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

Psychometric Validation of the Chinese Version of the Lymphedema Functioning, Disability, and Health Questionnaire for Upper Limb Lymphedema in Patients With Breast Cancer-Related Lymphedema

BACKGROUND

Breast cancer-related lymphedema (BCRL) has a notable impact on patients' quality of life. However, no instrument is available to assess the problems in functioning due to BCRL in China.

OBJECTIVE

The aims of this study were to translate and validate a Chinese version of the Lymphedema Functioning, Disability, and Health Questionnaire for Upper Limb Lymphedema (Lymph-ICF-UL).

METHODS

A process of translation and cultural adaptation was conducted based on international standards. The study included 155 patients with BCRL and 90 patients without lymphedema. Psychometric properties that were tested consisted of internal consistency, test-rest reliability, content, construct and discriminant validity.

RESULTS

The Cronbach's α was .92, and intraclass correlation coefficient was 0.83. Content validity was confirmed by a sufficient content validity index in item level and scale level. Exploratory factor analysis identified 5 factors accounting for 62.44% of the total variance, and confirmatory factor analysis fit indices were acceptable. Convergent validity was supported by a moderate correlation with the 36-item Short-Form Health Survey Questionnaire and relatively weak correlations with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30. There was good divergent validity with all hypotheses evaluating divergent validity were confirmed. Significant differences were found between the lymphedema and nonlymphedema groups.

CONCLUSION

The Chinese version of the Lymph-ICF-UL is a valid and reliable instrument that can be used in both clinical and scientific settings in China.

IMPLICATIONS

The Chinese version of the Lymph-ICF-UL could be applicable in assessing the impairments in function, activity limitations, and participation restrictions of Chinese patients with BCRL.

Assessment of Family Caregiver Burden and Its Relationships Between Quality of Life, Arm Disability, Grip Strength, and Lymphedema Symptoms in Women with Postmastectomy Lymphedema: A Prospective Cross-Sectional Study

OBJECTIVE

The aim the study is to assess relationships between caregiver burden, quality of life, arm disability, grip strength, and lymphedema symptoms in women with postmastectomy lymphedema.

MATERIALS AND METHODS

Fifty-two patients with postmastectomy lymphedema were recruited. Burden Interview, Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-30 and EORTC QLQ BRE-23) were used for the assessments of caregiver burden, arm disability, and quality of life. Lymphedema symptoms were questioned by Visual Analogue Scale (VAS) for pain, heaviness, and tension. Grip strength and arm volumes of the affected and unaffected sides were measured.

RESULTS

Statistically significant positive correlations were detected between Burden Interview scores and DASH scores, VAS for pain and EORTC QLO-30 symptom scores. There were statistically negative correlations between Burden Interview and grip strength of affected side and unaffected side and lymphedema duration. Multiple linear regression was calculated to predict Burden Interview and EORTC QLO-30 functional and symptom scores based on age, DASH, stage, and duration of lymphedema. DASH score was significant predictors of Burden Interview while DASH score and Burden Interview scores were significant predictors of quality of life.

CONCLUSION

Arm disability indicates caregiver burden and quality of life in patients with postmastectomy lymphedema while caregiver burden predicts the quality of life. These findings have implications for the management of lymphedema. We suggest that arm disability should be diagnosed and treated to improve caregiver burden and quality of life.

Persistent Post-Mastectomy Pain: Risk Factors and Current Approaches to Treatment

Persistent Post-Mastectomy Pain (PPMP) is a common condition that can follow surgeries for breast cancer, the most common cancer in women. Because of the frequency of PPMP and its potential severity, it has received increasing research attention. This manuscript reviews the recent research literature, beginning with a brief history and then relevant medical, surgical, demographic, and psychosocial risk factors. Subsequently, social, psychological, and functional sequelae that have been linked to PPMPS are considered, as is research on current pharmacological, psychological, and rehabilitative approaches to treatment. The review concludes with a discussion of directions for future research and treatment that might reduce the incidence and impact of PPMP on breast cancer survivors. PERSPECTIVE: This article describes current research literature involving mechanisms, risks, and treatments related to persistent post-mastectomy pain. Implications of research findings also are discussed for pre- and post-surgical approaches to pain management, current treatments, and promising research directions.

Upper Extremity Strength Imbalance after Mastectomy and the Effect of Resistance Training

The purpose of this non-randomized pre/post comparison trial was to explore the effect of resistance training (RT) on upper extremity strength imbalance in breast cancer survivors. Seventeen right-side dominant female breast cancer survivors (age: 58.2±2.7 years; BMI: 27.8±1.1 kg/m ² ) with right-sided (RSM) or left-sided (LSM) mastectomy completed strength testing (30-second arm curl) before and after an 8-week RT program. At baseline, LSM (n=8) had equal strength bilaterally (right=16.8±1.1 repetitions; left=16.4±1.4 repetitions), whereas RSM (n=9) had impaired strength on the right (16.7±1.3 repetitions) compared to the left (18.6±1.1 repetitions) side ( p <0.01). After RT, RSM increased strength by 25% on the right (initially weaker) side and 19% on the left (initially stronger) side, which resolved the imbalance. By comparison LSM increased 19% on both sides that were initially equal in strength. Based on our findings, breast cancer survivors with dominant-side mastectomy are at risk for upper extremity strength imbalance that can be resolved with a relatively short-term RT program.

Return to work after early-stage breast cancer: a cohort study into the effects of treatment and cancer-related symptoms

INTRODUCTION

Earlier diagnosis and better treatment have increased the survival rates of cancer patients. This warrants research on return to work of cancer survivors. What is the return to work rate following early-stage breast cancer? What is the effect of the type of treatment and cancer-related symptoms on return to work?

METHODS

Our occupational health department registers sickness absence of about 50,000 employees. In the period 2001-2005 we counted 154 cases of newly diagnosed breast cancer of which 72 were eligible for analysis. In these women, return to work was followed for 24 months after diagnosis and linked to the type of treatment and cancer-related symptoms.

RESULTS

The mean duration of absence with early-stage breast cancer was 11.4 +/- 5.5 months; 35% of patients were absent longer than one year and 4 patients did not return to work within two years after diagnosis. The duration of absence depended on the type of treatment and was significantly longer in patients who underwent chemotherapy (hazard rate [HR] = 0.31; 95% confidence interval [CI] = 0.12-0.81) or multimodal treatment (HR = 0.24; 95% CI = 0.10-0.54). Women started working about 4 months after the end of therapy irrespective of the type of treatment. At that moment, reaching above shoulder level was impaired in 11 patients (15%) which significantly delayed partial return to work (HR = 0.48; 95% CI = 0.23-0.98) but not full return to work (HR = 0.63; 95% CI = 0.31-1.26). Fatigue was reported by 9 patients (13%) and neither postponed partial return to work nor full return to work.

CONCLUSIONS

The time taken to return to work after early-stage breast cancer was principally determined by the type of treatment.

Preoperative assessment enables the early diagnosis and successful treatment of lymphedema

BACKGROUND

The incidence of breast cancer (BC)-related lymphedema (LE) ranges from 7% to 47%. Successful management of LE relies on early diagnosis using sensitive measurement techniques. In the current study, the authors demonstrated the effectiveness of a surveillance program that included preoperative limb volume measurement and interval postoperative follow-up to detect and treat subclinical LE.

METHODS

LE was identified in 43 of 196 women who participated in a prospective BC morbidity trial. Limb volume was measured preoperatively and at 3-month intervals after surgery. If an increase>3% in upper limb (UL) volume developed compared with the preoperative volume, then a diagnosis of LE was made, and a compression garment intervention was prescribed for 4 weeks. Upon reduction of LE, garment wear was continued only during strenuous activity, with symptoms of heaviness, or with visible swelling. Women returned to the 3-month interval surveillance pathway. Statistical analysis was a repeated-measures analysis of variance by time and limb (P<or=.001) comparing the LE cohort with an age-matched control group.

RESULTS

The time to onset of LE averaged 6.9 months postoperatively. The mean (+/-standard deviation) affected limb volume increase was 83 mL (+/-119 mL; 6.5%+/-9.9%) at LE onset (P=.005) compared with baseline. After the intervention, a statistically significant mean 48 mL (+/-103 mL; 4.1%+/-8.8%) volume decrease was realized (P<.0001). The mean duration of the intervention was 4.4 weeks (+/-2.9 weeks). Volume reduction was maintained at an average follow-up of 4.8 months (+/-4.1 months) after the intervention.

CONCLUSIONS

A short trial of compression garments effectively treated subclinical LE.

Long-term morbidity of sentinel node biopsy versus complete axillary dissection for unilateral breast cancer

BACKGROUND

Postoperative changes after axillary lymph node surgery may significantly alter breast cancer survivors' (BCS) quality of life. Although sentinel lymph node biopsy (SLNB) has less immediate morbidity than axillary lymph node dissection (ALND), its long-term impact on shoulder abduction, arm swelling, and neurosensory changes has not been evaluated. The purpose of this study was to compare long-term morbidity after SLNB or ALND and breast-conservation surgery.

METHODS

Female BCS who remained free of disease at least 3 years after ALND or SLNB for Stage I-III unilateral breast cancer completed a symptom questionnaire and a brief neurosensory physical examination of the upper arm and axilla (range of motion, arm circumference, and sensation to light touch with cotton and needle).

RESULTS

The mean age of the 187 participating BCS was 62 years. At a mean follow-up of 6.6 years after ALND and 4.9 years after SLNB, most BCS had full abduction; only 10 cases (8 ALND, 2 SLNB) had a >/=2 cm proximal and/or distal circumference difference on the ipsilateral side compared with the contralateral side. ALND was associated with a significantly greater likelihood of subjective arm numbness (P < .001), chest or axillary numbness (P < .001), arm or hand swelling (P < .001), and objective neurosensory changes in the posterior axilla, medial and distal upper arm (P < .001). Operative procedure was the only significant predictor of neurosensory changes (P < .001).

CONCLUSION

SLNB is associated with significantly less subjective and objective long-term morbidity than ALND.

The development of an arm activity survey for breast cancer survivors using the Protection Motivation Theory

Background

Current research evidence indicates that women should return to normal use of their arm after breast cancer surgery. However, it appears some women continue to hold the view that they are supposed to protect their arm from strenuous activities because of the risk of lymphoedema. Many factors contribute to women's perceptions about lymphoedema and their ability to use their affected arm, and it is the aim of this study to explore and understand these perceptions.

Methods/design

A survey, based on the Protection Motivation Theory, has been developed and tested. The survey assesses whether subjective norms, fear and/or coping attributes predict women's intention to use their affected arm. In addition, the survey includes questions regarding cancer treatment and demographic characteristics, arm and chest symptoms, and arm function. Recruitment of 170 breast cancer survivors has begun at 3 cancer treatment sites in Sydney, Australia.

Discussion

This study will identify perceptions that help predict the extent women use their affected arm. The results will also determine whether upper limb impairments arise secondary to over-protection of the affected arm. Identification of factors that limit arm use will enable appropriate prevention and better provision of treatment to improve upper limb outcomes.