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.     

Secondary lymphoedema after breast cancer surgery: A survival analysis

This study explores the time of occurrence and risk factors of secondary lymphoedema after breast cancer surgery. A cross‐sectional study of women with breast cancer (n = 230) recruited from Chongqing Breast Cancer Center from July 2009 to June 2010 provided data. A self‐reported questionnaire was used to evaluate the lymphoedema by telephone interview at 6 monthly intervals between 12 and 24 months after breast cancer surgery. The Kaplan–Meier method and Cox proportional hazards regression were used to analyse the collected data. The mean time reported by women who had lymphoedema after breast cancer surgery was 18 months; body mass index and preoperative chemotherapy associated with lymphoedema development were identified in the present study. Given these findings, oncologists and nurses should provide sufficient knowledge to patients to recognize the symptoms, risk factors of lymphoedema and know‐how to use interventions to prevent it.     

Effects of photobiomodualtion therapy on breast cancer-related lymphoedema: A systematic review and meta-analysis of randomised controlled trials

ObjectiveLymphoedema characterised by the persistent accumulation of the interstitial fluid in peripheral tissues post breast cancer treatments. Photobiomodualtion therapy (PBMT) is widely used as supportive care in patients with breast cancer or breast cancer-related lymphoedema (BCRL). This systematic review and meta-analysis analysed the effectiveness and safety of PBMT for the treatment of BCRL.MethodPubMed, EMBASE, PEDro, SCOPUS, CINAHL, and Cochrane Central Register of Controlled Trials were searched for RCTs on PBMT published before July 2019. Randomised controlled trials (RCTs) that evaluated the efficacy of PBMT on BCRL were included. The primary outcome was the arm circumference or volume, and secondary outcomes were grip strength and pain scores. This study is registered with PROSPERO (number CRD 42018102107).ResultsWe reviewed nine RCTs that included 316 patients and six studies for mata-analysis. We found no significant difference in the reduction of the arm circumference or arm volume after treatment, one month, and three month follow-up between the PBMT and control groups. Studies revealed no significant differences in the reduction in grip strength and pain scores at 0, 1, 2, and 3 month between the PBMT and control groups.ConclusionsAlthough PBMT demonstrated a slight improvement in reducing arm circumference and arm volume, the results of our meta-analysis did not show significant benefits in relieving of lymphoedema. Further trials are needed to recruit more participants, and to evaluate the long-term efficacy and safety of PBMT in management of breast cancer-related lymphoedema.     

Breast cancer information dissemination strategies--finding out what works.

This study aimed to identify the best strategies for dissemination of information about breast cancer In November 2004, 28 breast cancer survivors were interviewed. Three themes emerged from these discussions: the shock of diagnosis; the onus being on the patient to search for information; and the different types of information that breast cancer survivors want. To learn multiple viewpoints, 12 focus groups were held with breast cancer survivors (n = 127) and three focus groups were conducted with information providers (n = 25) in the spring of 2005. Participants validated the themes and identified two programs using "best practices" to provide information for women dealing with breast cancer. This article highlights the study findings, including implications for practice, education, and research.     

不同弹力绷带联合包扎治疗在乳腺癌相关淋巴水肿患者中的应用效果

目的探讨不同弹力绷带联合包扎治疗在乳腺癌相关淋巴水肿患者中的应用效果。方法选取2018年5—12月淋巴水肿护理门诊收治的38例乳腺癌相关淋巴水肿患者,采用泡沫块绷带+低弹力绷带+高弹力绷带联合包扎,实施综合淋巴消肿治疗。治疗前1 d,治疗后10、20 d测量患侧上肢周径。对比治疗前1 d和治疗20 d后患者肢体周径比率、组织水分比率、皮肤纤维化发生率。结果治疗10、20 d后,患侧上肢5个测量点周径均小于治疗前,差异均有统计学意义(P<0.05)。治疗20 d后患者的患侧上肢肢体周径比率、组织水分比率、皮肤纤维化发生率均较治疗前降低,差异有统计学意义(P<0.05)。结论用不同弹力绷带联合包扎实施综合淋巴消肿治疗可有效地改善乳腺癌患者患侧上肢的淋巴水肿程度,缩短疗程,同时可改善淋巴水肿皮肤纤维化程度,值得临床推广。     

The lived experience of breast cancer-related lymphoedema

AIM: This study focused on the impact that breast cancer-related lymphoedema has had on the lives of 20 women, who were already being treated for lymphoedema. METHOD: It was a qualitative research study that used data gathered from tape recordings of four focus groups. The data were subsequently analysed using the grounded theory process. RESULTS: The findings suggested that the main themes were finding information, suffering silently and counting blessings. CONCLUSION: The core category illuminated the main theme: 'Finding out information for women with breast cancer-related lymphoedema can help to ease their sense of anxiety and loss, and increase their ability to adapt to a changed life.'     

Thai nurses’ perspectives on the use of complementary and alternative medicine among Thai breast cancer survivors in northern Thailand

Breast cancer survivors are more likely to seek complementary and alternative medicine (CAM) for their health and well‐being than other cancer patients. The purpose of the study was to describe how Thai nurses perceive the use of CAM in Thai breast cancer survivors. An ethno‐nursing research method was used. Fifteen Thai nurses who had experience in taking care of Thai breast cancer survivors who used CAM from a tertiary care referral and resource centre in the lower northern part of Thailand were interviewed. Two major themes emerged from this study: Meaning of care practices in CAM was seen as: (i) an additional beneficial choice for health; and (ii) emotional and psychological healing. Nurses should be concerned about CAM use in Thai breast cancer survivors. Open communication about CAM helps ensure that safe and holistic care is provided. Further research to enhance integration of CAM into health care is needed.     

Assessing task “burden” of daily activities requiring upper body function among women following breast cancer treatment

Goals of work To determine which individual or groups of upper-body daily tasks are considered most burdensome to women following breast cancer treatment, and to assess whether certain patient or treatment characteristics influence task burden.Patients and methods A convenience sample of breast cancer survivors ( n =619) completed a self-administered questionnaire regarding 48 daily tasks requiring upper-body function. Women were asked to rate how frequent and physically demanding each task was using a five-point Likert scale, and the product of task frequency and physical demand determined overall task burden. Tasks were ranked to identify the most burdensome individual tasks, while a factor analysis was performed to define independent constructs (groupings) among the tasks. Multiple linear regression models were fitted to consider the independent influences on task groups of various participant characteristics.Main results Factor analysis identified seven distinct task groups and the individual tasks considered most burdensome fell in five of these groups, specifically whole body, flexibility, carrying/upper-body strength, hand and weighted flexion tasks. Having lymphoedema or poor fitness was associated with upper-body disability involving all seven task groups, whereas other patient and treatment characteristics were related only to certain types of activities.Conclusions Breast cancer survivors report difficulty with a range of upper-body tasks, particularly if they also have lymphoedema or poor fitness. Using all or some of the tasks within the reported constructs in a questionnaire format, or the functional requirements of the most burdensome tasks to develop more objective and quantitative measures, would provide a solid base for the measurement of upper-body function in women with breast cancer.     

Change in extracellular fluid and arm volumes as a consequence of a single session of lymphatic massage followed by rest with or without compression

Purpose

This study evaluated the acute effect of massage and compression components of lymphoedema treatment in women with and without arm lymphoedema secondary to breast cancer from a single treatment session.

Methods

Women with (n?=?15) and without (n?=?15) lymphoedema underwent a single session of lymphatic massage. Following the session, women were randomised to receive or not receive a compression sleeve. Measurements were taken prior to, during, and following the massage as well as 30?min after completion of the massage. Bioimpedance spectrometry (BIS) was used to measure changes in extracellular fluid volume of all limbs as well as 10-cm segments within the upper limbs; perometry was used to measure changes in total upper limb volume as well as 10-cm segments within the limb.

Results

There were no significant changes after massage with or without compression. The median (and interquartile range) BIS ratios (unaffected:affected) for the whole upper limb for women with lymphoedema changed from 1.152 (1.053 to 1.422) to 1.192 (1.045 to 1.410) after massage, while the control group changed from 1.024 (0.998 to 1.047) to 1.041 (0.982 to 1.07). The median change in both the BIS ratio and the total arm volume measured with perometry from prior to the massage to following 30-min rest changed <2%, irrespective of whether women used a compression garment and whether women presented with or without lymphoedema. Examination of 10-cm segments within the arm also revealed no significant change in BIS ratio from one segment to the next.

Conclusion

Massage alone or the application of compression after a single session of lymphatic massage was ineffective for reducing lymphoedema.     

A systematic review of counselling for HIV testing of pregnant women

Background. Evidence‐based strategies have made it possible to limit mother‐to‐child transmission of the HI‐virus to a large extent and enable HIV‐positive women to stay healthy for longer, provided their HIV status is known. Although voluntary counselling and testing for HIV is part of routine antenatal care in South Africa, the uptake of testing varies and a large number of pregnant women’s HIV status is not known at the time of birth. Aim. The aim of the study was to establish research evidence regarding factors influencing counselling for HIV testing during pregnancy by means of systematic review, forming part of a larger study using a variety of evidence to develop best practice guidelines. Design. Systematic review. Methods. The question steering the review was: ‘What factors influence counselling for HIV testing during pregnancy?’. A multi‐stage search of relevant research studies was undertaken using a variety of sources. A total of 33 studies were retrieved and critically appraised. Data were extracted from the studies and assessed according to its applicability in the South African context. Results. The results are presented according to the following themes: effects of counselling, quality of counselling, group vs. individual counselling, ways of offering HIV testing, rapid testing, counselling and testing during labour, couple counselling and testing, counsellor and organisational factors. Conclusions. According to research evidence, factors such as whether counselling is presented in a group or individually, different ways to present HIV testing as well as counsellor and organisational factors can influence counselling for HIV testing during pregnancy. When developing best practice guidelines for settings very dissimilar from where the research was done, research evidence must be contextualised. Relevance to clinical practice. Implementation of the best practice guidelines may lead to the increased uptake of HIV testing in pregnancy in developing countries like South Africa and thus to an increase in the number of women whose status is known when their babies are born.     

Effect of persistent menopausal symptoms on the wellbeing of Japanese breast cancer survivors

While more women with breast cancer survive because of advances in cancer treatment including hormonal therapy, they are at a risk of menopausal symptoms, which can threaten their psychological wellbeing. We examined the effect of menopausal symptoms on women's psychological wellbeing during three different phases of breast cancer: short‐term (0–1 years since diagnosis), medium‐term (2–5 years), and long‐term (more than 5 years). In this cross‐sectional study, 425 survivors treated with hormonal therapy were recruited from a convenience sample in Japan and completed an anonymous self‐administered questionnaire. Multiple regression analysis revealed that menopausal symptoms significantly contributed to psychological wellbeing in all phases. In long‐term survivors, menopausal symptoms were significantly milder; however, the negative effect was prolonged. One in three to four survivors was suspected to have poor psychological wellbeing, irrespective of time. Although the effect of menopausal symptoms on psychological wellbeing has been described in short‐term survivors, little is known about the long‐term effect. This study examines the effect of menopausal symptoms on psychological wellbeing, thereby providing useful information regarding long‐term quality of life.     

“I’m still who I was” creating meaning through engagement in art: The experiences of two breast cancer survivors

PurposeThe aim of this feasibility study was two-fold: i) develop lifelike torsos of two breast cancer survivors using innovative sculpting material and; ii) shed light on the meaning women give to the experience of breast cancer after viewing their sculpted torsos.MethodsThis collaborative initiative between nurse researchers and artists was situated within phenomenological inquiry. Two breast cancer survivors shared their bodies, as models, and stories of their cancer journey and the experience of modeling to create life-sized torsos of their bodies.Key resultsThe participants articulated embodied knowing as each shared experiences of connectedness and relationship which culminated in the emergence of four core themes: The Landscape of Breast in Cancer; Red Shoes: The Re-claiming of Self; Liberation: towards an embodied self; and, Scars: Re-authoring Life.ConclusionsActive engagement in art through the use of one’s body has the potential to open the door to healing, the generation of meaning and a reaffirmation of self.     

Assessment of local tissue water in the arms and trunk of breast cancer survivors with and without upper extremity lymphoedema

Given the paucity of information on local tissue water (LTW) in the upper extremity and trunk of women after breast cancer surgery, the purpose of this study was to compare tissue dielectric constant (TDC) values between the affected and unaffected sides of breast cancer survivors with and without upper extremity lymphoedema (LE). Differences in LTW were assessed using the TDC method for three sites in the upper limbs, three sites in the lateral thorax and two sites on the back. Additional measures included demographic and clinical characteristics, arm circumference and bioimpedance analysis. For the 112 survivors without LE, no differences in TDC values were found between the affected and unaffected sides for the first dorsal web space, ventral forearm and upper arm, and upper and lower back. Compared to the unaffected side, TDC values were significantly higher on the affected side for the upper, mid and lower lateral thorax. For the 78 survivors with LE, compared to the unaffected side, TDC was significantly higher on the affected side for all of the sites evaluated except the hand web space. Our findings support the use of the TDC method to detect differences in upper extremity and truncal oedema in survivors with LE following breast cancer treatment. Measurement of LTW may provide a useful method to determine truncal as well as extremity LE. The ability to detect early signs of truncal oedema may lead to pre‐emptive interventions in breast cancer survivors.     

Breast cancer patients' experiences of lymphoedema

The aim of this study was to explore employed women's experiences of light or moderate arm lymphoedema following breast cancer treatment in order to gain a deeper understanding of this phenomenon. Twelve women took part in a semistructured interview. A qualitative method with a phenomenological approach was applied to analyse data. In order to integrate the experiences in the everyday life of the women, a critical incident method was used. The findings indicate that there are many different practical and psychosocial problems related to arm lymphoedema. Three main themes were common to all the women. These themes were: (i) Attitudes from people in their surroundings, including reactions to the problem from other people and reactions from the women on the attitudes of other people. (ii) Discovery and understanding of oedema as a chronic disease and its treatment. (iii) Coping, including both problem-focused and emotion-focused strategies. The problems integrated in daily life were of low frequency but of considerable importance to the women. In conclusion, it is of great importance that health care professionals should be aware of and have knowledge about these problems. The women's needs for expressing their experiences of arm lymphoedema may be encouraged at the time of discovery and then regularly as long as the women seek care. Efforts may be made to strengthen the women's coping skills, eventually in a multidisciplinary approach. The interaction skills of health care professionals are probably of great importance in strengthening the resources of the women leading to a positive outcome.