[decorative logo]Lymphovenous Canada: Canadian researcher undertakes long range study on lymphedema in the arms of Canadian breast cancer survivors

Final report on Arm Disability after Breast Cancer

Charting the Course of arm morbidity in breast cancer:
a prospective, longitudinal follow-up

[Picture of Dr. Roanne Thomas-MacLean]

Note to readers: this interview with Dr. Roanne Thomas-MacLean took place while she was undertaking her cross-Canada study (described below) on arm disability after breast cancer. She is now working at the University of Ottawa.

Says Thomas-MacLean, " We received a new grant in 2007 from the CIHR and Saskatchewn Health Research Foundation to continue the study. We've enrolled over 650 women and plan to reach our target sample size of 725 in the Spring. We do plan to follow all women in the study for 5 years, assuming our next grant application (due in March) is successful. We have some papers underway and one has been published in Oncology Nursing Forum.

Our main finding to date is that many women experience pain and range of motion restrictions 6-12 months post-surgery. We did not expect rates of lymphedema to be high that soon after surgery and they are not. However, pain and ROM restrictions may predict onset of lymphedema, but we need more longitudinal data to find that out. We also need to follow the women over time to really be able to trace the impact of arm problems."

Dr. Roanne Thomas-MacLean of the University of Saskatchewan is heading up a cross-Canada study on lymphedema, pain and limitations to range of motion in breast cancer survivors.

Her research team received funding from the Breast Cancer Research Alliance (CBCRA)to undertake the study from 2004 - 2007. Close to 1,000 women were to be followed over a three year period to learn how many women will develop arm problems, what type of symptoms they have, what triggers arm problems, the extent to which arm problems can be disabling and their impact on women's emotional health.

The study involved four sites: Fredericton, Montreal, Winnipeg and Surrey. Over 200 women were enrolled in the study as of October 2005.

In the journal article, "Arm morbidity and disability after breast cancer: New directions for care", published in Oncology Nursing Forum in 2007, Roanne Thomas-MacLean, and her research colleagues Thomas Hack, Winkle Kwan, Anna Towers, Baukje Miedema and Andrea Tilley reported on the three year results of their study. The study charted 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. Their sample size involved 347 patients with breast cancer 6 –12 months after surgery at first point of data collection. 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.

The group noted in their abstract that 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 and called for additional research into the longevity of various arm morbidity symptoms and possible interrelationships.

In 2005 preliminary findings showed that 42% of participants were experiencing pain, while 25% of participants were reporting some level of arm, shoulder or hand disability. About 26% of the participants had two or more of four identified risk factors for lymphedema. At that time, researchers found that 9% of their participants have had to change some aspect of paid work, while 28% are on sick leave. About 5% of the women said that arm problems had a negative impact on relationships with partners, children or grandchildren.

The same percentage, however, reported that arm problems have had a positive affect on their relationship with their husband or partner. Some women reported that they had trouble playing with children/grandchildren, but others reported that family members have taken on more household responsibilities. About 27% of the women have made changes to leisure activities, such as knitting, golfing and needlework.

Thus, even in its early stages, their research showed that arm problems can have a significant impact upon many dimensions of women's lives.

For more information on this study contact:
Roanne Thomas, Ph.D.
Associate Professor
School of Rehabilitation Sciences
University of Ottawa
Guindon Hall, 451 Smyth Rd, Room 3068
Ottawa, ON K1H 8M5 Canada
T. 613.562.5800 ext. 8645
Tel: 306-966-1489
Fax: 306-966-6950

View a videoclip on this initiative

List of Presentations associated with these grants:

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Last revised Nov. 2, 2012.