Limited information exists regarding the common physical, functional, and psychological effects that arise late in the course of breast cancer treatment and recovery. The proposed study will first describe the incidence, prevalence, and related symptoms of early- and late-onset Iymphedema (LE) among persons diagnosed with breast cancer and followed from pre- and post-op baseline through 3 to 7years after treatment in a predominantly rural Midwestern state. We propose to then examine the long-term effects of post-treatment lymphedema at 3 to 7 years after diagnosis on psychosocial adjustment and functional health status. The sample for this prospective longitudinal study includes breast cancer survivors, already accrued at pre-op (N=290 of 300, soon to be completing an earlier RO1 study), who will be followed an additional 3 to 7 years post-diagnosis. The study has one primary (Aim 1) and three secondary aims (Aims 2.1, 2.2, and 2.3). These include: First, (Aim 1) To explore in breast cancer survivors over time (from baseline through 3 to 7 yrs after diagnosis): (a) limb volume and limb volume changes (LVC), (b) associated LE-related symptoms, (c) problem solving and social support;(d) levels of perceived coping effectiveness and ways of managing LE symptoms;and (e) the outcome variables of psychosocial adjustment and functional health status. Further, as secondary aims, we propose to explore:
(Aim 2. 1) associations among (a) perceived coping effectiveness and ways of managing LE symptoms with (b) LVC and associated LE-related symptoms;
(Aim 2. 2) associations of the above-mentioned post-treatment changes (LVC, symptoms, perceived coping effectiveness, and ways of managing symptoms) on psychosocial adjustment and functional health status;
and (Aim 2. 3) the complex interactions of these predisposing, mediating, and moderating variables on psychosocial adjustment and functional health status over time. Internal funding, contingent upon the NIH award, will support the recruitment and retention of an additional 100 breast cancer survivors to be followed 3 to 7 years post-diagnosis, enabling us to increase minority recruitment and to carry out more sophisticated subgroup analysis. Results of this longitudinal investigation will provide ground-breaking new information about the onset and progression of lymphedema and their impact on psychosocial adjustment and functional health status over an extended time. These findings will form the basis for design and timing of subsequent interventions with breast cancer survivors aimed at reducing LE risk and improving symptom management and overall survivorship quality of life. Without further funding, after April 30, 2006, this opportunity for long-term follow-up will be lost.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Research Project (R01)
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Nursing Science: Adults and Older Adults Study Section (NSAA)
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Marden, Susan F
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University of Missouri-Columbia
Schools of Nursing
United States
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Hulett, Jennifer M; Armer, Jane M; Stewart, Bob R et al. (2015) Perspectives of the Breast Cancer Survivorship Continuum: Diagnosis through 30 Months Post-Treatment. J Pers Med 5:174-90
Voss, Rachel K; Cromwell, Kate D; Chiang, Yi-Ju et al. (2015) The long-term risk of upper-extremity lymphedema is two-fold higher in breast cancer patients than in melanoma patients. J Surg Oncol 112:834-40
Armer, Jane M; Hulett, Jennifer M; Bernas, Michael et al. (2013) Best Practice Guidelines in Assessment, Risk Reduction, Management, and Surveillance for Post-Breast Cancer Lymphedema. Curr Breast Cancer Rep 5:134-144
Green, Jason M; Paladugu, Sowjanya; Shuyu, Xu et al. (2013) Using temporal mining to examine the development of lymphedema in breast cancer survivors. Nurs Res 62:122-9
Shigaki, Cheryl L; Madsen, Richard; Wanchai, Ausanee et al. (2013) Upper extremity lymphedema: presence and effect on functioning five years after breast cancer treatment. Rehabil Psychol 58:342-9
Armer, J M; Stewart, B R (2010) Post-breast cancer lymphedema: incidence increases from 12 to 30 to 60 months. Lymphology 43:118-27