in breast cancer survivors. A comprehensive search of several databases will be performed to identify all relevant research. All identified studies will be screened and those including the objective measurement of shoulder function of breast cancer survivors post-surgery will be included. Data will be extracted by two reviewers and results will be consolidated and presented in narrative form as well as tables and figures.

Conclusion: The resulting synthesis of the literature will provide a comprehensive overview of the current methods of evaluating shoulder function in breast cancer survivors. This review will elucidate gaps in knowledge regarding objective measurement of shoulder function and help to develop future research questions.     

Measuring cognitive complaints in breast cancer survivors: psychometric properties of the patient’s assessment of own functioning inventory

Purpose

Cognitive complaints are a concern for breast cancer survivors. Among various published measures for cognitive complaints, the Patient’s Assessment of Own Functioning Inventory (PAOFI) is one of the few assessing a spectrum of cognitive abilities, including those most commonly reported by breast cancer survivors. This study aimed to examine the psychometric properties of the PAOFI in breast cancer survivors.

Methods

An exploratory factor analysis was conducted with a sample of breast cancer survivors (n?=?189) who had completed all primary cancer treatments. Construct validity was examined by correlating factor scores with valid measures of cognitive complaints, fatigue, and quality of life. Reliability was measured by internal consistency of the items in each factor within this sample, a separate sample of breast cancer survivors with high persistent cognitive complaints (n?=?72), and healthy controls (n?=?63). Factor scores were compared across the three samples.

Results

A five-factor structure similar to the PAOFI standardization study was found, with factors related to executive functioning (accounting for most of the variance), two aspects of memory functioning, language, and motor/sensory-perceptual abilities. Factor scores highly correlated with measures of cognitive complaints, fatigue, and quality of life. Executive functioning and memory-related factors achieved adequate reliability across samples. Scores were significantly different across the three samples as expected.

Conclusions

The PAOFI is a reliable and valid tool for measuring cognitive complaints in breast cancer survivors.

     

A randomised controlled trial of two programmes of shoulder exercise following axillary node dissection for invasive breast cancer

Objective

To compare the incidence of treatment-related complications, including lymphoedema, after two programmes of shoulder mobilisation in women with invasive breast cancer when surgical treatment included axillary lymph node dissection.

Design

Randomised controlled trial.

Setting

Two secondary care National Health Service trusts.

Participants

One hundred and sixteen women (mean age 57 years, standard deviation 13.1 years) recruited from November 2003 to March 2006 (58 intervention group, 58 control group). Seven patients (6%) did not complete the study.

Intervention

Arm exercises and shoulder movement restricted to below shoulder level for the first 7 days after surgery. Controls commenced an exercise programme that incorporated exercises above shoulder level within 48 hours.

Outcome measures

All outcomes were recorded at baseline (pre-operatively) and at 1 year. The primary outcome was incidence of lymphoedema, defined by a limb volume difference of 200 ml or more compared with the contralateral arm. This outcome was measured using volume displacement. Secondary outcome measures included volume differences between the two limbs measured by actual volume displacement difference, wound drainage volumes, range of shoulder movement (manual goniometer), grip strength (hand-held dynamometer) and health-related quality of life (Shoulder Disability Questionnaire, Functional Assessment of Cancer Therapy - Breast).

Results

All statistical tests were two-sided. Data were analysed using intention-to-treat principles. The incidence of lymphoedema (200 ml or more) increased significantly in women who had undertaken a programme of early full shoulder mobilisation. Twenty-two women (19%) developed lymphoedema (200 ml or more) in their first postoperative year. There were significantly more women with lymphoedema in the early full shoulder mobilisation group (n = 16) compared with the delayed full shoulder mobilisation group (n = 6). The relative risk of developing lymphoedema after early mobilisation was 2.7 (95% confidence interval 1.1 to 6.3; P = 0.031). Limb volume differences were significantly higher in the early mobilisation group. This was apparent in differences in limb volume displacement (P = 0.004) and percentage difference between the two limbs (P = 0.007). There were no statistically significant differences in shoulder movement, grip strength or self-evaluated outcomes between the two groups at 1 year.

Conclusion

A programme of exercise that delays full shoulder mobilisation for 1 week is recommended after axillary node dissection for invasive breast cancer.