The association between nocturnal hot flashes and sleep in breast cancer survivors. Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Randomized controlled trial of the effects of print materials and step pedometers on physical activity and quality of life in breast cancer survivors. Physical Activity and Lymphedema (the PAL trial): assessing the safety of progressive strength training in breast cancer survivors. Outcomes from the Moving Beyond Cancer psychoeducational, randomized, controlled trial with breast cancer patients. Fatigue, menopausal symptoms, and cognitive function in women after adjuvant chemotherapy for breast cancer: 1- and 2-year follow-up of a prospective controlled study. Sleep aid use during and following breast cancer adjuvant chemotherapy. Long-term effects of educational and peer discussion group interventions on adjustment to breast cancer. Efficacy and costs of two forms of stress management training for cancer patients undergoing chemotherapy. A pilot study evaluating the safety and efficacy of modafinal for cancer-related fatigue. Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part I: Sleep and psychological effects. A menopause-specific quality of life questionnaire: development and psychometric properties. Sleep, fatigue, and depressive symptoms in breast cancer survivors and matched healthy women experiencing hot flashes. The management of cancer-related fatigue after chemotherapy with acupuncture and acupressure: a randomised controlled trial. Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part II: Immunologic effects. Lymphedema in breast cancer survivors: incidence, degree, time course, treatment, and symptoms.
This study examined the relationship between objective ly measured nocturnal hot flashes and objective ly measured sleep in breast cancer survivors with insomnia . Twenty-four women who had completed treatment for non-metastatic breast cancer participated . All were enrolled in a study of cognitive-behavioral treatment for chronic insomnia .  Nocturnal hot flashes and sleep  were measured by skin conductance and polysomnography  , respectively . The 10-minute periods around hot flashes were found to have significantly more wake time , and more stage changes to lighter sleep , than other 10-minute periods during the night . Nights with hot flashes had a significantly higher percentage of wake time , a lower percentage of Stage 2 sleep , and a longer REM latency compared to nights without hot flashes . Overall , hot flashes were found to be associated with less efficient , more disrupted sleep . Nocturnal hot flashes , or their underlying mechanisms , should be considered as potential contributors to sleep disruption in women with breast cancer who report poor sleep BACKGROUND Chronic sleep-onset insomnia is a prevalent health complaint in adults . Although behavioral and pharmacological therapies have been shown to be effective for insomnia , no placebo-controlled trials have evaluated their separate and combined effects for sleep-onset insomnia . The objective of this study was to evaluate the clinical efficacy of behavioral and pharmacological therapy , singly and in combination , for chronic sleep-onset insomnia . METHODS This was a r and omized , placebo-controlled clinical trial that involved 63 young and middle-aged adults with chronic sleep-onset insomnia . Interventions included cognitive behavior therapy ( CBT ) , pharmacotherapy , or combination therapy compared with placebo . The main outcome measures were sleep-onset latency as measured by sleep diaries ; secondary measures included sleep diary measures of sleep efficiency and total sleep time , objective measures of sleep variables ( Nightcap sleep monitor recorder ) , and measures of daytime functioning . RESULTS In most measures , CBT was the most sleep effective intervention ; it produced the greatest changes in sleep-onset latency and sleep efficiency , yielded the largest number of normal sleepers after treatment , and maintained therapeutic gains at long-term follow-up . The combined treatment provided no advantage over CBT alone , whereas pharmacotherapy produced only moderate improvements during drug administration and returned measures toward baseline after drug use discontinuation . CONCLUSIONS These findings suggest that young and middle-age patients with sleep-onset insomnia can derive significantly greater benefit from CBT than pharmacotherapy and that CBT should be considered a first-line intervention for chronic insomnia . Increased recognition of the efficacy of CBT and more widespread recommendations for its use could improve the quality of life of a large numbers of patients with insomnia PURPOSE To determine the effects of breast cancer-specific print material s and step pedometers on  physical activity ( PA ) and quality of life ( QoL ) in breast cancer survivors . PATIENTS AND METHODS Breast cancer survivors ( N = 377 ) were r and omly assigned to receive one of the following : a st and ard public health recommendation for PA , previously developed breast cancer-specific PA print material s , a step pedometer , or a combination of breast cancer-specific print material s and step pedometers . The primary outcome was self-reported moderate/vigorous PA minutes per week . Secondary outcomes were QoL ( Functional Assessment of Cancer Therapy-Breast ) , fatigue , self-reported brisk walking , and objective step counts . Assessment s were conducted at baseline and postintervention ( 12 weeks ) . RESULTS Attrition was 10.3 % ( 39 of 377 ) . On the basis of linear mixed-model analyses , PA increased by 30 minutes/week in the st and ard recommendation group compared with 70 minutes/week in the print material group ( mean difference , 39 minutes/week ; 95 % CI = -10 to 89 ; d = 0.25 ; P = .117 ) , 89 minutes/week in the pedometer group ( mean difference , 59 minutes/week ; 95 % CI , 11 to 108 ; d = 0.38 ; P = .017 ) , and 87 minutes/week in the combined group ( mean difference , 57 minutes/week ; 95 % CI , 8 to 106 ; d = 0.37 ; P = .022 ) . For brisk walking minutes/week , all three intervention groups reported significantly greater increases than the st and ard recommendation group . The combined group also reported significantly improved QoL ( mean difference , 5.8 ; 95 % CI , 2.0 to 9.6 ; d = 0.33 ; P = .003 ) and reduced fatigue ( mean difference , 2.3 ; 95 % CI , 0.0 to 4.7 ; d = 0.25 ; P = .052 ) compared with the st and ard recommendation group . CONCLUSION Breast cancer-specific PA print material s and pedometers may be effective strategies for increasing PA and QoL in breast cancer survivors . A combined approach appears to be optimal . CLINICAL TRIAL REGISTRATION Clinical Trials.gov Identifier Lymphedema is a chronic and progressive long-term adverse effect of breast cancer treatment commonly defined by swelling of the affected arm . Current clinical guidelines indicate that women with and at risk for lymphedema should protect the affected arm from overuse . In clinical practice , this often translates into risk aversive guidance to avoid using the arm . This could lead to a disuse pattern that may increase the likelihood of injury from common activities of daily living . Further , such guidance poses an additional barrier to staying physically active , potentially translating to weight gain , which has been shown to be associated with worse clinical course for women with lymphedema . We hypothesize that a program of slowly progressive strength training with no upper limit on the amount of weight that may be lifted would gradually increase the physiologic capacity of the arm so that common activities represent a decreasing percentage of maximal capacity . Theoretically , this increased capacity should decrease the risk that daily activities put stress on the lymphatic system of the affected side . The Physical Activity and Lymphedema ( PAL ) Trial is a recently completed r and omized controlled exercise intervention trial that recruited 295 breast cancer survivors ( 141 with lymphedema at study entry , 154 at risk for lymphedema at study entry ) . The purpose of this report is to provide detail regarding the study design , statistical design , and protocol of the PAL trial PURPOSE Evidence suggests that the re-entry phase ( ie , early period after medical treatment completion ) presents distinct challenges for cancer patients . To facilitate the transition to recovery , we conducted the Moving Beyond Cancer ( MBC ) trial , a multisite , r and omized , controlled trial of psychoeducational interventions for breast cancer patients . METHODS Breast cancer patients were registered within 6 weeks after surgery . After medical treatment , they completed baseline measures and were r and omly assigned to st and ard National Cancer Institute print material ( CTL ) ; st and ard print material and peer-modeling videotape ( VID ) ; or st and ard print material , videotape , two sessions with a trained cancer educator , and informational workbook ( EDU ) . Two primary end points were examined : energy/fatigue and cancer-specific distress . Secondary end points were depressive symptoms and post-traumatic growth . Perceived preparedness for re-entry was analyzed as a moderator of effects . RESULTS Of 558 women r and omly assigned to treatment , 418 completed the 6-month assessment and 399 completed the 12-month assessment . In analyses controlling for study site and baseline depressive symptoms , VID produced significant improvement in energy/fatigue at 6 months relative to CTL , particularly among women who felt less prepared for re-entry at baseline . No significant main effect of the interventions emerged on cancer-specific distress , but EDU prompted greater reduction in this outcome relative to CTL at 6 months for patients who felt more prepared for re-entry . Between-group differences in the primary outcomes were not significant at 12 months , and no significant effects emerged on the secondary end points . CONCLUSION A peer-modeling videotape can accelerate the recovery of energy during the re-entry phase in women treated for breast cancer , particularly among those who feel less prepared for re-entry PURPOSE We previously evaluated fatigue , menopausal symptoms , and cognitive dysfunction in patients receiving adjuvant therapy for breast cancer and matched healthy women . Here we report assessment of these women 1 and 2 years later . PATIENTS AND METHODS Patients without relapse and controls were evaluated by the Functional Assessment of Cancer Treatment-General Quality of Life question naire , with subscales for fatigue and endocrine symptoms , and by the High Sensitivity Cognitive Screen . RESULTS There were 104 , 91 , and 83 patients and 102 , 81 , and 81 controls assessed at baseline and at 1 and 2 years , respectively . Median Functional Assessment of Cancer Treatment-Fatigue scores ( range , 0 to 52 ) for patients improved from 31 ( on chemotherapy ) to 43 and 45 at 1 and 2 years , respectively , but were stable in controls ( 46 to 48 ) . Median Functional Assessment of Cancer Treatment-Endocrine Symptoms scores ( range , 0 to 72 ) for patients improved from 57 ( on chemotherapy ) to 59 and 61 at 1 and 2 years , respectively , and were stable in controls ( 64 to 65 ) . Differences between patients and controls remained significant for these scales . The incidence of moderate-severe cognitive dysfunction by the High Sensitivity Cognitive Screen  decreased in patients from 16 % ( on chemotherapy ) to 4.4 % and 3.8 % and in controls from 5 % to 3.6 % and 0 % at 1 and 2 years , respectively . There were minimal differences between estrogen receptor-positive patients who started hormonal therapy ( mainly tamoxifen ) after chemotherapy and estrogen receptor-negative patients who did not . Differences in quality of life between patients and controls were significant only at baseline . CONCLUSION Fatigue , menopausal symptoms , and cognitive dysfunction are important adverse effects of chemotherapy that improve in most patients . Hormonal treatment has minimal impact on them BACKGROUND Knowledge of sleep aid use is limited despite the high prevalence of insomnia among women before , during , and following breast cancer adjuvant chemotherapy treatments ( CTX ) . This study 's purpose was to ( 1 ) determine the frequency and characteristics of participants taking sleep aid(s ) ; ( 2 ) identify the frequency and percentage of sleep aid use by category ( prescription sedative/hypnotics , prescription anti-depressants , prescription analgesics , prescription anti-emetics , over-the-counter ( OTC ) analgesics , OTC cold/flu/sinus , OTC sleep , alcohol , and herbal supplements ) ; and ( 3 ) compare sleep aid use by category in the experimental and control groups within a r and omized-controlled clinical trial ( RCT ) . METHODS Longitudinal , descriptive , secondary RCT data analysis of women ( n=219 ) receiving out-patient CTX , and at 30 , 60 , and 90 days following the last CTX and 1 year following CTX1 . Participants recorded daily sleep aid use on a Sleep Diary . Analyses included descriptives , chi-square , and RM-ANOVA . RESULTS Approximately 20 % of participants took at least one  sleep aid  before CTX1 ; usage decreased over time ( 12 - 18 % ) ; a second sleep aid was used infrequently . Prescription sedative/hypnotics ( 46 % ) and OTC analgesics  ( 24 % ) were used most frequently . OTC sleep aids  were most commonly used as a second aid . Prescription sedative/hypnotics [ F(7,211)=4.26 , p=0.00 ] and OTC analgesics [ F(7,211)=2.38 , p=0.023 ] use decreased significantly over time . CONCLUSIONS Results reflect the natural course of CTX , recovery , and healing . Comprehensive screening for sleep-wake disturbances and sleep aid use may lead to a better underst and ing of the risks and benefits of pharmacologic and non-pharmacologic interventions , and ultimately lead to selection of the safest and most effective treatment The authors report a 3-year follow-up of the effects of 8-week support group interventions on the quality of life of women with early stage breast cancer . Shortly after diagnosis , women were r and omly assigned to 1 of 4 conditions : control , education , peer discussion , and education plus peer discussion . The education group intervention focused on providing information to enhance control over the illness experience , whereas the peer discussion group intervention focused on providing emotional support through the expression of feelings . Consistent with the results that emerged 6 months after the interventions ( V. S. Helgeson , S. Cohen , R. Schulz , & J. Yasko , 1999 ) , the authors found that the benefits of the education intervention were maintained over a 3-year period ( N=252 ) , although effects dissipated with time . The authors continued to find no benefits of the peer discussion intervention , either alone or in combination with education PURPOSE Professionally administered psychosocial interventions have been shown to improve the quality of life of cancer patients undergoing chemotherapy . The present study sought to improve access to psychosocial interventions during chemotherapy treatment by evaluating the efficacy and costs of a patient self-administered form of stress management training that requires limited professional time or experience to deliver . PATIENTS AND METHODS Four hundred eleven patients about to start chemotherapy were r and omly assigned to receive usual psychosocial care only , a professionally administered form of stress management training , or a patient self-administered form of stress management training .  Quality -of-life assessment s were conducted before r and omization and before the second , third , and fourth treatment cycles . Intervention costs were estimated from both payer and societal perspectives . RESULTS Compared with patients who received usual care only , patients receiving the self-administered intervention reported significantly ( P < or = .05 ) better physical functioning , greater vitality , fewer role limitations because of emotional problems , and better mental health . In contrast , patients who received the professionally administered intervention fared no better in terms of quality of life than patients receiving usual care only . Costs of the self-administered intervention were estimated to be 66 % ( from a payer perspective ) to 68 % ( from a societal perspective ) less than the average costs of professionally administered psychosocial interventions for patients starting chemotherapy . CONCLUSION Evidence regarding the efficacy and favorable costs of self-administered stress management training suggests that this intervention has the potential to greatly improve patient access to psychosocial intervention during chemotherapy treatment BACKGROUND Fatigue is a common symptom that lowers the quality of life of patients with cancer , affecting between 60 % and 90 % of patients . Relatively few options are available for the treatment of this debilitating condition . Modafinal , a psychostimulant developed for the treatment of narcolepsy , has been used to treat fatigue in other diseases such as multiple sclerosis , but little data support its use in cancer patients . OBJECTIVE AND DESIGN The primary objective of this open-label pilot study was to evaluate the safety , and efficacy of modafinil in improving cancer-related fatigue ( CRF ) as measured by the Brief Fatigue Inventory ( BFI ) . The effect of this agent on depression , quality of life , functional status , and cognitive function was also assessed . Modafinal was self-administered at a dose of 100 mg/d during weeks 1 - 2 , and 200 mg during weeks 3 - 4 . Assessment s were performed at baseline , 2 , and 4 weeks . RESULTS BFI score was improved in 46 % of patients at 2 weeks and 75 % at 4 weeks ( p = 0.025 ) . Hospital Anxiety and Depression Scale scores declined at 2 and 4 weeks ( p < 0.001 ) . Most scales for neurocognitive function were unchanged . Score for all Functional Assessment of Cancer Therapy-Brain ( FACT-BR ) subscales ( measuring quality of life ) , except social/family well-being , were improved ( p < 0.05 ) at 2 and 4 weeks . Significant changes in Eastern Cooperative Oncology Group ( ECOG ) performance status were noted , with 40 % of patients improving at least one level . Modafinil was well-tolerated with only one patient discontinuing treatment due to drug-related toxicity . CONCLUSION In this pilot study modafinil was well-tolerated and effective for fatigue  in patients with cancer . Improvements were also seen in mood , quality of life , and functional status PURPOSE Chronic insomnia is highly prevalent in cancer patients .  Cognitive-behavioral therapy ( CBT ) is considered the treatment of choice for chronic primary insomnia . However , no r and omized controlled study has been conducted on its efficacy for  insomnia secondary to cancer . Using a r and omized controlled design , this study conducted among breast cancer survivors evaluated the effect of CBT on sleep , assessed both subjectively and objective ly , and on hypnotic medication use , psychological distress , and quality of life . PATIENTS AND METHODS Fifty-seven women with insomnia caused or aggravated by breast cancer were r and omly assigned to CBT ( n = 27 ) or a waiting-list control condition ( n = 30 ) . The treatment consisted of eight weekly sessions administered in a group and combined the use of stimulus control , sleep restriction , cognitive therapy , sleep hygiene , and fatigue management . Follow-up evaluations were carried out 3 , 6 , and 12 months after the treatment . RESULTS Participants who received the insomnia treatment had significantly better subjective sleep indices ( daily sleep diary , Insomnia Severity Index ) , a lower frequency of medicated nights , lower levels of depression and anxiety , and greater global quality of life at post-treatment compared with participants of the control group after their waiting period . Results were more equivocal on polysomnographic indices . Therapeutic effects were well maintained up to 12 months after the intervention and generally were clinical ly significant . CONCLUSION This study supports the efficacy of CBT for insomnia secondary to breast cancer OBJECTIVE To develop a condition-specific quality of life question naire for the menopause with documented psychometric properties , based on women 's experience . METHODS SUBJECTS Women 2 - 7 years post-menopause with a uterus and not currently on hormone replacement therapy . Question naire development : A list of 106 menopause symptoms was reduced using the importance score method . Replies to the item-reduction question naire from 88 women result ed in a 30-item question naire with four domains , vasomotor , physical , psychosocial and sexual , and a global quality of life question . Psychometric properties : A separate sample of 20 women was used to determine face validity , and a panel of experts was used to confirm content validity . Reliability , responsiveness and construct validity were determined within the context of a r and omized controlled trial . Construct validation involved comparison with the Neugarten and Kraines'Somatic , Psychosomatic and Psychologic subscales , the reported intensity of hot flushes , the General Well-Being Schedule , Channon and Ballinger 's Vaginal Symptoms Score and Libido Index , and the Life Satisfaction Index . RESULTS The face validity score was 4.7 out of a possible 5 . Content validity was confirmed . Test-retest reliability measures , using intraclass correlation coefficients were 0.81 , 0.79 , 0.70 and 0.55 for the physical , psychosocial , sexual domains and the quality of life question . The intraclass correlation coefficient for the vasomotor domain was 0.37 but there is evidence of systematic change . Discriminative construct validity showed correlation coefficients of 0.69 for the physical domain , 0.66 and 0.40 for the vasomotor domain , 0.65 and -0.71 for the psychosocial domain , 0.48 and 0.38 for the sexual domain , and 0.57 for the quality of life question . Evaluative construct validity showed correlation coefficients of 0.60 for the physical domain , 0.28 for the vasomotor domain , 0.55 and -0.54 for the psychosocial domain , 0.54 and 0.32 for the sexual domain , and 0.12 for the quality of life question . Responsiveness scores ranged from 0.78 to 1.34 . CONCLUSIONS The MENQOL ( Menopause-Specific Quality of Life ) question naire is a self-administered instrument which functions well in differentiating between women according to their quality of life and in measuring changes in their quality of life PURPOSE S/ OBJECTIVES To compare sleep quality and disturbance , fatigue , and depressive symptoms between breast cancer survivors and healthy women experiencing hot flashes and to examine relationships among sleep and remaining variables ( fatigue , depressive symptoms , and frequency of hot flashes ) . DESIGN Cross-sectional , descriptive , comparative pilot study . SETTING University-based outpatient setting . SAMPLE 15 breast cancer survivors and 15 healthy women matched on age , race , and menopausal status . All women had untreated hot flashes ( no hormone replacement therapy or other hot flash treatments ) . METHODS Question naires ( sleep quality and disturbance , fatigue , and depression ) ; two ambulatory , 24-hour sternal skin conductance monitoring sessions ( hot flash frequency ) ; and medical records review . MAIN RESEARCH VARIABLES Sleep quality and disturbance , fatigue , depressive symptoms , and objective hot flash frequency . FINDINGS The majority of participants evidence d poor sleep quality and high sleep disturbance ( 73 % of breast cancer survivors and 67 % of healthy women above a cutoff score of 5 ) . Sleep duration was significantly shorter for breast cancer survivors in contrast to healthy women . Nighttime flashes were experienced by 67 % of breast cancer survivors and 37 % of healthy women . No group differences were found in fatigue , depressive symptoms , or objective hot flash frequency . Global sleep scores were significantly positively correlated with fatigue and depression but not with hot flash frequency . CONCLUSIONS Findings suggest that sleep disturbance is common in menopausal breast cancer survivors and healthy women , is not necessarily related to hot flashes , and may stem from a multifactorial etiology . IMPLICATION S FOR NURSING Menopausal breast cancer survivors who present with any one of these symptoms should be screened for all symptoms both during and after treatment BACKGROUND Cancer-related fatigue after chemotherapy is a difficult symptom to manage in practice and the most disruptive symptom in patients ' lives . Acupuncture is a popular complementary therapy among cancer patients and some evidence exists that it could potentially alleviate fatigue by stimulating ' energy ' points in the body . Hence , this study was carried out to assess the effects of acupuncture and acupressure in managing cancer-related fatigue and the feasibility of running a r and omised trial with these two complementary therapies in preparation for a large trial . METHODS This study was a r and omised controlled trial . Forty-seven patients with cancer who experienced moderate to severe fatigue were r and omised either to an acupuncture group ( n=15 ) , an acupressure group ( n=16 ) or a sham acupressure group ( n=16 ) . The acupuncture group received six 20-min sessions over 2 weeks , while the patients in the two acupressure groups were taught to massage/press the points and did so daily thereafter for 2 weeks on their own . Patients completed the Multidimensional Fatigue Inventory before r and omisation , at the end of the 2-week intervention and again about 2 weeks after the end of the intervention . RESULTS Significant improvements were found with regards to General fatigue ( P<0.001 ) , Physical fatigue ( P=0.016 ) , Activity ( p=0.004 ) and Motivation ( P=0.024 ) . At the end of the intervention , there was a 36 % improvement in fatigue levels in the acupuncture group , while the acupressure group improved by 19 % and the sham acupressure by 0.6 % . Improvements were observed even 2 weeks after treatments , although they were lower ( 22 % , 15 % , 7 % , respectively ) . Acupuncture was a more effective method than acupressure or sham acupressure . Subjects needed a longer treatment period to have more sustained results . The trial was method ologically feasible . CONCLUSION Acupuncture shows great potential in the management of cancer-related fatigue . As a r and omised trial with acupuncture is feasible and preliminary data shows significant improvements , it should be tested further using a large sample and a multicentre design PURPOSE Cross-sectional studies suggest that clinical insomnia is associated with immune downregulation . However , there is a definite need for experimental studies on this question . The goal of this r and omized controlled study was to assess the effect of an 8-week cognitive-behavioral therapy ( CBT ) for chronic insomnia on immune functioning of breast cancer survivors . Previous analyses of this study showed that CBT was associated with improved sleep and quality of life , and reduced psychological distress . PATIENTS AND METHODS Fifty-seven women with chronic insomnia secondary to breast cancer were r and omly assigned to CBT ( n = 27 ) or to a waiting-list control condition ( WLC ; n = 30 ) . Peripheral-blood sample s were taken at baseline and post-treatment ( and postwaiting for WLC patients ) , as well as at 3- , 6- , and 12-month follow-up for immune measures , including enumeration of blood cell counts ( ie , WBCs , monocytes , lymphocytes , CD3 + , CD4 + , CD8 + , and CD16+/CD56 + ) and cytokine production ( ie , interleukin-1-beta [ IL-1beta ] and interferon gamma [ IFN-gamma ] ) . RESULTS Patients treated with CBT had higher secretion of IFN-gamma and lower increase of lymphocytes at post-treatment compared with control patients . Pooled data from both treated groups indicated significantly increased levels of IFN-gamma and IL-1beta from pre- to post-treatment . In addition , significant changes in WBCs , lymphocytes , and IFN-gamma were found at follow-up compared with post-treatment . CONCLUSION This study provides some support to the hypothesis of a causal relationship between clinical  insomnia  and immune functioning . Future studies are needed to investigate the clinical impact of such immune alterations PURPOSE To examine the incidence , degree , time course , treatment , and symptoms of  lymphedema in breast cancer survivors . METHODS We conducted a 5-year , population -based prospect i ve study of 631 r and omly selected Philadelphia and Delaware County , Pennsylvania female residents with incident breast cancer who were diagnosed from 1999 to 2001 . Using a question naire previously vali date d against physical therapists ' measurement-based clinical criteria , we assigned a score indicating the degree of lymphedema ( none , mild , or moderate/severe ) to each month of follow-up based on the respondent 's perceived differences in h and /arm size . St and ard survival analysis methods permitted maximum use of follow-up . RESULTS Five-year cumulative incidence of lymphedema was 42 ( 42 % ) per 100 women . Among the 238 affected women , lymphedema first occurred within 2 years of diagnosis in 80 % and within 3 years in 89 % . Among 433 women observed for 3 years , 23 % reported no more than mild lymphedema , 12 % reported moderate/severe lymphedema , and 2 % reported chronically moderate/severe lymphedema . Women with mild lymphedema were more than three times more likely to develop moderate/severe lymphedema than women with no lymphedema . Thirty-seven percent of women with mild lymphedema and 68 % with moderate/severe lymphedema received treatment . Increasing proportions of women with increasing degree of lymphedema reported symptoms ( eg , jewelry too tight , tired/thick/heavy arm ) . Symptoms present before the first occurrence of lymphedema were associated with a higher probability of later lymphedema ( eg , hazard ratio for jewelry too tight = 7.37 ; 95 % CI , 4.26 to 12.76 ) . CONCLUSION Lymphedema after breast cancer is common but mostly mild . Subtle differences in self-reported h and /arm size and symptoms can be early signs of progressing lymphedema
BACKGROUND Advances in breast cancer therapies have given rise to a growing number of patient survivors .
Nevertheless , these women deal with long-term sequelae that impair their quality of life and that are lacking satisfactory assessment and expeditious management .
Importantly , a new era is raising in the oncology field , namely , survivorship .